Medigap Plans in Texas

Medigap Plans in Texas

The best Medicare Supplement insurance plans in Texas are designed to help Medicare beneficiaries pay for healthcare expenses that Original Medicare (Part A and B) does not cover. Because there are “gaps” between what Medicare approves and pays, these supplemental policies are called Medigap policies. 

Ashford Insurance offers a selection of Medigap Plans from many top carriers. Note: Medicare Plan F is no longer available to those who are eligible for Medicare after January 1, 2020.

(Medigap) is specifically designed to supplement Medicare’s benefits and is regulated by federal and state law, it must be clearly identified as Medicare Supplemental Insurance and it must provide specific benefits that help fill the gaps in your Medicare coverage. Other kinds of insurance may help you with out-of-pocket health care costs, but they do not qualify as Medigap plans.

Medigap Plans are standardized by the Federal Government. They are labeled A, B, C, D, F, G, K, L, M, and N. Each standardized Medigap policy must offer the same basic benefits no matter which insurance company sells it. Cost is usually the only difference between Medigap policies with the same letter sold by different insurance companies. Plan A pays the Medicare hospital and physician coinsurance, the first three pints of blood, and 365 days of hospitalization beyond Medicare. Plans B through N provide these benefits and add more benefits such as coverage for Medicare deductibles, excess charges and limited preventive care, and foreign travel. You can only have one Med Sup plan. No one should try to sell you an additional Medigap plan unless you decide you need to switch policies.

Depending on the Medicare supplement plan you choose, the plan may provide a benefit for (Benefits and cost vary depending on the plan you choose.):

• Part A coinsurance (and most plans provide a benefit for the Part A deductible)
• Some of the out-of-pocket costs not paid by Part B (some plans also cover the Part B deductible)
• Cost of blood transfusions (first 3 pints)
• Cost of up to 365 extra hospital days after you’ve used up your Part A benefits
• Skilled nursing facility coinsurance or copayment
• Part A hospice/respite care coinsurance or copayment

You pay a monthly premium and some out-of-pocket costs.

Open Enrollment for Texas Medicare Supplement Insurance is at age 65 for all consumers, including those already receiving Medicare due to disability. The Open Enrollment period is a six-month period, beginning when you are both age 65 or older and enrolled in Medicare Part B, companies must sell you any Medicare supplement plan they offer. After this limited open enrollment period, companies can choose who they will cover and how much they will charge based on your health. If you have an individual or “bank group” insurance policy, becoming Medicare eligible does not require you to cancel it and purchase a Medicare supplement. Doing so may save premium costs but it is important to compare benefits before deciding which will work best.

Medigap plans in Texas are available with no medical underwriting during your initial enrollment period. This is when you become eligible for Medicare Part B. You may, however, apply to a company and fill out the medical underwriting questions at any time.

If you are eligible for employer retirement insurance, review the plan carefully to understand what benefits are available and how it works with Medicare. Be aware that employer plans are not standardized and are not subject to the requirements governing standardized Medicare supplement policies. Also, it is important to remember that if you leave an employer plan you may not be able to go back on it.

To see a list of all the Medicare supplements available – look at a Medigap supplement chart. This chart can be found in the booklet called “Choosing a Medigap,” published by Medicare. The chart details the benefits that are included in each Medicare supplement, which are labeled Plan A – Plan N.

Medigap vs. a Texas Medicare Advantage Plan

If you find your Original Medicare benefits lacking but can’t afford a Medicare Supplement plan, there is a second option. It’s Medicare Advantage. We have the complete catalog of Medicare Advantage Plans available in Texas. Most Medicare Part C plans also include a drug plan.

How-to Add a Prescription Drug Plan in Texas

Don’t forget that Original Medicare and Texas Medigap plans do not cover the cost of your prescriptions. For this you need Medicare Part D. We offer the complete catalog of Medicare Prescription Drug Plans available in Texas.

Insurance plans that aren’t Medigap

Some types of insurance aren’t Medigap plans, they include:

• Medicare Advantage Plans (like an HMO, PPO, or Private Fee-for-Service Plan)
• Medicare Prescription Drug Plans
• Medicaid
• Employer or union plans, including the Federal Employees Health Benefits Program (FEHBP)
• TRICARE
• Veterans’ benefits
• Long-term care insurance policies
• Indian Health Service, Tribal, and Urban Indian Health plans