North Richland Hills Texas Medigap
Medigap Made Simple
North Richland Hills Texas Medigap (Medicare Supplements)
What is Medicare Supplement Insurance?
A Medigap or Medicare Supplement insurance plan can help you save on out-of-pocket expenses you face after Medicare pays its share of your medical bills. Medigap plans are standardized and there are 10 different plans available, although the number and type vary by state and provider. Depending on the plan, you may have coverage for the copays and coinsurance you pay with Medicare and coverage for some of the deductibles of Medicare.
As an example, Medigap Plan A pays all of the copays and coinsurance of Medicare Part A and Part B, although it won’t cover the deductibles. Plan F, by comparison, covers almost all deductibles and copays but it’s the most expensive.
Just note: plans sold starting in 2020 won’t cover the Part B deductible.
After you sign up for Medicare Part B, you have 6 months to buy a Medigap policy without the insurance provider checking your medical history and using it to consider whether you can qualify. After 6 months, unless there are unique exceptions in your state, you need to go through a medical underwriting process to buy coverage.
How Is it Different From a Medicare Advantage Plan?
You can only have a Medicare Advantage Plan or Medicare Supplement insurance: you can’t have both. That means it pays to consider which will save you the most money and choose wisely. Both plans are designed to fill the gaps of traditional Medicare but they differ in many ways.
A Medicare Advantage Plan is different than Medigap coverage. It comes with the same Part A and Part B coverage as traditional Medicare plus it usually includes vision and dental coverage and out-of-pocket maximums. Many plans even include Part D prescription coverage. The average premium is about $30 and some plans have no premiums.
You can think of a Medicare Advantage Plan as a PPO or HMO. You’re still part of Medicare but you’ll need to choose in-network providers when possible. In exchange, you get coverage for some services not covered by Medicare and you’ll have an out-of-pocket maximum.
Medicare Supplements, also known as Medigap, 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 Medsup plan unless you decide you need to switch policies.
Open Enrollment for Medicare Supplemental 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. For six months 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 pick and choose whom 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.
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, if you leave an employer plan you may not be able to go back on it.
Some Texas residents are eligible to enroll in approved Medicare Advantage plans. These plans are offered by private insurance companies. Each year Medicare Advantage companies decide where they will offer their plans, what benefits will be offered, and what the premiums will be. Several include vision, dental, hearing, and wellness programs not covered by original Medicare. As noted earlier many Medicare Advantage Plans also offer prescription drug coverage. There are several Medicare Advantage plans available in Dallas, Tarrant, and surrounding counties. Depending on plan choice, a member may be responsible for paying co-payments for certain covered services. Most importantly, with Medicare Supplements, Medicare Advantage, and standalone Part D Prescription Drug Plans, you must continue to pay your Part A (if any) and part B Medicare premiums.
Unfortunately, Medicare Plan F is no longer available to those who are eligible for Medicare after January 1, 2020.