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Texas Medicare Supplements Made Easy



What is a Medicare Supplement (Medigap)

A Medicare Supplement plan (Medigap) is a plan sold by private insurance companies that may help fill the gaps in Original Medicare coverage (Part A and Part B). These plans may pay for some or all of the cost-sharing or gaps in coverage such as copayments, coinsurance, and deductibles. Medicare Supplement plans do not include prescription drug coverage. You must purchase a Part D plan separately.

Why Do You Need a Medicare Supplement? 

Many people don’t realize this, but Medicare does not cover all of your expenses. For example, Medicare only covers eighty percent of your Part B expenses. If you go into the hospital, have surgery, or any other medical complication, twenty percent of that will be an astronomical amount of money. You would be responsible for the other 20% of the cost. As mentioned above, there is no limit as to what you could pay. When you purchase a Medicare Supplement, your policy will pick up the gaps in Original Medicare (the 20% you otherwise would have been responsible for). 

The Advantages of a Medicare Supplement

If you’re new to Medicare, you may not realize just how much a Medicare Supplement Plan will help. There are many benefits to purchasing a Medicare Supplement Plan that you might not be aware of. 

Freedom Of Choice

When you purchase a Medicare Supplement Plan, it provides you with a lot of freedom regarding your healthcare. 

No Network
You don’t have in-network and out-of-network doctors when it comes to a Supplement Plan. You will go to any Doctor or Hospital that you wish to see as long as they accept Medicare – hint, most do. The majority of physicians accept Medicare (93%), comparable to the share accepting private insurance.* It doesn’t matter which insurance company you purchased your Supplement Plan from. As long as the doctor you wish to see accepts Original Medicare, they will also accept your Supplement Plan.

Travel Flexibility
‍Another significant benefit of purchasing a Medicare Supplement plan is that you will use it anywhere in the United States, wherever Original Medicare is accepted. This includes U.S territories as well, such as Washington DC, Puerto Rico, The Virgin Islands, Guam, American Samoa, and The Northern Mariana Islands. If you’re on vacation in a different city or state from where you live and need to receive medical treatment for any reason at all, you will be able to do so. You don’t have to worry about higher charges caused by being out-of-network. You also don’t have to worry about waiting for treatment until you get home.

In contrast, if you have a Medicare Advantage Plan instead of Original Medicare and a Supplement Plan, your coverage can be terminated simply for being outside of the coverage area for too long. If you decide to travel for an extended period of time, you could basically end up without health coverage if you’ve opted for a Medicare Advantage Plan.

If you travel, a Medicare Supplement Plan is incredibly beneficial. Many Medicare Supplement Plans even cover certain medical services if you receive them outside of the United States. For example, Plans C, D, E, F, G, M, and N will pay for eighty percent of the cost of emergency services that you receive while traveling abroad. However, when traveling outside the US, we recommend purchasing additional travel insurance.

No Pre-Authorization 
With many other types of insurance plans, you will be required to receive a pre-authorization before you will receive medical services. This can be time-consuming and, quite simply, annoying and frustrating. With a Supplement Plan, you never have to wait for a pre-authorization. Once you determine which services you need, you simply make appointments for the care that you need. 

No Referrals
Another major annoyance and roadblock that many insurance plans have is requiring a referral before you will get the care you need. With a Supplement Plan, you will never need to get a referral from your primary care physician. This saves time and lets you get the treatment as soon as you can get scheduled. Once a doctor orders treatment or tests, you just set it up and get it done. 

More Predictable Expenses

 ‍With Original Medicare, you’re almost always responsible for twenty percent of your medical bills. Additionally, Original Medicare has no out-of-pocket maximum. This means that your medical bills are potentially unlimited. Once you purchase a Medicare Supplement Plan, it covers all or some of the twenty percent that Original Medicare doesn’t cover, depending on which Supplement Plan you buy. Some plans cover the entire twenty percent that Original Medicare doesn’t pay for, but some plans cover less.  

With a Supplement Plan, you also have an out-of-pocket maximum

Guaranteed Coverage

Generally speaking, your Medicare Supplement Plan is a guaranteed service as long as you continue to pay your monthly premium. No matter how many different healthcare providers you see, how many surgeries you have, or what kind of treatment you require, they must continue to offer you coverage once you’re enrolled in the Supplement Plan. 

If your coverage is dropped because the insurance company becomes bankrupt or insolvent, you will be permitted to purchase a new Supplement Plan without medical underwriting because your insurance company canceled it through no fault of your own. This means that when you go to purchase a new Supplement Plan, the insurance company is not permitted to ask you questions about your current or past health status, including any pre-existing conditions. From the date your insurance company terminated your coverage, you will have 63 days to enroll in a new Supplement Plan without medical underwriting. This scenario, however, is highly unlikely to occur.

When can I join a Medicare Supplement plan?

• Any time after you turn 65. With some plans, you may save money on your premium if you enroll during your Initial Enrollment Period (IEP).
• You may not purchase a Medicare Supplement plan at the same time you have a Medicare Advantage Plan.
• A Medicare Supplement plan is guaranteed renewable as long as you pay your premium.
• You are covered nationwide and will be accepted by any Medicare-approved facility or health care provider that is accepting patients with Original Medicare.

Are You Eligible for Medicare?

Generally, you are eligible for Medicare if you or your spouse worked for at least 10 years in Medicare-covered employment and you are 65 years old and a citizen or permanent resident of the United States.

If you are not 65, you might also qualify for coverage if you have a disability or with End-Stage Renal Disease (permanent kidney failure requiring dialysis or transplant).

Here are some simple guidelines. You can get Part A at age 65 without having to pay premiums if:

  • You already get retirement benefits from Social Security or the Railroad Retirement Board.
  • You are eligible to get Social Security or Railroad benefits but have not yet filed for them.
  • You or your spouse had Medicare-covered government employment.

If you are under 65, you can get Part A without having to pay premiums if:

  • You have received Social Security or Railroad Retirement
  • Board disability benefit for 24 months. You are a kidney dialysis or kidney transplant patient.

While you don’t have to pay a premium for Part A if you meet one of those conditions, you must pay for Part B if you want it. It is deducted from your Social Security, Railroad Retirement, or Civil Service Retirement check. If you don’t get any of the above payments, Medicare sends you a bill for your Part B premium every 3 months.