Texas Medigap Plans

Medical bills are a concern as we age. Getting older brings with it greater risks of illness or accidents such as slips and falls. That means it’s more important than ever to make sure your insurance is in order.

Medicare is the Federal insurance option for seniors age 65 and over (and some younger people who qualify due to a disability.) Medicare generally covers inpatient care, skilled nursing facility care, hospice care, at-home care, medical equipment, ambulance services, and mental health care. Exact coverage varies by state and according to your situation, but those are the basics.

Ashford Insurance offers a selection of Texas Medigap Plans from many top carriers in Texas.

Texas Medigap Plans

Texas Medigap insurance plans (Medicare Supplements) are standardized by the Federal Government. They are labeled A, B, C, D, F, G, K, L, M, and N. Note: Medicare Plan F is no longer available to those who are eligible for Medicare after January 1, 2020.

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 Texas Medigap 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 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 the benefits before deciding which will work best.

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

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.

Depending on the Texas Medigap 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.

There are no ratings for Medigap plans

Consumers are often surprised to find this out because there is plenty of rating information available for Medicare Advantage plans. Basically, there is very little to base Medigap plan ratings on. The benefits of Plan F are the same no matter which company you buy it from.

In almost every case, the companies get information on your Medicare bills straight from Medicare and pay their share automatically. They don’t have networks of doctors or hospitals.

And the rules for Medigap are not the same everywhere, the way they are for Medicare Advantage. The federal government sets some minimum rules to protect consumers but many states have decided to add additional consumer protections on top of those.

Some Texas residents are eligible to enroll in approved Part C 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 stand-alone Part D Prescription Drug Plans, you must continue to pay your Part A (if any) and part B Medicare premiums.