Hurst Medicare Supplements
Medigap Made Simple
Summary: Medicare Supplement Insurance plans help cover your out-of-pocket Medicare costs. There are 10 Medicare Supplement plans that may be available to you, each providing different level of benefits.
Do you have Original Medicare (Part A and Part B) for your Medicare coverage? You may want to know about the added protection available with Medicare Supplement plans. Out-of-pocket costs with Part A and Part B can pile up, especially if you have a chronic health condition or a medical emergency.
Medicare Supplement plans help cover those out-of-pocket Medicare costs so it’s easier to budget for your health care. Here’s what to know so you can make an informed decision.
Hurst Medicare Supplements (Medigap)
The best time to check into Medicare Supplements (Medigap) is before you are eligible for Medicare. If you are nearing age 65, the choices you make now can help you in the future. But choosing the correct supplemental insurance to meet your needs can be confusing and overwhelming. Fortunately, our trained agents are committed to helping you sort through all the options available.
Everyone 65 and older is entitled to the basic Medicare coverage, but typically it only covers about 64 percent of the annual health-care costs. Added to the expense not covered by Medicare, there are deductibles, co-payments, and coinsurance to pay. This is why many choose Medicare Supplements and at Ashford Insurance, we can assist you in your Texas insurance coverages.
Medicare Supplements Options in Hurst, Texas
Both Medicare Part A and Part B were designed to help retirees with their Texas health insurance. If you choose to add Medicare Part B, it is wise to add your supplements within the first 6 months. During this time the Medigap program must accept you and any preexisting conditions, known as “guaranteed issue rights”. In most cases, as long as you continue paying the premiums you cannot be canceled. After the 6 months, if you decide you want a supplement policy, you can be turned down for pre-existing conditions such as diabetes, heart disease, or cancer.
Texas Medicare Supplemental Health Insurance has a wide variety of plans and is organized alphabetically with each plan designated with a single letter. Plans are designed to help with the cost of deductibles, co-payments, and coinsurance. Some plans offer prescription, vision, or dental coverage. The different plans offer the flexibility of choosing your own doctors and hospitals that accept Medicare patients and specialists, without referrals. You have the freedom to travel and take your coverage with you anywhere in the United States.
Rates for Medicare Supplements can vary greatly between different carriers and are usually based on age, location, gender, and health. You don’t have to sort through this alone, our agents at Ashford Insurance are committed to searching for the best rates and coverage which are affordable and meet all your needs.
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.
Can they refuse to cover me or delay coverage? Once your open enrollment period ends (up to six months after turning 65), insurers can refuse coverage, charge you a higher premium based on your health, or make you wait to get coverage for an illness you currently have. In limited situations, you have the right to buy a plan, regardless of your health, after your open enrollment period ends.
Can I change my coverage later? You can drop your policy and apply for another one at any time. How does renewal work? Medigap policies must be “guaranteed renewable.” That means the policy must be renewed automatically from year to year, so long as you pay the premium on time.
Lastly, don’t forget Medicare Plan F is no longer available to those who are eligible for Medicare after January 1, 2020.
Medicare is like a health insurance policy offered to senior-citizens, along with people under 65 who have disabilities in certain ways. It is considered to be an entitlement: If you paid Medicare taxes on your earnings while working (they’re usually taken out of your paycheck automatically, just like your Social Security contributions), you are automatically eligible for Medicare at age 65. It is not income-based.
Medicare has four parts. Some parts require payment of a monthly premium just like private health insurance, but the program is not based on your financial need:
- Part A – covers hospital care: Covers the cost of being in a medical facility.
- Part B – covers doctors, medical tests, and procedures: Basically, anything that is done to you. There is a monthly premium for Part B coverage.
- Part C – Medicare Advantage: This is an alternative to traditional Medicare coverage. Coverage often includes Parts A, B, and D. Private insurance companies administer Medicare Advantage plans.
- Part D – Prescription drug coverage: Part D is administered by private insurance companies, and you are required to have it unless you have coverage from another source. Part D requires you to pay a monthly premium in most cases.
Medicare isn’t like a comprehensive health insurance plan. If you only have traditional Medicare, there are gaps in coverage. For example, Medicare doesn’t cover any long-term care, unless you purchase a Medicare Advantage Plan or a Medigap (Medicare Supplement) policy.
Even if you aren’t eligible for Medicaid, you may qualify for one of three Medicare Savings Programs (MSPs), administered by your state’s Medicaid program.
Federal income and resource limits listed below are for 2015. Limits for 2016, when released, will be slightly higher. Some states have more liberal allowances, so it might be worth applying even if you are over the limit.
- Qualified Medicare Beneficiary (QMB) Program: QMB helps pay for Medicare Part A premiums, Part B premiums, deductibles, co-insurance, and co-payments. Income limits are $1,001 for an individual and $1,348 for a couple. The value of assets (or “resources”) you can own are limited to $7,280 for a single person and $10,930 for a couple.
- Specified Low-Income Medicare Beneficiary (SLMB): SLMB helps pay for the cost of Medicare Part B premiums. SLMB income is limited to $1,197 for an individual and $1,613 for a couple. Resources limits are the same as for the QMB program.
- Qualifying Individual (QI) Program: QI helps pay the cost of Medicare Part B premiums only. Each year, you have to apply for QI benefits (or re-apply). These benefits are granted on a first-come, first-served basis; priority is given to those who received QI benefits the previous year. Income limits are $1,345 (individual) and $1,813 (couple). Resources allowed are the same as for QMB and SLMB. You may not receive QI benefits if you qualify for Medicaid.
If you qualify for a QMB, SLMB, or QI program, you will automatically qualify to get “Extra Help” paying for Medicare prescription drug (Part D) coverage. In determining the value of your resources, your checking and savings account balances, as well as the value of all stocks and bonds, are counted. Your home, one car, a burial plot plus $1,500 worth of burial expenses, furniture, and other household and personal items are not counted.
If someone qualifies for both Medicare and Medicaid, they are “dual eligible.” Under this status, most if not all, of your healthcare costs will be covered. Medicaid will pay for most of your Medicare Parts A and B premiums (if there are premiums), along with deductibles and co-payments you may have. It doesn’t matter if you get your Medicare coverage through a Medicare Advantage (MA) Part C plan or traditional (Original) Medicare.
If you are “dual eligible” and receive full Medicaid, your prescription drug coverage (Part D) will go through Medicare, but you will automatically qualify for Extra Help paying for your medicines. In addition, Medicaid may cover some drugs that Medicare does not.
As a taxpayer, you contribute to Medicare during your working years and will receive Part A coverage probably at no cost to you. Additional coverage, such as Part B and Part D, might be required and could come with a monthly premium. Because Medicare has gaps in coverage, you’ll likely need additional coverage that might come with an extra monthly premium on top of what you already pay.
Medicaid is a needs-based program. Although states have the option of charging out-of-pocket fees, certain groups, such as children and people living in institutions, are generally exempt from these costs.
Since life expectancies are getting longer, and retirement savings are falling short, more and more seniors might find themselves qualifying for Medicaid benefits, either in full or in part. In addition to helping with medical costs, Medicaid offers coverage not normally available through Medicare, such as extended nursing home care and custodial or personal care services. But since the income requirements are stringent and the program penalizes people who try to shed assets right before they apply, long-term planning is required to qualify.
Sonia first got interested in Medicare insurance while helping her grandmother navigate her Medicare and insurance back in the late 1990s to early 2000s. She learned the many benefits of having a great Medicare insurance plan to help take care of the charges Medicare did not cover. Sonia then desired to start helping other Medicare-eligible seniors with their Medicare and insurance. Sonia Ashford is now the owner of the Independent Marketing Organization known as Ashford Insurance.