Medicare Supplement Plans in Texas

Medigap Made Easy

Medicare Supplement Plans in Texas

Medicare is a federal program to help older Americans and some disabled Americans pay for the high cost of health care. However, Medicare was never intended to cover all your health care costs. So even if you’re covered by Medicare, you are still responsible for a large portion of your health care costs. Medicare Supplement plans in Texas include 10 standardized options, lettered A – N. Each insurance company must offer at least Plan A but can offer any of the other plans as well. Medicare does not cover all health care costs. Medicare coverage consists of Part A (which covers hospital and skilled nursing facility care), and Part B (which covers doctor bills and other medical expenses).
 
Remember, Medicare Plan F is no longer available to those who are eligible for Medicare after January 1, 2020.
 

Medicare Supplement Plans, 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.

The best time to buy a Medicare supplement is during the first six months after you enroll in Part B. This open enrollment window allows you to purchase any Texas Medigap policy without health underwriting. After this window expires, you may have to answer health questions when you apply. 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. 

Medigap or MedSup 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.

Most beneficiaries take advantage of their Medigap Open Enrollment Period. The OEP begins on the first day of the month your Part B is in effect and will last for 6 months.

This enrollment window gives you the option to enroll in a plan without having to answer any underwriting questions. Once this window has come and gone, you might have to answer health questions during the enrollment process.

Medicare supplement plans in Texas have some common features. First, you can choose any doctor, no matter who your Medicare supplement carrier is. About 93 percent of healthcare providers in America accept Medicare. You can see any of these doctors at any time, regardless of which insurance company you purchased your Medigap policy from.

Another feature is that there are no referrals required. These plans have no networks, so you are not required to see a primary care physician first to get a referral to see a specialist. You can book your own appointments with doctors hassle-free.

Sometimes specialists who are unfamiliar with Medigap’s rules will ask you to first get a referral. Simply explain that your insurance doesn’t require a referral if you have a Medigap plan.

All Medicare supplement plans in Texas are also guaranteed renewable. Your coverage can never be canceled based on a health condition that you develop. As long as you are paying your monthly premiums on time, your Medicare supplement will remain in place and be there for you when you need 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.

Sarah began working in the healthcare industry in 2001, where she worked for many years with elderly Alzheimer and Dementia patients. From there she worked as a Group Benefits Administrator with a local healthcare company in the Human Resource Department for a period of 10 years. Since then, she has decided to work in the Medicare insurance industry full time and has joined the family business, Ashford Insurance, as a Medicare Insurance Agent.

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