Medicare Supplemental Insurance Plans in Texas
These out of pocket costs are from the 20% that Medicare leaves up to the beneficiary to pay. These costs also fall under deductibles, coinsurance & copays. We’ll give you a quick scenario.
After Leona spent the day running errands, she was in a car accident on her way home. Thankfully, the accident was minor. As a precaution, she went to the hospital to get looked over.
She spent the day at the hospital, only to schedule a follow-up appointment with her primary physician.
A month later, she received a bill for her Part A deductible, which was $1,364. Then she another bill came from her primary physician for the Part B deductible, which was $185. Plus 20% coinsurance for the services she received while there.
If Leona had a Medigap plan, the above cost would’ve gone directly to the carrier. Depending on which letter plan she selects; she could have zero out of pocket costs or only be responsible for the Part B deductible.
Texas Medicare Supplement Insurance Plans for 2019
Original Medicare consists of parts, Medigap consists of plans. A percentage of payroll taxes are processing towards Medicare.
However, the parts do not pay for all your medical costs. That’s where Medicare supplemental policies come into play.
Medicare Supplement benefits won’t terminate due to a health condition. Medigap plans guarantee renewability. Your policy will remain active as long as you’re paying your premiums on time each month.
With Texas supplemental Medicare plans, you can choose any doctor and see them at any time. There are almost 900,000 (and counting) healthcare providers that accept Medicare.
Also, with supplemental plans, there are no referrals. Since these plans have no networks, you can see any specialist at any time.
Employer Coverage vs Texas Medigap Plans
If you have other creditable coverage, such as employer coverage, you may delay enrolling into a Medigap plan. In this case, those beneficiaries may be eligible later for their Open Enrollment Period with Guaranteed Issue (GI) rights.
Those losing coverage also qualify for GI rights. You need to provide proof regarding losing your previous health insurance coverage to qualify for GI rules.
As long there is proof, enroll in certain policies within 63 days of losing previous coverage.
By law, the carrier cannot deny you coverage due to pre-existing conditions.
When you continue working, you get a 63-day Special Enrollment Period to enroll in coverage.
Often times we find that Medicare costs less than your employer coverage. That’s why it’s important to work with an agent.
Benefits Included in Medicare Coverage
If you’ve worked at least 10 years and paid Medicare taxes while you worked, you qualify for premium-free Part A. For those who didn’t pay at least 40 quarters, you’ll end up paying a premium.
Beneficiaries need coverage for inpatient hospital care, which is what Part A benefits include. There are also some deductibles in coinsurances that fall under Part A.
Part B is for physician care. The current annual deductible for 2019 is $185. After the deductible, the beneficiary pays 20% of Medicare services.
The 20% as well as copays and deductibles can become overwhelming as healthcare costs rise. Therefore, a Medigap policy will help with the financial burden of your healthcare expenses.
Requirements for Texas Medicare Supplements
Almost 4 million Texans are on Medicare. To enroll in a supplement policy, beneficiaries must have their Part B in effect.
Beneficiaries should enroll in Medicare Part B once eligible. Otherwise, you could be exposed to a late penalty.
Medicare Insurance Eligibility for the Disabled Under 65
Some Medicare Supplement plans are available to those under 65. However, this is dependent on the rules of your state.
State law requires carriers to offer at least one Medigap plan to those under 65. While there is a plan available to those on disability, the premiums can be astronomical.
Texas Medicare Supplement Plan Enrollment
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.
Quality Medicare Supplement Carriers in TX
It doesn’t matter which carrier you choose, the benefits will be the same. The only difference is the premium.
That’s why it’s important to compare rates with all the carriers in your area for the same plan. Regardless if you’re in Houston, San Antonio or Dallas, the same benefits may have a different premium.
Keep in mind, the insurance carrier with the lowest premium may not give the best long-term value.
Top-Rated Medigap Insurance Policies in Texas
Medicare Plan F is the most popular plan amongst Medicare beneficiaries. This is due to it covering everything from your Part A and B deductible to any Part B excess charges.
TX Medicare Advantage Plans
In other words, you get what you pay for. These plans vary county to county, so not every plan will be available. The main downfall of advantage plans is that you can only see a doctor that’s within the plan’s network.
If you cannot afford a Medigap plan, an advantage plan may be a good alternative for you. There are costs with this type of Medicare plan. These costs include copays for doctor and hospital visits.
Medicare Prescription Drug Plans
Medicare Part D covers your prescription drug expenses. Enrolling in Part D should be done as soon as you are eligible for Medicare. A penalty may be added to your Part D costs for as long as you have Part D.
Part D policies in Texas can cost as low as $10.40 and as much as $140.10 monthly. Not all beneficiaries will need coverage; however, some coverage is better than no coverage.
The best way to find affordable coverage is through a broker. The $10.40 plan might have a cheap premium, but for someone taking medications, this policy could end up costing more than it’s worth.
Let’s say Leona takes 2 brand name medications that aren’t covered under the low-monthly costing policy. Well, Leona ends up paying $400 out of pocket each month for her medications. Then, those expenses don’t even count towards her deductibles because those drugs aren’t on the formulary.
The “low-cost” policy isn’t so low-cost when it doesn’t cover properly. Now, Let’s say Leona finds a $40 policy and her medications only cost $100 for the month. Sure, her premium is higher, but her expenses are much lower.
Brokers are great at looking at the bigger picture and identifying ways to save. Contact us today to add value to your Medicare.
In addition, if you need extra assistance with your Medicare expenses, there are a few programs that can help. Texas Health and Human Services’ website is for information on Medicare and/or Medicaid savings programs.
Medicare premiums can be a financial burden for some lower-income beneficiaries. If the premiums are too much, you may be able to find help by enrolling in a Medicare Savings Program.
Contact your state Medicaid office to apply. Or visit Your Texas Benefits to learn more and find out if you qualify.
Beneficiaries losing Medicaid coverage in Texas can find plan options with GI rights through Aetna, Central States Indemnity, Bankers Fidelity, Cigna, Gerber, Combined Insurance, GPM, Manhattan Life, Mutual of Omaha, Medico, New Era, United American, United Healthcare, and TransAmerica.
If you recently lost Medicaid eligibility, you may be eligible to enroll in a Medigap policy with no medical underwriting.
The Texas Department of Insurance website is another great resource for state-specific insurance information. Find information regarding your rights and public assistance benefits on the Texas Legal Services Center Hotline website.
How to Apply for Texas Medicare Supplement Plans
Choosing the right Texas Medigap plan is easy with our free side by side comparison.
When you are ready to apply for additional Medicare coverage, we can help. Let us help you get coverage for the portion of your medical costs from Medicare.
Call the number above to speak directly to an agent licensed in Texas.
Don’t have time to chat right now? Fill out an online rate form to discover the best local policy for you.