Medicare Supplement Plans in Texas

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Texas Medicare Supplement Plans were created to protect Medicare beneficiaries from unexpected high out of pocket medical costs.

These plans can be challenging to understand. Especially since they can change from year to year.

We work diligently to make sure our information is accurate and up to date. We want you to make the best-educated decision on your healthcare.

We’ve updated all our information regarding Texas Medigap Plans for 2020 below.

2020 Guide on Texas Medicare Supplement Plans

First, we’ll go over some basic knowledge to know about all supplement plans.

They are guaranteed renewable as long as you pay your premiums.

Supplement plans have no networks. You can see a specialist at any time. Guaranteed renewable means as long as your doctors accept Medicare, they will take your Medicare Supplement.

There are multiple plans available. Having many plans to choose from ensures you’ll find one that matches your healthcare needs, as well as your budget.

Do I Need a Medigap Plan in Texas

To help answer this question, we’ll provide an example scenario that we’ve seen first hand with one of our clients.

We’ll use the name Leona for our scenario. Leona lives in Dallas, Texas. She turns 65 this month, which also means she’s aging into Medicare.

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 receives a bill from the hospital for the Part A deductible. A few weeks later, she received another bill from her primary physician for the follow-up visits.

Between both the Part A & Part B deductible, as well as the 20% coinsurance that she is left responsible for under Part B, she is out of pocket over $2,300.

If Leona had a supplemental Medigap Plan, the above out of pocket costs would’ve gone directly to the carrier. Depending on which letter plan she selects, she could have zero out of pocket costs. At the very least, she would only be responsible for the Part B deductible.

When Should I Enroll in a Texas Medicare Supplement Plan

We wish Medicare focused on informing beneficiaries of this basic knowledge. Unfortunately, they don’t. This causes a lot of confusion when it’s time for Texans to enroll in both Medicare & Medigap.

The best time to enroll in Medicare is during your Initial Enrollment Period. Once your Part B is in effect, your Medicare Supplement Open Enrollment Period beings.

The reason it’s essential to know these enrollment periods is that these are the windows you can enroll without having to answer health questions.

They only happen once in your lifetime. Once you miss these enrollment periods, you won’t see them again. The only scenario you may have two Open Enrollment windows is if you’re collecting Social Security Disability.

If you miss your Initial Enrollment Period, you have to wait until the General Enrollment Period to enroll in Original Medicare.

If you missed your Medicare Supplement Open Enrollment Period, you could still enroll in a plan at any time of the year. You’ll have to go through medical underwriting.

If you’re still actively working, you can delay Medicare coverage as long as you have creditable coverage.

What is the Best Supplemental Insurance for Medigap in Texas

The answer to this question is unique to each beneficiary. The best plan depends on your health & budget.

The most popular plan is Plan F. However, if you’re newly eligible for Medicare after 2020, this plan won’t be available to you. You’re next best option is Plan G. The only difference between the two is Plan F covers the Part B deductible, and Plan G doesn’t.

Let’s use Leona again. Since Leona is considered Medicare-eligible after 2020, she can’t enroll in Plan F. So we’ll compare Plan G & Plan N.

The average Plan G in Texas costs between $95-$160 per month. The reason there’s such a significant difference is that carriers are allowed to charge what they want in premiums. However, the benefits do not change. That’s why it’s crucial to compare the same letter plan across multiple carriers.

Leona enrolls in a Plan G with Aetna that costs her around $100 per month. We’ll go back to the previous story when Leona got into a car accident & was out of pocket over $2k.

If Leona had Plan G at the time of her accident, she would’ve only had to pay the Part B deductible. Her Medigap Plan would’ve covered the Part A deductible as well as the Part B coinsurance.

Now, if Leona had Plan N, she would’ve had to pay a small copay for both her hospital visit and her follow up appointments. The average Plan N in Dallas costs about $85 per month.

Why You Need a Medicare Agent

The above is a prime example of why you need a Medicare agent. There are too many factors that need to be taken into consideration when it comes to enrolling in Medicare to do it on your own.

The good news is, using one of our agents at MedicareFAQ doesn’t cost you a penny. We’re also not tied down to one carrier, which means we’ll provide you a nonbiased comparison.

Rules Specific to Medicare Supplements in Texas

Some carriers offer discounts. In Texas, specific carriers offer a 7% spousal discount, while others provide a 12% household discount.

When it comes to being eligible for Medicare due to disability, not every state makes plans available to you if you’re under 65.

Foruntnatly, Texas does offer one plan to those on disability, Plan A. However; it comes at a very high cost. This plan will run somewhere between $400-$500 in monthly premiums.

If you smoke, it’s essential to know which carriers have an increased tobacco rate. In Texas, some companies apply tobacco rates while others do not.

Not every state will grant you Guaranteed Issue Rights when you lose Medicaid. Good news for Texans is almost every carrier does. One of the only carriers that don’t is Mutual of Omaha.

For some, Medigap premiums are not always affordable. If this is the case, then a Medicare Advantage Plan might be an option for you.

Medicare Advantage Plans in Texas

Before enrolling in a Medicare Advantage Plan, you must understand the difference between Medicare Advantage & Medigap Plans.

Yes, there’s a hype that these policies include extra benefits like dental, vision, and hearing. However, they come with lots of restrictions and limitations.

Some plans cover prescription drug coverage, but also come with a high deductible for medications.

Depending on if you choose an HMO or PPO, your monthly premium could be zero. However, the less you pay in premiums, the higher your maximum out of pocket costs will be.

If Leona was unable to afford a supplement plan, she could compare rates for Medicare Advantage plans in Dallas.

HMO plans with zero dollar deductible in Dallas, Texas, could come with a maximum out of pocket costs of $5,300. Or, Leona could choose an HMO that has a $90 monthly premium with only a $3,900 max out of pocket costs but has no drug benefits.

Leona does have some PPO options available to her. Some of these plans come with drug benefits. Depending on the level of benefits, your monthly premium could be anywhere between $0-$100.

According to KFF, about 36% of Medicare-eligible state residents in Texas enrolled in a Medicare Advantage plan in 2019.

Texas Medicare Part D

Texas-Medicare-Part-D-Prescription-Drug-AvailabilitySince Medigap & Original Medicare don’t cover prescription drug coverage, beneficiaries must enroll in a Part D plan.

Unless you have creditable coverage, like employer group coverage, then you could be penalized for not enrolling in Part D when you first became eligible.

Another form of creditable coverage is veterans’ benefits. However, there is a big BUT here. Veterans benefits are only considered creditable coverage under Part D, NOT Part B.

So if you’re a veteran and choose to delay Part B, don’t. Many VA facilities fail to inform our veterans that they will be penalized if they delay their Part B enrollment.

If Leona enrolled in a Medigap Plan, she would then enroll in a Part D plan that’s available in Dallas. Just like every other Medicare plan, your monthly premium will be determined by the number of benefits you select.

Part D policies in Texas can cost as low as $10 and as much as $140 monthly. Not all beneficiaries will need coverage; however, some coverage is better than no coverage.

The best way to find affordable coverage is through an agent. The $10 plan might have a cheap premium, but for someone taking medications, this policy could end up costing more than it’s worth.

Low-Cost Scenario

Let’s say Leona takes two 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 your prescriptions adequately. Now, Let’s say Leona finds a $40 plan, and her medications only cost $100 for the month. Sure, her premium is higher, but her expenses are much lower.

For example, a Humana Walmart Value Rx Plan will run Leona around $13 per month. The Humana plan does have a $435 deductible. If Leona wanted a prescription plan with a lower deductible, she could go with a Cigna-HealthSpring Rx plan. With around a $55 monthly premium, it only has a $100 deductible.

Agents are great at looking at the bigger picture and identifying ways to save.


State Resources

If you need extra assistance with your Medicare expenses, there are a few programs that can help. You can visit the Texas Health and Human Services‘ website for information on Medicare and 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.

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 is another excellent resource for state-specific insurance information.


Texas Medicare Q&As

How much do Medicare Supplements cost in Texas?

The answer to this question depends on the level of benefits you want. If you want the most benefits with the lowest premium, then a high-deductible plan, like High-Deductible Plan F or High-Deductible Plan G, might be your best option. They cost between $30-$45 a month and come with a $2,340 deductible. If you don’t want a high-deducible, then a standard Plan F or Plan G will cost at a minimum of $100 a month.

Who qualifies for Medicare in Texas?

Anyone who is at least 65 years old or anyone who’s been collecting SSDI for 24 months qualifies for Medicare.

How does Medicare work in Texas?

Medicare works the same way in Texas as it does in every other state. Part A is your inpatient coverage & Part B is your outpatient coverage. Part A is free if you paid enough quarters. While Part B has a monthly premium & 20% coinsurance, to help cover the 20% coinsurance, you’ll want to enroll in a Medicare Supplement Plan.

How can I apply for Medicare in Texas?

If you’re collecting Social Security benefits, you’ll automatically be enrolled in Part A & Part B. If you’re not automatically enrolled, you can register online.


Get Free Help with Medigap in Texas

We understand first hand how overwhelming enrolling in Medicare coverage can be. Our agents are experts in Medicare. They always stay up to date with the most recent changes to make sure their clients have all the information they need to make the best choice on their healthcare coverage.

Our services are 100% free. We’ll compare rates with over 30+ carriers. This includes carrier rates, history of rate increases, as well as the financial ratings of each company.

Also, when you enroll in a plan through us, you’ll have unlimited support from our Client Care Team. If you have any issues with claims, we can help.

To get help now, call us at the number above. You can also use our online rate comparison tool to see rates in your area now.