Texas Medicare Supplement Plans (Medigap)
Texas Medicare Supplement Plans were created to work with Medicare to add additional benefits to your Traditional Medicare coverage. These plans are available to provide extra benefits for what isn’t covered by Original Medicare. These out of pocket expenses include items such as deductibles, copayments, and coinsurance.
Medigap policies are the same as Medicare Supplement plans. These policies can be purchased from private insurers. Texas Federal Medicare program options are broken down into parts and plans.
Texas Medicare Options Broken Down
Original Medicare, Part A and Part B: These cover hospital care (Part A) and physician care (Part B).
Medicare Advantage Part C: These plans are offered by private insurance companies. Medicare Advantage plan options may vary depending on location. There are limitations on what Part C covers in comparison to choosing Parts A & B.
Medicare Part D Prescription Drug Plans: These provide separate prescription medicine coverage for beneficiaries who have Original Medicare, Part A and Part B. This option is offered by private insurance companies that are approved by Medicare. You can also get Medicare Part D coverage through a Medicare Advantage Prescription Drug plan. Keep in mind that your out of pocket costs may be higher.
Medicare Supplement Plans: These covers health care costs that Original Medicare does not. This includes plan deductibles, copayments, and coinsurance. Texas Medicare Supplement Plans are available for consumers from a variety of insurers.
For the best options in your Medicare coverage and benefits, most new beneficiaries choose to go with:
- Medicare Parts A & B
- Medicare Part D Prescription Drug Plan
- Supplemental Medigap policy
Benefits Included in Texas Medicare Coverage
Medicare Part A is hospital benefits. Part A pays for inpatient hospital care, limited stay in a skilled nursing facility, some home health care services, and hospice care.
- For days 1 through 30, there is $0 per day coinsurance payment.
- 61 through 90 days: $335 per day coinsurance.
- 91 days and beyond: $670 per day coinsurance for each lifetime reserve day (you may get up to 60 lifetime reserve days in your lifetime).
- After lifetime reserve days are used up: Medicare typically doesn’t cover your inpatient hospital stay.
If you’ve worked at least 10 years and paid Medicare taxes while you worked, you qualify for premium-free Part A. Furthermore, if you didn’t pay at least 40 quarters you’ll end up paying a premium.
- physician services
- outpatient hospital services
- some home health services
- included medical equipment
Once you’ve met the deductible, you will be responsible for Part B coinsurance of 20% of the Medicare-approved amount. However, there are some limits on physical therapy, occupational therapy, and speech language pathology services. These copays and deductibles can quickly add up for Medicare recipients. Therefore, a Medigap plan can cover the difference.
Requirements for Texas Medicare Supplements
Texas Medigap Plans are available to Medicare enrollees who are 65 years or older and enrolled in Medicare Part B. It’s important to enroll in Medicare Part B as soon as you are eligible. If you don’t, you will be subjected to a late penalty.
Texas Medicare Eligibility for the Disabled Under 65
Those under 65 and disabled will automatically get Medicare Part A and Medicare Part B after receiving disability benefits from Social Security, or disability benefits from the Railroad Retirement Benefits, for 24 months. In addition, it’s a requirement that insurers offer a Medigap plan for disabled and under 65 Medicare recipients.
When to Enroll in Texas Medicare Supplement Plans
The Open Enrollment Period (OEP) starts on the first day of the month you are 65 years old, and you are covered under Medicare Part B. For example, if your birthday was August 31st and your Medicare Part B effective date was October 5th, then your OEP begins November 1st.
Your Open Enrollment Period is effective for six months, during which you are granted Guaranteed Issue (GI) for coverage. Guaranteed Issue means that insurers must cover you, no matter your pre-existing conditions. After your OEP, it can be difficult to find Medigap plans that cover pre-existing conditions or disabilities, so it is essential that you enroll promptly.
There are Special Enrollment Periods (SEP) for some circumstances, including if you relocate to another state or are a newly naturalized citizen.
The Best Medicare Supplement Plans in Texas
With many carriers to choose from, you might think Medicare Supplement plans might vary, depending on who you choose to go with. The fact is, the benefits are the same from carrier to carrier. The only difference is the cost. Whether you are in Houston, San Antonio or Dallas, the same benefits may have a different premium.
Texas Medicare Plan F
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.
Plan N is considered a cost sharing plan. It has a small copayment for some emergency room visits and doctors visits. It does not cover any Part B excess charges.
Texas Medicare High Deductible Plan F
Plan High Deductible F offers a more affordable way to supplement Medicare, just with a higher deductible. It has the same benefits as the standard Plan F, but coverage doesn’t kick in until the deductible is met.
Texas Medicare Advantage Plans
Medicare Advantage Plans – Part C – offer lower premiums, but with some disadvantages when compared with Medicare Part A, Part B and Part D coverage used in conjunction with a Medigap plan. Furthermore, Medicare Part C limits provider choices to PPOs and HMOs as determined by the plan.
Texas Medicare Prescription Drug Plans
Medicare Part D covers your prescription drug expenses. Enrolling in Medicare Part D should be done as soon as you are eligible for Medicare. Because, a penalty may be added to your Part D premiums that will never go away.
How to Apply for Texas Medicare Supplement Plans
When you are ready to apply for additional Medicare coverage in the state of Texas, we can help. Contact us to get coverage for the portion of your medical costs not covered by Medicare.
You can get online rates for Texas Medicare Supplement plans here. Or you can call the number above to speak directly to an agent licensed in the state now.
Texas Medicare Resources
In addition, if you need extra assistance with your Medicare expenses, there are a few programs that can help. There’s a Medicare savings program and another program called SHIP.
Texas Medicare FAQs
- Does Medicare pay for hearing aids in Texas? Medicare does not pay for hearing aids.
- What hospitals around Houston take Medicare? There are at least 25 hospitals in Houston that take Medicare, including Houston Methodist Hospital, Woman’s Hospital of Texas and Memorial Hermann.