Texas Medicare Supplement Plans
Medicare Supplement Plans, also known as Medigap Plans, are designed to help cover some of the medical costs that are not covered by Medicare, and are available to anyone enrolled in part A and B of Medicare. There is an open enrollment period for the first six months after you turn age 65, in which you do not need to qualify.
Medicare Supplement Plans are Standardized
By law, Medicare Supplement insurance is standardized into twelve plans (Plans A through L). That means Plan F from one company must include the same benefits as plan F from another company. Since Medicare Supplement insurance plans are standardized and all insurance companies offer the same basic supplemental coverage, your Medicare supplement choice comes down to price and a company’s service, reputation and experience with Medicare supplement insurance policies. In addition to the standard Plan A – L Medicare supplement health care policies, Medicare SELECT is a type of Medicare Supplement health care policy that can cost less than standard Medicare supplemental. However, you can only go to certain doctors and hospitals for your care.
Texas Medicare Supplement FAQ
What is Medicare Supplement Insurance?
Medicare Supplement Insurance is a private health insurance policy designed to help pay some or all of the costs that are not covered by Medicare Parts A and B.
Who is eligible for Medicare Supplement Insurance?
Anyone who is covered under both Medicare parts A and B is eligible for Medigap Coverage.
When can I apply for Medicare Supplement Insurance?
You can apply for Medicare Supplement Insurance during open enrollment. Open enrollment includes a six-month period from the date you enrolled in Medicare Part B if age 65 or older, or up to six-month after you turn 65 if you were eligible for Part B benefits before age 65. If you become eligible for Medicare Part B benefits before age 65 because of disability or ESRD (permanent kidney failure), you are guaranteed the Medicare Supplement policy of your choice during the first six months you are age 65 and enrolled in Part B.
Does Medicare Supplement coverage include prescription drug benefits?
No, Medicare Supplement is designed to fill in the “gaps” with Medicare Plans such as Part A (which covers hospital and skilled nursing facility care) and Part B (which covers doctor bills and other medical expenses). For prescription drug coverage, you can select a separate Medicare Part D Prescription Drug Plan.
Can I enroll if I do not have Medicare Parts A or B?
No, you must be entitled to Medicare Part A and/or enrolled in Medicare Part B to be eligible for a Medicare prescription drug coverage. To learn how to get Medicare Part A and/or Part B, please call Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day/7 days a week. For the hearing or speech impaired, please call 1-877-486-2048. You may also contact your State Medicaid Office or the Social Security Administration at 1-800-772-1213, Monday – Friday, 7 a.m. – 7 p.m. CST. For the hearing or speech impaired, please call 1-800-325-0778.
Does Everyone Need a Medicare Supplement Policy?
Not everyone needs a Medicare supplement policy. If you have certain other types of health coverage, the gaps in your Medicare coverage may already be covered. You probably don’t need Medicare supplement insurance if
- you belong to a Medicare Advantage plan
- Medicaid or the Qualified Medicare Beneficiary (QMB) Program pays your Medicare premiums and other out-of-pocket costs.
- You are covered under an employer group health plan
What if I (or my spouse) plan to work after age 65 and continue receiving group health care benefits?
Check with your group plan administrator. You may be able to choose either your group plan or Medicare plus Medicare Supplement coverage. If you stay with your group health care plan, a Special Enrollment Period lets you delay purchasing Part B until you need it.
Will I need to switch doctors if I enroll in a Medicare Supplement plan?
No, you may continue to see your own doctor. Medicare Supplement plans are convenient and flexible, giving you freedom of choice.
Can I see a specialist whenever I want?
Yes. Just remember that your out-of-pocket costs will be less if you choose a physician who accepts Medicare assignment.
What Medicare Doesn't Cover
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).
Even with Medicare Part A and Part B coverage, you’re responsible for some out-of-pocket expenses including:
- Part A hospital deductible ($1,340
- Part B deductible ($183)
- Copayments for hospital stays over 60 days
- Care in a skilled nursing facility after 20 days
- Twenty percent coinsurance for doctor bills and other medical expenses
To qualify for a Medicare Supplement policy, you must be age 65 or older (may vary by state), enrolled in Medicare parts A and B, and you must reside in the state in which you are applying for supplemental coverage.
When to Enroll
Your open enrollment period is the best time to buy a Medicare Supplement policy because companies must sell you any plan they offer regardless of your pre-existing health conditions. Your open enrollment period lasts for 6 months and begins on the first day of the month in which you are age 65 or older and enrolled in Part A and B of Medicare.
To help control rising costs, carriers apply the pre-existing condition clause to newly issued Medicare Supplement plans in most states if you enroll after the open enrollment period. Expenses resulting from a condition existing six months prior to the supplemental policy effective date are not covered unless they are incurred three months after the supplemental policy effective date. If the supplemental policy replaces another creditable individual or group insurance coverage due to a person’s eligibility for Medicare, this Pre-Existing Conditions Limitation will be reduced by the number of months that coverage was in force. If this supplemental policy replaces another Medicare Supplement policy, this Pre-Existing Conditions Limitation will be reduced by the number of months that the coverage was in force.
Medicare Supplement Basic Benefit Overview
Basic benefits included in all plans include:
Hospitalization – Part A coinsurance plus coverage for 365 additional days after Medicare benefits end.
Medical Expenses – Part B coinsurance (generally 20% of Medicare-approved expenses), or in the case of hospital outpatient department services under a prospective payment system, applicable copayments.
Blood – First three pints of blood each year.
Medicare Supplement Benefits by Plan
The chart below shows the standard benefits included in each plan.
|Skilled Nursing Coinsurance||–||–||X||X||X||X||X||X||X||X||50%||75%|
|Part A Deductible||–||–||X||X||X||X||X||–||–||–||50%||75%|
|Part B Deductible||–||–||–||–||–||–||–||X||–||–||–||–|
|Part B Excess||–||–||–||–||–||100%||80%||–||100%||100%||–||–|
|Foreign Travel Emergency||–||–||X||X||X||X||X||X||X||X||–||–|
|At Home Recovery||–||–||–||X||–||–||X||–||X||X||–||–|
*Plan F has a high deductible option, which some companies may offer. These high deductible plans pay the same benefits as Plan F after one has paid a calendar year $2,240 deductible. Benefits from high deductible Plans F will not begin until out-of-pocket expenses exceed $2,240.
**Plan K and Plan L provide for different cost-sharing than plans A-F. Once you reach the annual limit, the plan pays 100% of the Medicare copayments, coinsurance and deductibles for the rest of the calendar year. The out-of-pocket annual limit does NOT include charges from your provider that exceed Medicare-approved amounts, called “excess charges.” You will be responsible for paying excess charges.
Medicare Supplement Plans in Texas
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