What is Medicare?
It is a federal health insurance program referred to as Original Medicare, which includes people 65 years of age, or older, certain people with disabilities who are under age 65 and those with end-stage renal disease (permanent kidney failure). It pays for a large portion of the health care expense but not all of it. The portion that Medicare does not pay is what the individual must pay for out of pocket such as coinsurance, co-payments, and deductibles. The gaps in Original Medicare coverage are commonly filled by a Medicare Supplement plan. Medicare in Texas and Texas Medicare plans are the same as Medicare in any state because it is a federal government that defines what the benefits are.

Medicare has four parts:
•Texas Medicare Part A: This covers area such as inpatient hospital, inpatient skilled nursing facility, home health, and hospice services. Most people do not have to pay for Part A due their contributions over 10 years. If you aren’t eligible for premium-free Part A, you may be able to buy Part A. Visit Medicare.gov, or call 1-800-MEDICARE (1-800-633-4227) to find out if you have to buy Part A premium.
•Texas Medicare Part B:  Covers outpatient and physician services. It also pays for other areas such as durable medical equipment, prosthetic devices, supplies incident to physician's services, and ambulance transportation. Most people pay monthly for Part B.
•Texas Medicare Part C: Medicare Advantage plans are offered by private insurance companies that serve as an alternative to Medicare. These plans can cover medical only or medical and dental. These plans are subsidized and regulated by the Federal government.
•Texas Medicare Part D: Prescription Drug Coverage plans are offered by private companies to provide coverage for prescription drug costs. These plans are subsidized and regulated by the Federal government.

MEDICARE SUPPLEMENT ASPECTS

Can you tell me more about Medicare Part A and Part B?
Part A referred to as hospital insurance, helps pay expenses for inpatient hospital care, some skilled nursing facility care, hospice care, and some home health care. The medical costs you incur with Medicare Part A include a large deductible per benefit period and copays if you are in the hospital for over 61 days. The benefit period for part A is your time in the hospital including 60 days after you are release.

Part B referred to as medical insurance, helps pay for outpatient hospital care, doctors' services, and some other medical services and supplies when they are medically necessary that Part A does not cover. The Part B deductible is based on a calendar year and is generally affordable. After the deductible is met you will be responsible for 20% of your Medicare Part B expenses. This can be quite expensive if you have any major medical treatments.

How many Texas Medicare Supplement Policies are there?
The modernized benefit policies are “A, B, C, D, F, High-Deductible F, G, K, L, M, and N.” Since they are standardized, by law each insurance companies plan offers the same basic benefits.

What is the most popular Texas Medicare Supplement Insurance plan?
Probably the most popular plan is probably Plan F. Most people choose Plan F because it covers the deductible and the coinsurance, if covered by Medicare. In order not to have any additional out of pocket costs it has to be a Medicare approved expense, and then you will pay nothing. Another popular is Plan G. The main difference between the two plans is that Plan G Medicare Supplement does not cover the Medicare Part B deductible.

Why do I need a Texas Medicare Supplement Insurance plan?
The original Medicare program is designed to provide health benefits but it does not cover the total cost of health care, or leaves gaps in coverage such as co-pays and deductibles for hospitalization, doctor visits and other medical services. Individuals that have enrolled in original Medicare program may decide that they need a Medicare Supplement often referred to as Medigap insurance because it provides supplemental health insurance coverage to fill in the gaps. Supplement plans may cost you more that the Medicare Advantage plans but once you pay the premium there will be less or no out of pocket expenses for most plans. more information

Do supplements cover all medical charges that Medicare doesn’t?
Medicare Supplements will not cover expenses if Medicare does not pay a portion of the bill. Generally, if it is not a Medicare approved expense then a Supplement will not pick up its portion, with some exceptions.

Is Medigap the same as a Supplement?
The Original Medicare Plan has health care areas that are not covered that are commonly referred to as “gaps.” Private insurance companies created supplemental insurance polices to fill gaps in the Original Medicare Plan. The Medigap or Supplement policies are sold to individuals who have Medicare Part A and Part B and are the exactly the same.

What is Medicare General Enrollment Period?
This period is during the time period between January 1 and March 31 when a Medicare beneficiary is eligible to sign up for Part B coverage. The beneficiary’s benefits will begin on July 1 of that year, and the beneficiary may be subject to a late enrollment fee of 10% for each 12 month period they did not have Part B Medicare.

What is the Medicare Open Enrollment Period?
“Open enrollment is the 6 month period beginning on the first day of the month in which you are enrolled in Medicare Part B. If you are on Medicare under age 65, you will also have a six-month open enrollment period when you reach age 65” more information

When am I eligible for Initial Enrollment Period?
Initial Enrollment Period is when the client can apply for Part B or Part D for the first time. For many it starts 3 months prior to when the person meets Medicare’s requirement for eligibility and goes on for the next 6 months. However, for SSDI, Social Security Disability Insurance applicants the period begins the 24th month of the SSDI’s payments. The person is not liable for medical history review during the enrollment period yet once the period is over any prior conditions that will create exclusionary problems can apply. “Open enrollment is the 6 month period beginning on the first day of the month in which you are enrolled in Medicare Part B. If you are on Medicare under age 65, you will also have a six-month open enrollment period when you reach age 65.”

I have Medicare Part A and Part B due to a disability and I would like to know which Medicare Supplement I can get since I am not 65 yet?
In Texas, insurance companies that offer Medigap policies are required to sell a Plan A to someone under 65 that qualifies for Medicare. Companies can offer additional plans as an option in addition to a Plan A to someone on disability.

What is the best Medicare Supplement Insurance in Texas for me?
There's not one plan that fits all needs. There many areas to consider when selecting a Medigap Insurance. Your personal preferences consisting of current and future financial abilities, benefits, age and current health will determine what the best plan is. Contact us to help you determine which plan is best for you.

How do I get a quote Texas Medicare Supplement Insurance?
Simply click here and we will provide you with a quote from some of the top rated companies that we represent. Please feel free to contact us to help you with a Medicare Supplement. We will discuss Texas Medicare coverage and Texas Medicare Guidelines with you and determine what your needs are then review the various plans available for you. Texas Medicare supplement plans are made easy for you to understand how they work with Texas Medicare.

How do I determine which type of Medigap plan is best for me?
Your personal requirements, needs and financial situation will determine which the best Medigap plan for you. There are many plans to choose from and many of the plan benefits overlap so review the coverage details, costs and additional or optional benefits offered by the insurance company. Contact us to help you determine which plan is best for you.