Medicare Supplement Plans in Texas

Medicare recipients have the option of selecting one of several Medicare Supplement plans in Texas. Medicare Supplement plans in Texas are intended to cover out-of-pocket expenses that are your responsibility to pay as the recipient of health care services rendered by Medicare providers. This includes coinsurance for hospital stays, hospice coinsurance and co-payment amounts and deductibles, foreign travel expenses, and Part B excess charges.

For example, Part B only covers 80% of doctor expenses. You would be responsible for paying the remaining 20% of the costs. This includes deductibles, co-payments, and co-insurance fees, and there are no Medicare out-of-pocket costs maximum.

Medicare Supplemental Insurance Plans in Texas

Medicare Supplement Plans are sold by private insurance companies. In order to qualify for enrollment, you must be enrolled to receive original Medicare benefits. Contact Social Security to enroll. Your eligibility will typically begin the year you turn age 65 unless you’ve been diagnosed with End-Stage Renal Disease or you’ve received Social Security disability checks for 24 months.

When eligible for Medicare plans when you turn age 65, there is an Enrollment Period that spans 7 months where you can enroll. This period begins three months prior to your 65th birthday, includes your birthday month, and ends three months after you turn 65. This period is called the Initial Enrollment Period. You’ll be automatically enrolled into Medicare Part A and Medicare Part B when you begin to receive Social Security or Railroad Retirement Board benefits.

Coverage will begin on the first day of the actual month that you turn age 65 or the month before your 65th birthday if your birthday is on the first of the month. This is another great reason to compare Medicare Supplement Plans in Texas.

You’re also able to enroll in Medicare after your Initial Enrollment Period. If you have to buy Parts A and B, you will only be able to do so during the General Enrollment Period or Special Enrollment Period. The General Enrollment Period is between January 1 thru March 31. If you sign up during this period, your coverage will begin July 1. These are things you’ll want to consider when choosing Medicare Supplement Plans in Texas.

The Special Enrollment Period is available if you’re working and covered under a group health plan by you or your spouse’s employer. This period also applies the month after employment ends or the month after your group health insurance coverage ends.

Part A is hospital insurance, which covers services such as skilled nursing facility and hospice stays, surgery, home health care, and inpatient hospital visits. If you or your spouse has worked and paid Medicare taxes, then you will not have to pay a monthly premium.

Part B is medical insurance that has a monthly premium. Part B covers medically necessary services such as services required to diagnose or treat any medical condition as well as any preventive care services such as vaccinations and wellness visits. All preventive care services are covered by providers that accept Medicare. Monthly premiums also cover durable medical equipment, medical health services, and drugs administered in a hospital setting.

Best Medicare Supplement Plans in Texas

All Medicare Supplement Plans in Texas are sold by private insurance agencies. There are currently ten plans to select from. Beginning January 1, 2020, plans that cover the Part B deductible will be unavailable for people who are turning age 65 after January 1, 2020. This means that Plan F and Plan C will not be available to new Medicare beneficiaries eligible for Medicare after January 1, 2020. If you’re already enrolled in C or F, you will be able to keep your plan. If you were eligible for Medicare before January 1, 2020, but not enrolled, these plans may be available. Contact your insurance agent for details.

Most Texas Medicare recipients are enrolled in the Plan F Medigap policy. This plan covers 100% of costs not covered by Original Medicare. This includes the outpatient and hospital deductible fees in addition to the 20% of expenses billed for Part B medical services that you would be responsible for. When Medicare approves the health care service that is rendered and pays its portion, then Part F benefits will cover all of the remaining expenses.

Below is an all-inclusive list of the coverage provided by Part F. This can be used to compare the benefits provided with other Medicare Supplement Plans in Texas:

• Part A inpatient hospital coinsurance and hospital costs, up to 1 year (365 days) after coverage has been exhausted. Exhausted coverage is considered once lifetime reserve days are completely used. This is when the actual benefits begin to pay.
• Skilled nursing facility coinsurance (a daily coinsurance of around $170 per skilled nursing facility stay day is required for stays of 21-100 days for your actual benefit period)
• Fees incurred with coinsurance and co-payments that are billed due to receiving Part B services
• All deductibles
• Coinsurance co-payments and insurance for hospice stays
• The cost of the first of three pints that are administered during a procedure completed at a hospital
• Costs for emergent medical expenses that are provided outside of the United States, for a total of up to 80% (A lifetime limit of $50,000 is provided for these expenses after a $250 deductible is paid)
• Excess charges incurred for Part B services

Plan F is also available as a high-deductible Medicare Supplement plan in Texas. The premium cost is lower than the regular plan because a $2300 deductible must be met before the plan pays 100% of expenses.

Plan C provides the same coverage as Part F, with the exception of excess charges, which are not covered. Excess charges are the difference between what Medicare pays and what your provider charges for a service.

The next highly selected Medicare Supplement plan in Texas is Plan G. Plan G provides the same benefits as F with the exception of the Part B deductible. This deductible is $185 for 2019 and will increase to $198 in 2020. This is the amount that you pay towards any health care services before Medicare begins to pay. Once Medicare pays the approved amount, you will be responsible for the 20%.

Plan N covers all Medicare Part B coinsurance fees, with the exception of office and emergency room co-payments.

Medigap plans do not cover services that are not covered by original Medicare nor do they add additional benefits. It will not cover any prescription drug or have drug coverage, nor will it provide vision, dental, or hearing benefits. These will be benefits provided by a Medicare Advantage plan, as well as a prescription drug plan. Enroll in Part D for a prescription drug plan or drug coverage.

How Much are Medicare Supplement Plans in Texas?

The prices for Medicare Supplement Plans in Texas will vary depending on which plan you are applying for, your gender, tobacco status, and age. Here is a sample Medicare Supplement Plan Chart in Texas showing a rate comparison for a 65-year-old male.

Medicare Supplement Plan N	Medicare Supplement Plan G	Medicare Supplement Plan F
$101.29	$144.86	$183.84

Again, rates will vary by age, gender, and tobacco status so if you’d like a custom quote, feel free to request one using the form at the top of the page.

When Can I Apply for a Medicare Supplement Plan?

The Medicare Supplement Open Enrollment Period begins the first day that your Medicare coverage is effective and ends after six months. During this period, you can sign up for a Medicare Supplement plan and not be subject to any underwriting.

There are also certain situations referred to as guaranteed issue rights where you’re able to enroll in a Medicare Supplement Plan in Texas and not be subject to medical underwriting due to pre-existing health conditions. This occurs when:

• You are enrolled in a Medicare Advantage plan and your health insurance company no longer provides coverage in your area or you move to a location where coverage is not provided
• You are enrolled in two health plans: Medicare part A and b, as well as a health plan, and one of the two health plans’ coverage is ending
• You have a Medicare and a Select policy and you move to a location outside of the coverage area
• You’re enrolled in a Medicare Advantage plan and want to switch to Original Medicare during the first year of your Medicare eligibility period
• You enrolled in a Medicare Advantage or Medicare Select plan after dropping a Medicare Supplement plan in Texas and want to switch back to Advantage plans or Medicare Select within the first year
• You lose Medigap coverage due to your policy ending due to issues with your insurance company, such as bankruptcy
• You don’t like the network restrictions with your HMO or Medicare Advantage plan

To facilitate your guaranteed issue rights, retain all documentation with your name and postmarked envelopes for proof that your coverage was terminated.

Signing up during an Open Enrollment or guaranteed issue rights will require you to answer medical questions which may increase your monthly Medigap or life insurance premium if you have a pre-existing medical condition.

Texas Medicare Resources

https://hhs.texas.gov/services/aging
https://www.medicare.gov/