Welcome to Texas Medicare Supplement Insurance, a site containing information
for Texas Seniors when considering a Medigap Policy. This site answers
some common questions about a TX Medicare Supplemental policy.
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Not connected with or endorsed by the United States government, the federal
Medicare program, or the State of Texas. |
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This site provides information to assist you when considering a TX Medigap
policy, and hopefully you will find it helpful. If you would like additional
information from a licensed Texas insurance agent, or a no-obligation TX Medigap
quote please visit the
Texas Medicare Supplement Web Site for more information.
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What Texas Medicare
Supplement (Medigap) policies are available? |
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Answer - There are
10 plans that can be sold in Texas, and they are identified as modernized plan
A, B, C, D, F, G, K, L, M, and N. In addition Plan F is available with
a high-deductible option. The plans must by law provide the same mandated
benefits
regardless of which insurance company offers them. Premiums
for the same or similar coverage may vary greatly. The following
chart shows the mandated benefits provided by each Texas Medicare Supplement plan. |
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Roll mouse over benefit for detailed description. |
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Basic Benefits (including 100% Part B coinsurance) |
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* YES |
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Skilled Nursing Co-Insurance |
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Part A Deductible |
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50%
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Part B Deductible |
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Part B Excess Charges |
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100% |
100% |
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Foreign Travel Emergency |
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- Plan N has a copayment of up to $20 for office visit, and up to $50 copayment for ER.
- Plans K and L are not shown. These plans cover
50% (K) and 75% (L) coverage of the Part A and B deductible, Blood, Hospice Care
Coinsurance, and Skilled Nursing Facility Coinsurance. Neither plan covers
any excess charges.
- Plan F is also available with a high
deductible option where you must pay the first $2,070 (2012) before the plan pays
anything.
As you can see the benefits vary widely between plans. Plan F and Plan
G cover 100% of any excess charges not covered by Medicare. Plan A-D, and Plans
M and N don't cover excess charges and can leave
you responsible for any charges above what Medicare approves.
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What is Medicare Part
A? |
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Answer -
Part A assists in covering inpatient hospital care including critical
access hospitals, and skilled nursing facilities (not including custodial, or long-term
care). It also helps cover hospice
care and some home health care if you meet certain conditions. |
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What is Medicare Part
B? |
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Answer -
Part B covers your doctors' services and outpatient care. It also
covers some other medical services that Part A
doesn't cover, such as some of the services of physical and occupational therapists,
and some home health care. These services are covered when medically necessary. |
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When can I get a Medicare
Supplement policy? |
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Answer - You generally
must have Medicare Part A and Part B. You are considered to be in open enrollment
during the first day of the month in which you turn 65 and are enrolled in Medicare
Part B, and for a period of 6 months following that date.
This is an important time to consider a Medigap policy because no insurance company
can deny you any Medigap policy it sells, and can not deny you because of any health
problems you may have. After your open enrollment period has passed
insurance companies may deny your application based on specific health conditions
you may have. If you are under 65 and disabled or have End Stage Renal Disease
(ESRD) you may be able to purchase a Texas Medicare Supplement. |
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What publications
are available to help me choose a Medicare Supplement? |
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Answer - The Centers
for Medicare & Medicade Services (CMS) publishes a booklet called "Choosing a Medigap Policy".
Click
here to download a free copy. This publication provides a great deal
of information that can assist you in choosing a Medicare Supplement policy. You
can also visit the official Medicare site at
Medicare.gov. |
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Will I be able to keep
seeing the same doctor with a Medigap Policy? |
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Answer - In most
cases yes. If you purchase a modernized plan A-N you can see any health care provider
that accepts Medicare. |
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What are some examples
of things not covered by a Medicare Supplement? |
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Answer - Long-term
care, vision or dental care, hearing aids, and private-duty nursing. These
are some health care items not covered by a Medicare Supplement. A Medigap
policy is designed to fill the gaps in Medicare Part A and Part B coverage. |
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What is a High
Deductible Plan F? |
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Answer - Plan F
allows for a high deductible option where you must pay the first $2,000 (the
2011 deductible) before your Texas Medicare Supplement pays anything. The
deductible can change each year, for example the deductible in
2008 was $1,900.
High-deductible plans often have lower premiums, but if you need considerable
health care your out-of-pocket costs will be higher, and you may not be able
to change to another Medicare Supplement policy. |
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What are Part B excess
charges? |
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Answer - Plan F and G cover all excess charges not covered by Medicare. Excess
charges occur when a hospital or doctor does not accept Medicare assignment. If
Medicare approves $20,000 for a procedure and a doctor who doesn't accept assignment
charges you $23,000, you are responsible for up to 15% of the amount over the
Medicare approved amount. Caregivers are limited to charging up to 15%
over the Medicare approved amount if they do not accept assignment.
Click here for a chart that explains how Medicare
excess charges can affect you.
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Why do my Medicare Supplement
premiums keep going up? |
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Answer- One of the main
reasons premiums go up is that the plan you have is experiencing higher health care
costs. If your plan has been sold for many years the people in your "block
of business" are getting older, and requiring more health care, and thus the premiums
must go up to keep the plan solvent. Click
here for a graphic that describes why your premiums go up.
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What is the Texas Department
of Insurance (TDI) Website? |
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Answer - Click here to view the TDI
site that can assist you with questions regarding Texas insurance issues. |
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Are there any useful
links for Senior Texans? |
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Official Medicare Web Site This is the official Web Site for Medicare,
and you will find information on all aspects of Medicare including choosing a Medigap
Supplement, and the Part D drug benefit program.
Choosing a Medigap Policy (Adobe PDF) This is the publication
is provided by The Department of Health and Human Services that assists you in choosing
a Medicare Supplement policy.
Suddenly Senior Web Site An informative and humorous web site dedicated
to Seniors. This site contains many links to other sites of interest.
SeniorJournal.com This is a site that
covers many health topics and news for todays Seniors and Baby Boomers.
Medicare Rights Center An advocacy group for Medicare and your rights.
This site is published in English and Spanish versions.
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We hope that you found this site helpful and informative. Please feel free
to visit TexasMedicareSupplement.com
for more information, or a
free no obligation TX Medigap quote. |
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