How many Texas
Medicare Supplement Policies are there?
The twelve standardized benefit policies
are labeled A through L. Since they are standardized, by law each insurance companies plan offers the same benefits
with the exception that they may have different premiums. For instance, Plan F with company ABC is identical in every
way except price with company XYZ. Policy A contains only the basic benefits and the other eleven policies contain the
basic benefits plus one or more additional 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 all the deductibles and all the coinsurance.
In order not to have any additional out of pocket costs it has to be a Medicare approved expense, 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.
In both of Medicare programs Part A and Part B they have gaps in coverage that may be covered by supplemental insurance.
Here's an example of how having a Texas
Medigap Policy can benefit you:
Say you were on Original Medicare only, your
out of pocket could consist of Medicare Part A 2009 deductible of $1,068 and Medicare Part B deductible of $135 deductible.
Medicare will then pay 80% of the Medicare approved expenses. That can be a hefty unplanned expense! Now let’s say you
have a Medigap policy, like a Plan F that picks up the Medicare Parts A and B deductibles as well as the 20% of Medicare Part
B expenses. So by purchasing a Medicare supplement plan and combining it with Medicare your out of pocket expenses can
end up being next to nothing. This type of advance planning for the unexpected covered medical expenses can be very advantageous.
When is the Open Enrollment
Period?
You have a six month Open Enrollment Period once you are age 65 or older and enrolled in Medicare
Part B. Enrollment may vary after age 65 based on your circumstances such as when you retire. The Texas Medicare
enrollment follows the same follows the same guidelines for Medicare supplemental insurance in Texas.
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 does a Benefit Period mean?
The Benefit Period is a span of time that Medicare uses to gage a person’s use of skilled nursing or hospital care.
The Benefit Period support starts the day the person enters the hospital or skilled nursing covered by the insurance. The
Benefit Period will end once the person is released from care and does not require any other care for 60 days. Once the benefit
period has ended, if the person of whom it concerns goes back into a hospital a new benefit period will start. The inpatient
hospital dues may be charged for every single benefit period. The number of benefit periods does not have a cap on limit.
If I move what happens to my Medicare supplement plan?
Your Medicare
supplemental plan is renewable and guaranteed; you will still have coverage if you move in state. If the move is into another
state, the supplement insurer may have to go over different premiums due to the states plans. If you have a select insurance
plan, which do include network restrictions, you will be asked to change your Medicare coverage. You will be given the opportunity
to buy supplemental insurance A, B, C or F in the state you move to without having to medically qualify.
Q. What is the General Enrollment Period?
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 period is when the applicant is guaranteed
a Medicare supplement insurance plan regardless of their current or past health history (generally, outside of this period
the applicant must meet medical underwriting guidelines to qualify). Open enrollment is a six-month period from the
date the beneficiary enrolled in Medicare Part B if age 65 or older (also includes a six-month period when you turn 65 if
you were eligible for Part B benefits before age 65).
What makes the open
enrollment period so critical?
The open enrollment period starts the first day of the month you turn 65
and have Medicare Part B extending for 6 months from that date. This period is critical because no company can
not offer you any Medicare Supplement Policy that they sell for any reason. After this your open enrollment period ends
companies then are allowed to use medical underwriting and can accept or deny your application. This can make it very difficult
and expensive, due to certain health conditions to obtain coverage after your open enrollment period expires.
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 7 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.
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 a Copayment?
A
set amount an individual must pay upon receiving medical services in combination with the amount paid by the insurer. For
example, you may have to pay $10 each time you visit the doctor, with the understanding that the health insurance policy covers
a large part or the remainder of the balance of the fee owed to the doctor. The Copay amount is usually indicated on
the prescription or insurance card. It is the portion the insured pays with the balance being paid by the insurer.
What does it mean to have Creditable Coverage?
Your current
insurance company can guide you on weather their plans are creditable. When you are going from one health insurance
plan to another the prior coverage will reduce pre-existing condition waiting period. However, if you didn’t have
any health insurance coverage for more than 63 consecutive days, you can not count them in the creditable coverage period.
What is a Deductible
A deductible is the cost a person
is required to pay for health services before the insurer or Medicare pays their portion. For instance, Medicare Part
B requires one deductible that is paid on a calendar year basis and Medicare Part A has a deductible that must be met for
each benefit period.
What does a participating Texas Medicare provider
mean?
A participating physician is enrolled in the Medicare program agreeing
to accept assignment on all Medicare claims that are submitted. You may only be billed by these doctors for Medicare deductible
and/or coinsurance amounts.
What is the best Medicare 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.
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
fee to call us at 469-293-7080. 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 understandhow they work with Texas Medicare.
How do I apply for Medicare in Texas?
The Medicare laws and regulations are subject
to change for Texas Medicare eligibility and enrollment at any time. Contact Social Security at 1-800-772-1213 to discuss
the Texas Medicare application or look here for your local Texas Social Security offices.
How do I know if I am
eligible for Medicare?
Generally you are eligible for Medicare if you are a U.S. citizen or have
been a permanent legal resident for 5 continuous years, are 65 years or older or if under 65 are disabled and have been receiving
either Social Security or the Railroad Retirement Board disability benefits for at least 24 months, or they get continuing
dialysis for permanent kidney failure or need a kidney transplant, or they have Amyotrophic Lateral Sclerosis (ALS-Lou Gehrig's
disease). You can also be dual-eligible which means you are on Medicare and Medicaid. If you have limited income,
in some states, Medicaid will actually pay for the Part B premium and for many individuals who have worked long enough won’t
have a Part A premium, and also pay any drugs that are not covered by Part D.
How do I determine which type of Medigap plan is best for me?
Your personal requirements, needs
and financial situation will determine which is 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.
Tell me about the
Medicare Preferred Provider Organization (PPO) Plan?
A Medicare Advantage PPO allows the
individual the choice of visiting providers within the network or seeing a provider outside of the network for an additional
cost. An individual does not need a referral from their primary care physician to see a specialist.
I want to switch to a different Medicare supplement policy, do I have to wait
for it to start?
You generally do not have to wait to switch to a different Medicare supplement
policy and can do so any month. However, If you had a Medicare Supplement plan for at least six months and you decide
to go to another company your new plan must cover all pre existing conditions. If you are on a plan for less than six months,
the new Medicare supplement policy must give you credit for the time the older policy covered you.
FYI:
Changes
to Medicare Supplement Policies June 1, 2010
There will be 11 Medicare supplement
plans to select from: A, B, C, D, F, high-deductible F, G, K, L, M and N. The Medicare supplement plans being eliminated
are E, H, I, and J. Medicare is adding M and N to Medicare supplements insurance plans that will include higher cost
sharing but at lower premiums. Some of the policy changes are Plan G policies will have 100% coverage for excess charges
instead of 80%; Hospice will be part of the basic benefits and will be included on all Medicare supplements, Also, benefits
that will no longer be included on Medigap policies are At-home recovery and preventative care.
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