Health insurance in Texas can change depending on what stage you are in life. Standard Health Insurance will usually be covered under the Affordable Care Act through health insurance policies that can be purchased in the Marketplace or through private insurance carriers. However, as we get older, we will graduate from these plans and move into the latter season of life, and Medicare will be the type of health insurance we will apply for in Texas. Knowing that you will need to apply for Medicare one day, we aim to answer your questions about when and how to apply for Medicare in Texas.
What is Medicare Insurance?
First, let’s answer the big question. What is Medicare? The big confusion many have, and we must clear up, is that Medicare is not Medicaid. These are two completely different types of insurance. Medicaid is a state program that assists low-income families in obtaining affordable health insurance. Medicare is a health insurance program for those 65 and older. It is essentially split into three different parts, Part A, Part B, and Part D. Each offers a different service:
- Part A: Hospital Insurance – This first part of Medicare is hospital insurance. This coverage is an inpatient in a hospital, nursing home, or long-term facility. It also covers hospice and home health care. It can pay for the following:
- Rooms
- Meals
- Nursing care
- Most medications while hospitalized
- Supplies needed as part of your treatment while hospitalized
- Part B: Medical Insurance – The medical insurance part of Medicare is for your routine medical treatment. This is known as medically necessary services to diagnose and treat a health condition. Medicare supplement plans in Texas can also include preventive treatment, but only when the medical service is proven to work best. Part B can also include
- Ambulance services
- Durable Medical Equipment
- Mental health treatment
- Limited outpatient prescription drugs
- Part D: Prescription Coverage – Medicare Part D is a Medicare supplement plan in Texas. It is a more advanced prescription drug program than what Part B offers. This optional part of Medicare will cover necessary medications prescribed by your physician. It is advised that even if you are healthy and don’t require many medications, you purchase a prescription coverage plan to avoid late enrollment penalties. You also have the option to obtain it as part of a Medicare Advantage plan in Texas.
Medicare Part D plans function on three tiers:
- Tier 1: Offers the lowest copayment – primarily generic drugs (formulary)
- Tier 2: Offers a medium copayment – preferred, brand-named drugs
- Tier 3: Offers the highest copayment – non-preferred, brand-named drugs
There is a specialty tier; however, it has a higher copay having all specialty drugs.
Medicare Part A and B both have gaps in their coverage. Especially when it comes to eyes, ears, and teeth. This is when one option can become attractive. It allows you to include these options but will also take you outside of the parameters of Medicare itself.
- Part C: Medicare Advantage: Medicare Advantage has the most extensive coverage. This form of Medicare is pretty much a combination of A and B, and D with a side order of coverages that Original Medicare doesn’t provide, like:
- Dental
- Vision
- Hearing
- Some RX coverage
- Other misc. perks like gym memberships
When shopping for your Medicare plan, you will choose between Original Medicare (Part A and Part B) and adding prescription coverage through Part D or elect a Medicare Advantage (Part A, Part B., and Part D) plan. They are two different plans and cannot coexist.
How does Medicare Insurance in Texas work?
Now that we’ve discussed Medicare supplement plans in Texas, let’s take a look at how they work.
- First, Medicare has a couple of stipulations for qualification. You must be a legal resident of the US for at least five years and you must be 65 years old to receive Medicare coverage.
- Next, your portion of Part A will be free as long as you or your spouse has contributed to Medicare for ten years through payroll deductions; these deductions are through the Federal Insurance Contributions Act (FICA).
- Finally, when you do become eligible, your enrollment in Part A, Hospital Insurance, and Part B, Medical insurance, is automatic; no paperwork or phone calls to make.
To make any changes, you must make them during your Open Enrollment Period (OEP). This is a seven-month window surrounding your 65th birthday; three months before, the month of, and three months after. If you miss your window, you will be locked into your choices unless you have a special circumstance to warrant a change.
Understand that Part A is mandatory to sign up for; Part B is not. However, if you choose not to sign up for Part B, your premium will increase by 10% each time you pass an OEP. It is better to sign up for it now at lower premiums than wait.
Signing Up for Medicare in Texas
This is the easy part. In most cases, there is nothing you need to do to apply for and receive Original Medicare, Parts A and B. The only time you will need to sign up manually is if you choose to purchase a Medicare Advantage plan in lieu of Original Medicare, you want to add Part D prescription coverage, or you fall under one of these stipulations:
- You do not collect Social Security
- You did not pay into FICA for the 10-year requirement through payroll deductions and are required to pay for your portion of Part A
NOTE: If you are under 65 and disabled you have the ability to sign up for Medicare. It can also be automatic. If you are considered disable under Social Security or the Railroad Retirement Board for 24 months, you will be automatically enrolled in Medicare beginning the 25th month of your disability.
It is always beneficial to speak with an insurance agent to ensure that everything is lined up, so that there are no surprises when you are blowing your candles out on your birthday cake.
Here are a few tips on how to apply for Medicare in Texas:
- Know in advance your contribution status. Don’t wait until the last minute. You can go online, check your eligibility on the Social Security website and apply when you hit your seven-month window. Delays can leave you paying more than you need to and locked into choices you will be unhappy with and paying out of pocket, as with prescription drugs and vision.
- Understand your options. You have choices. While there is the traditional route with Original Medicare and adding a Part D for prescription coverage. Having a Medicare Advantage option allows you to select a private health insurance company to provide your Medicare plan. This can open the door to added benefits such as prescription coverage.
- Plan for the future. While you may be healthier now and considering not including Part B or D because you don’t visit the doctor that often or rarely gets sick, consider that the longer you do not sign up for it, the premium will increase each year until you do.
These tips can help you apply for Medicare in Texas as you step closer to retirement age. Other Medicare policies that can assist with costs are Medigap policies. These Medicare supplement plans in Texas come in a wide variety and are like Original Medicare, letter based: Medicare Plan A, Plan B, Plan C, and so forth. They are designed to assist the insured with covering the costs that Original Medicare doesn’t cover, like skilled nursing facilities, hospice, and foreign travel.
Summary
Medicare is not part of the Affordable Care Act. This insurance plan in Texas is designed for those who are graduating from the group insurance plans and into their own health insurance tier. Cover Mile desires to assist you with understanding the insurance process during the golden years and finding the best policy that fits you and your family’s needs. Contact us today.
