Medicare Supplement Plans in Texas
Benefits of choosing a Medicare Supplement Plan N in Texas
Many people are unaware that Medicare covers only about 80% of your Medicare Part B health care expenses. That leaves you responsible to pay for the additional 20%, which can be financially distressing if you are diagnosed with a serious and costly illness. Medicare Supplements are designed to help pay a part of or all of that extra 20% for you as well as some additional costs. By purchasing a Medicare Supplement plan in Texas you buy some peace of mind by minimizing your financial risk/responsibility.
Benefits of choosing a Medicare Supplement Plan N in Texas
There are several things to consider when choosing a Medicare Supplement plan, also known as Medigap plans. Before you can select which Medicare Supplement plan is best for you it is important to understand how Medicare Supplement plans work and also that they are very different from Medicare Advantage plans.
Medicare Supplement plans are a type of health insurance you buy from a Medicare Supplement insurance company. These plans work alongside Original Medicare to help pay for health care costs like co-payments, coinsurance, and deductibles that are not covered by Original Medicare. Medicare Supplement policies are very different than Medicare Advantage HMO or PPO Plans in several ways.
Medicare Advantage plans completely replace Original Medicare while Medicare Supplement policies work in tandem with your Original Medicare benefits. In Texas (and in all but three other states) Medicare Supplement plans have been standardized and given letter designations starting with A running through N. Each of these plans offers varying levels of coverage. The advantage of having standardized plans like these is the benefits provided in say a Medicare Supplement Plan G for example, are the same no matter which insurance company you purchase it from.
Below is a chart that outlines the different Medicare Supplement plans in Texas. This will give you a high-level overview of the benefits covered but it is best to find an independent Medicare insurance advisor near you to help you decide which plan is the best Medicare supplement plan in Texas for you given your unique situation. You will note that Plans C and F are highlighted in red, this is because they are no longer available to people who are newly eligible for Medicare on or after January 1, 2020.
|Medigap Benefits||Medigap Plans|
|Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up||Yes||Yes||Yes||Yes||Yes||Yes||Yes||Yes||Yes||Yes|
|Part B coinsurance or copayment||Yes||Yes||Yes||Yes||Yes||Yes||50%||75%||Yes||Yes***|
|Blood (first 3 pints)||Yes||Yes||Yes||Yes||Yes||Yes||50%||75%||Yes||Yes|
|Part A hospice care coinsurance or copayment||Yes||Yes||Yes||Yes||Yes||Yes||50%||75%||Yes||Yes|
|Skilled nursing facility care coinsurance||No||No||Yes||Yes||Yes||Yes||50%||75%||Yes||Yes|
|Part A deductible||No||Yes||Yes||Yes||Yes||Yes||50%||75%||50%||Yes|
|Part B deductible||No||No||Yes||No||Yes||No||No||No||No||No|
|Part B excess charge||No||No||No||No||Yes||Yes||No||No||No||No|
|Foreign travel exchange (up to plan limits)||No||No||80%||80%||80%||80%||No||No||80%||80%|
|Out-of-pocket limit in 2020**||N/A||N/A||N/A||N/A||N/A||N/A||$5,880||$2,940||N/A||N/A|
* Plans F and G also offer a high-deductible plan in some states. With this option, you must pay for Medicare-covered costs (coinsurance, copayments, and deductibles) up to the deductible amount of $2,340 in 2020 before your policy pays anything.
** For Plans K and L, after you meet your out-of-pocket yearly limit and your yearly Part B deductible ($198 in 2020), the Medigap plan pays 100% of covered services for the rest of the calendar year.
*** Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don’t result in an inpatient admission.
Let’s review Plan N in a little more detail.
Medicare Supplement Plan N is a type of Medicare Supplement insurance that can help cover some of the costs that Original Medicare does not cover, such as copayments, coinsurance, and deductibles. Plan N is a good option for people who want some additional coverage but don’t want to pay a high premium. Plan N is most often the least expensive Medicare Supplement plan. Some of the benefits of Plan N include lower out-of-pocket costs for covered services and the freedom to see any provider that accepts Medicare.
What does Plan N cover?
- Hospitalization: pays Part A coinsurance and provides coverage for 365 additional days after Medicare benefits end
- Medical Expenses: pays Part B coinsurance (excluding copays for office visits and ER) and 20% of Medicare-approved expenses or copayments for hospital outpatient services
- Blood: pays the first three pints of blood annually. Original Medicare pays for any pints beyond 3
- Hospice Care: pays Part A coinsurance
- Skilled nursing facility care
- Foreign travel benefits that will pay for up to 80% of the treatment costs
What does Plan N not cover?
- Part B deductible
- Part B excess charges
- Up to $20 in copayment for some doctor’s office visits
- Up to $50 in copayment for emergency room visits that don’t require inpatient admission
If you’re considering a Medicare Supplement plan, it’s important to compare the different plan options and consider your individual needs and budget before making a decision.
What about prescription drugs?
It is important to understand that neither Original Medicare nor Medicare Supplement plans cover prescription drugs. To have prescription drug benefits you will also have to purchase a prescription drug plan in addition to your Medicare Supplement plan from an insurance company in Texas as well. These plans are commonly known as stand-alone Part D plans. There are a lot of things you will want to consider when choosing a stand-alone Part D plan to go with your Medicare Supplement plan but we will cover that in another post.
When can you enroll in a Medicare Supplement Plan?
When you turn 65 and sign up for Medicare Part B you are given a six month open enrollment period for Medicare Supplements in Texas that starts the first day of the month of your 65th birthday. During your open enrollment period, you can purchase any Medicare Supplement policy in Texas without medical underwriting this is called guaranteed issue (GI). If you buy a Medicare Supplement in Texas outside your open enrollment, guarantee issue window, you may be declined due to health reasons or pay a higher premium. There are exceptions to that rule which is why it is so important to work with a Medicare Insurance Advisor near you who will review your specific situation and help you choose the right plan for your unique situation. You may have heard of the Annual Election Period that happens each fall from October 15th through December 7th. This does not apply to Medicare Supplement plans The Annual Election period only applies to Medicare Part D plans and Medicare Advantage Plans NOT Medicare Supplements. Your 6-month Guarantee Issue Open Enrollment period for Medicare Supplements happens only once when you turn 65.
If you are still working when you turn 65 you can defer enrollment in Medicare without any penalty. You simply keep the health insurance provided by your employer and enroll in Medicare at a later date when you retire and are no longer covered by an employer group health plan. At that time you will have something called a guaranteed issue window which allows you to enroll without any health questions. It is however a shorter period of time (63 days after the loss of your employer group health coverage) and you will have fewer plan choices. The insurance company also cannot deny your application for any health reasons during this enrollment window.
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