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:
Proposed
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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