A Guide to the Medigap Plans in Texas

Medigap Plans in Texas

Looking for Medigap plans in Texas? Any Texas resident at the age of 65 years and above is eligible for the Medicare insurance plan, which covers a percentage of the total medical treatment. However, the original Medicare leaves a certain percentage, which the policyholder has to pay. For example, Medicare pays 80% of the total medical costs, leaving the policyholder with 20% to cover.

A Medigap insurance policy covers gaps that the Medicare Part A and Part B don’t cover. The out of pocket expenses include deductibles, medical care provided while traveling out of the country, any treatment fee, coinsurance, and copayments.

Medigap Plans in Texas

Over 2.4 million Texas residents had the Original Medicare insurance in 2015 while more than 675,000 had acquired Medigap insurance by 2014. The number has now increased over the years with Plan F gaining more popularity over the other plans.

The Texas Department of Insurance standardizes the insurance plans, but the private companies are responsible for selling the insurance covers to the residents. This means that the insurance benefits across all plans sold by the companies in Texas are similar. However, TDI only regulates the plans meaning that the premiums vary from one company to another.

Eligibility for Insurance Coverage

Any Texas resident who has attained 65 years of age is eligible for the Medicare Supplement plan. Most companies also provide the coverage to anyone with any disability or the end state renal disease. You also need to acquire Medicare Part A and B before getting the Medigap plans in Texas. Remember that spouses cannot get the Supplement plan, but they can get separate policies. You may not need the Medigap insurance if you fall into any of these categories.

  • If you hold a Medicare Advantage Plan.
  • If you have a group health insurance provided by the employer, government institutions, or if you served in the military.
  • If you have Medicaid or Qualified Medicare Beneficiary Program.

Medicare Supplemental Plan and Benefits

The private insurance companies provide ten standardized Medigap insurance plans depicted by the alphabetical numbers ranging from A to N. The plans included Plan A, B, C, D, F, G, K, L, M, and N which attracted applications of approximately 27% of the Medicare beneficiaries in 2014.

The policyholders are free to seek services from any medical practitioner or hospital facility that accepts Medicare in the Texas state. Therefore, you do not need any referral or networks to get treatment. Some of the benefits that the policyholder expects from the Medigap insurance plan include:

  • Part A hospice care, copayments, and coinsurance.
  • Skilled nursing facility care and coinsurance.
  • Medical care provided while traveling out of the country up to the plan limits.
  • Part A deductible and the Medicare Part A coinsurance of up to one year after exhaustion of the Medicare benefits.
  • Part B deductibles and excess charges.

Plan F, G, and N remain the most popular among the Texans following their broad range of benefits. Plan N provides $20 for the office visitations made by the policyholder while a $50 copayment go to the emergency visits that the patient makes that do not result in admissions. Plan F comes in two-fold, the standard plan, and the high deductible.

The high deductible Plan F requires one to pay an annual deductible to cover the treatment costs before your insurer covers the cost. Plan K and L have out-of-pocket expenses that policy holder has to settle before the insurance provider covers 100% medical expenses for the rest of the year.

What Medigap Does Not Cover

Medicare supplement plans in Texas may have many benefits, but it has some services that it does not cover including long-term care and homemaker services. It also does not cover skilled nursing home care for more than 100days from when the benefit period began. Other cases include visual and dental care, cosmetic care and routine foot care, private-duty nursing care, hearing aids, and eyeglasses.

Pricing Method

The insurance premiums that one chooses right now for their Medigap insurance have a direct impact on the future insurance costs. Therefore, the Texans should be extra careful while choosing an insurance coverage. Some of the primary pricing methods used include:

  • Issue-age rated- the insurance company focuses on the age of the policyholder at the time of purchase. The future age does not affect the premiums, but other factors like inflation may have a direct impact.
  • Attained-age rated- the premiums increases as you age.
  • Community-rated- all the policyholders, pay the same premiums regardless of their age.

Conclusion

Texas resident above 65 years and above or anyone with a disability or ESRD should consider acquiring Medigap plans in Texas. The policyholders have a guarantee of renewal as long as they maintain consistency in monthly premium payment.

Remember, application during the open enrollment period, which is six months from when you attain 65 or acquire Medicare Part B, protects you from denial of coverage and increment in premiums due to an underlying medical condition.