Who Needs Medicare Supplement?

Posted by Raul Gonzalez on March 30th, 2023

If you are 65 or above and covered under Original Medicare, you must be wondering if you actually require one of the best Medigap plans in Texas. The good news is that you are not alone. The Medicare website has a wealth of information that is easy to read and understand. But, it may still be difficult for some people to determine if they get a Medicare supplement plan in Texas. Continue reading to get the answer.

Understanding Medigap Policies in Texas

Medigap is basically a supplement to Original Medicare. Based on the kind of coverage, Medicare Supplement is designed to offer extra coverage for medical care services covered by Original Medicare – and sometimes Medigap plans cover the costs – partly or wholly – that are not covered by Medicare. These may include services like vision care, dental care, or long-term care.

The main objective of Medicare Supplement is to help you reimburse the costs of medical services you pay out-of-pocket. Medigap Texas plans are sold by Medicare-approved private health insurance carriers, so you may want to do some research and compare multiple plans while shopping around for Medigap, to find the plan that meets your needs within your budget. As per the government's mandate, all lettered Medigap plans from every company must provide the same levels of benefits.

Why Should You Buy Additional Insurance?

As mentioned earlier, Medicare is by no means blanket insurance. Simply put, Original Medicare has some gaps. Original Medicare comprises Part A and Part B, along with Part D (also called Medicare prescription drug coverage) which cover the bulk of our health care costs.

However, it may not be able to cover all of your expenses should you get severely injured or become seriously ill. Even some routine services have deductibles and copayments. This is where Medigap insurance comes to your rescue.

Medicare Deductible

Here are some examples. If you are hospitalized, you have complete hospital stay coverage after an annual deductible of the ,600 under Part A in 2023. This includes the basic board and bed. However, you may have to pay on your own up to 20% of a few other expenses, like anesthesiologist fees.

If you stay in the hospital for over 60 days, you have to pay 0 each day in 2023. For long stays in nursing facilities and hospice care, there could be similar copayments. You may also incur additional costs of doctor visits and outpatient medical care. Your deductible for 2023 is 6, but post that too, you would require paying up to 20% of the costs approved by Medicare for the majority of physician services – and there is no cap.

Medicare Donut Hole

Prescription drugs may also zap your budget should you require costly medicines. However, you may consider buying a standalone prescription drug plan. In the language of Medicare, it is called Part D.

Thanks to the Affordable Care Act (ACA), the prescription drug rate donut hole has been shrinking with each passing year, but it’s not fully closed yet. At a specific point, (,660 in 2023), you get into the infamous donut hole with respect to coverage, where you need to pay up to one-fourth of the costs of Part D-covered generic or brand-name medications. Once the costs reach ,400 (in 2023), you get out of the donut hole and pay just 5% of the expenses of those drugs out-of-pocket.

How Does Medicare Supplement Work?

As you know, Medicare Part A and Part B offer basic health coverage, whereas Part D is optional insurance to cover prescription drug expenses that you may purchase from a private insurer and get it linked to your Original Medicare. Medicare Part C, also called Medicare Advantage, is also offered by private insurers, which is an alternate way of getting the basic coverage of Original Medicare. It is to be noted that if you choose Medicare Advantage, you can’t have any of the Medicare supplement plans in Texas.

However, if you choose to stick with Original Medicare, along with Medicare Part D, and you want a Medigap plan for comprehensive coverage, you may opt for a lettered Medigap plan. Each lettered plan is standardized and offers a specific level of coverage. The most preferred choices for Medigap are Plan F and Plan G.

• Medicare Plan F: Being the most exhaustive option, it has been the most preferred choice for many years. However, Plan F is no longer available to people, who became eligible for Medicare after January 1, 2020. People, who had enrolled in Plan F before January 1, 2020 can still keep it, and those, who became eligible for Medicare prior to 2020 but didn’t consider buying Medigap, can still get Plan F if they want.

• Medicare Plan G: This plan has the potential of replacing Plan F with respect to popularity, since it has almost the same level of coverage, but without reimbursement of the deductible of Part B, which is a major benefit that is not available with any Medigap plans offered to Medicare enrollees after 2020. Plan G is generally cheaper than Plan F. However, the actual rates may differ, based on an enrollee’s gender, area of residence, and tobacco use – and as you know, rates rise with age.

What Is the Best Medicare Supplement Plan in Texas?

Well, the straightforward answer is: If you are looking for complete coverage of everything, Plan F or Plan G plan (based on your eligibility) is your ideal option. The other lettered plans provide less coverage in a progressive manner for lower upfront expenses.

For a more comprehensive answer to this question, you can do any of the following:

• Speak with an independent Medicare insurance agent in San Antonio, Texas to find the Medicare Supplement plan that suits you most.

• Go through the publication: “Choosing a Medigap Policy,” on the Medicare website which contains detailed information on all types of Medigap plans and their coverage.

Medicare Supplement vs. Medicare Advantage

Medigap is basically a supplemental insurance that fills the cost-sharing gaps in Original Medicare, and covers costs that are not covered by Original Medicare. Medicare Advantage (also called Medicare Part C) on the other hand is a private alternative to receiving the benefits of the federal Medicare health insurance. The majority of Medicare Advantage plans are available as Health Maintenance Organizations (HMOs) that not just replace all the services covered by Original Medicare, but in most cases, offer additional services, like preventive care, as part of a predefined network of medical care facilities and physicians.

A Medicare Supplement plan gives you more freedom than Medicare Advantage with respect to choices, given that your care facility or physician is in contract with Medicare. It is a better option for people who travel a lot or have residences in several locations.

Is My Spouse Covered?

The straightforward answer is “No.” A Medigap policy covers only a single person and doesn't cover health costs incurred by your partner/spouse. Medicare is not the same as employer-funded plans that also provide coverage to your spouse. In other words, you and your partner have to purchase two separate Medigap plans to get coverage.

Can Your Plan Get Canceled?

No, as it is illegal to do that. As long as you continue to pay your premiums on time, your Medigap policy remains renewable for your entire lifetime. You policy might get canceled for any of the reasons below:

• You stop paying your premiums

• You provided false information on your Medigap application

• The insurer goes bankrupt.

If you choose to cancel your Medicare Supplement, you can do so by reaching out to your insurer.

How Much Does Medicare Supplement in Texas Cost?

Since Medigap is offered by private health insurance companies, each insurer has different premiums for different Medigap plans. The prices may vary based on several factors, such as age, inflation, or the length of your enrollment in a Medigap plan.

Final Words

If you are still not sure whether or not you should opt for Medigap Texas – or you are finding it difficult to choose the right lettered Medigap plan – consider speaking with an independent Medicare broker in Texas.