Texas Medigap Insurance Market Summarized
In Texas senior health insurance concentrates on Medicare for those individuals 65 and older or individuals under 65 who qualify for Medicare due to a disability. Medicare is divided into four components: Part A for hospital, Part B for physician services, lab, x-rays, durable medical equipment and dialysis, Part C for Medicare Advantage plans and Part D for prescription drugs. Medicare Supplement policies were introduced in 1971 to pay the estimated 30% of health care charges not paid by Medicare. By 1981, the National Association of Insurance Commissioners standardized Medicare Supplement policy benefits. Medicare Supplement Plans A through J were created with varying levels of benefits, which could not be altered. A prescription drug benefit was added with the creation of Part D in December 2003.
Key Points for Medigap Insurance Coverage
Medigap policies are typically written under guaranteed issue, which is six months from receiving your Medicare Part A and Part B enrollment. You can also qualify for Medicare and a supplement if you become Medicare Part A and B eligible regardless of age due to a disability or leave an employer sponsored plan or lose Medicaid eligibility, or if you are enrolled in a Medicare Advantage plan and the carrier withdraws from the territory, typically expressed by county.
All Medicare Supplement plans include standardized, mandated benefits. One carrier’s Plan G has the same benefits as a second carrier’s Plan G.
Plan G generates the most interest because it will pay the Part A deductible, Part B expenses after the $198 deductible and it will pay the excess charge. Plan G has replaced Plan F since Congress in an effort to curb spending eliminated Plan F. If you are eligible for Medicare prior to January 1, 2020 you can still be covered by Plan F. For those individuals who enroll in Medicare after January 1, 2020 Plan G will replace Plan F.
Premiums for Part A have been deducted from your paycheck and will not require additional premium once you enroll in Medicare. Part B will result in a premium charge and the amount you pay is means tested based on income. Part D requires additional premium to be paid by the policyholder.
Almost all hospitals accept Medicare but the providers are allowed to charge an “excess” charge, which the Plan F pays.
Many carriers offer Medicare Supplement policies but the active carriers in the Texas market include Blue Cross Blue Shield, United of Omaha, Aetna, Gerber, and AARP.
Premiums can vary greatly, especially in the pre-65 Medicare Supplement market. Premium for Medigap Pre-65 Plan A can vary from $200 per month to $904 per month for the exact same coverage.
Stateside quotes eight different carriers for Medicare Supplement policies for applicants that are 65 or older. Eight carriers are quoted so the Texas consumer can rely on one source for the dominant carriers in the market.
If you delay enrollment in Part D you will charged 1% penalty for each month you elect not to enroll.
Part D enrollment is guaranteed issue each year between October 15th and December 7th with a January 1st effective date.
STATESIDE CAN HELP!
Stateside Insurance Services, since 2003, has focused on providing comprehensive health insurance information, responsive customer service and expert industry knowledge for Texas consumers. Stateside has annually been recognized by health insurance carriers and the Health Insurance Marketplace as a Top Producer in Texas.
Whether the health insurance policy is for an individual, family, small business or supplemental Medicare coverage, Stateside dedicates the time, and our deep industry expertise, to ensure our clients have identified the best health insurance plan for their specific needs.
Stateside is available to answer any general questions regarding your coverage options, can provide a subsidy determination, and even assist in creating and submitting online applications for ACA compliant plans during an Open Enrollment or throughout Special Enrollment periods.
By using the Telephone Appointment System, clients can take advantage of scheduling a health insurance discussion when convenient for their schedule. During Open Enrollment phone appointment availability is expanded to include extended hours and weekends.