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Comparison of Medicare Supplemental Insurance Plans in Texas

Medicare is federally funded health insurance for those age 65 or older and the permanently disabled. Medicare has Part A, which covers hospitalization, skilled nursing and hospice care, and Part B, which covers other medical care. Even though Medicare is comprehensive, there are significant out-of pocket costs if you have Medicare alone. Your work, retirement or Veterans Administration coverage may fill the gaps. If not, the Texas Department of Insurance has approved numerous Medicare Supplement and Medicare Advantage plans for Texans on Medicare.

  1. Medigaps

    • Medigap plans, also known as Medicare Supplements, are plans regulated and designed by the federal government to fill the gaps in Medicare. The plans are lettered; plans available in Texas as of 2011 are Plans A, B, C, D, F, G, K, L, M and N. A is the most basic plan, and generally the least expensive. B, C, D, F and G are more comprehensive. Some cover foreign travel emergencies (Medicare doesn't provide coverage overseas). Plans K and L are cost sharing plans, where you pay a lower premium in exchange for paying a percentage of out-of-pocket costs. N is the only plan that has copays for visits to a doctor's office.

    Part D

    • Texans who choose to purchase a Medigap plan should also consider a Part D plan. Medicare Part D is Medicare's prescription coverage, although, unlike Parts A and B, it's not offered directly from Medicare. You can only purchase Part D plans through private companies approved by Medicare. In 2011, 16 companies offered 28 different Part D plans. Each company has its own formulary, or prescription drug classification list. Each plan has its own monthly premium, copays and deductibles.

    Medicare Advantage Plans

    • Texans also have access to Medicare Advantage plans approved by Medicare and the Texas Department of Insurance. Medicare Advantage plans usually combine medical and prescription coverage. These plans are approved by Medicare, but run by private companies. They are part of the Medicare and sometimes are called Part C. Medicare Advantage are offered regionally (some are offered statewide as well) and are Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs) or Private Fee-for-Service Plans (PFFS plans). If you're considering a Medicare Advantage plan, make sure the network has providers in your area.

    Other Options

    • Texans have other options as well. If you are currently working, you can, and should, keep the health insurance you have through work. Medicare will be secondary to your work insurance until you retire. At retirement, Medicare will be primary and, if you can continue your health insurance, it will be secondary. Veterans may utilize their Veterans Administration coverage; depending on where you're receiving care, Medicare may be primary or secondary. If you have limited means, you may want to apply for Medicaid; if you qualify, all or part of your Medicare premiums will be paid, and Medicaid will serve as your secondary insurance.

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