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Medicare Supplement in Texas

Medicare comes in four main parts. Parts A and B include benefits for hospital and preventive services. Part C allows members to buy policies from private companies. Part D was added in 2003 and covers prescription drugs. Medicare is not free and comes with a number of premiums, deductibles, copayments and coinsurance, which all have to be paid out-of-pocket. Many Medicare users buy Medicare supplements, called Medigap, which help with some of these fees. Not all all states sell Medigap plans, but Texas does, and its Medicare supplements are supervised by the state Department of Insurance.

  1. Plan A

    • All insurance providers in Texas that sell Medigap must sell Plan A, although they are not required to sell all of the other nine standardized Medicare supplements available in the state. Plan A offers basic benefits only, but is the least expensive. Plan A benefits in 2011 include an additional 365 days of lifetime hospital benefits after regular Medicare benefits have stopped, the reasonable costs of the first three pints of blood you use per year, hospital coinsurance coverage and coverage of the Part B coinsurance costs.

    Additional Benefits

    • Medigap policies are referred to by letter. As of 2011, Texas allows the sale of plans B, C, D, F, G, K, L, M and N in addition to A. Each policy offers the basic benefits of Plan A and adds other benefits. Skilled nursing care coinsurance is part of Plans C through N. Plans C and F both pay for the Medicare Part B annual deductible, while C, D, F and G pay for 80 percent of medicare treatment you receive while traveling outside the U.S., after you reach an annual deductible amount. Plans F and G also pay 100 percent of the Part B excess charges.

    Plan F

    • Plan F, which has the most benefits of any Medigap policy, is available in Texas as both a regular plan and as a high-deductible plan. The regular plan only has a deductible for foreign travel emergency care. The high-deductible Plan F has both a foreign travel emergency deductible and an annual deductible. The yearly deductible is set by Medicare; as of 2011, it is $2,000. The high-deductible plan can be used along with a medical savings account, and it has lower premiums than regular Plan F, but the foreign travel emergency deductible does not count toward the annual deductible and vice versa.

    Medicare Select

    • Texas allows insurance companies that sell Medigap to offer their plans with the Medicare Select option. Medicare Select supplements have the same benefits as the regular policies but are sold as HMO-style managed-care plans, which require you to receive nonemergency medical treatment within a network of approved service providers in return for lower out-of-pocket costs. You can go outside the network with Medicare Select, but your bills will be higher.

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