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Medicare Supplements and Insurance in Texas

Medicare, a health insurance program offered primarily to senior citizens in the United States, comes in four basic parts. Parts A and B are often called original Medicare, as for many years these were the only ways to get Medicare. Medicare also features Part C Medicare Advantage and prescription drug plans called Part D. Even with all these plans, however, Medicare does not cover all services. Medicare supplements, called Medigap, are meant to help fill in these holes. In Texas, Medigap is overseen by the Department of Insurance, with 10 standard Medigap plans offered.

  1. Original Medicare

    • You must first be enrolled in Parts A and/or B Medicare before you can join any other kind of Medicare or Medigap plan in Texas. Part A mostly covers inpatient hospital services, hospice care and home health services, while Part B has benefits for outpatient hospital care and preventive services, such as health screenings. Part A is often premium-free, but Part B requires a monthly charge. Many Part B services also require you to pay a 20 percent co-insurance charge.

    Medicare Advantage

    • Texas residents can also get their Part A and Part B Medicare benefits through a Part C, usually called Medicare Advantage, plan. Unlike traditional Medicare, Medicare Advantage is purchased from private companies. These insurance companies must be approved by the Centers for Medicare and Medicaid services and offer all the same benefits as the government for Part A and Part B, except for hospice. Medicare Advantage in Texas is offered in different forms, including HMOs, PPOs and special needs plans. MA policies offers benefits you do not get from original Medicare, such as vision, hearing, prescription drug coverage or dental services. However, MA plan benefits can vary depending on the company, which also sets its own premiums, deductibles, co-insurance and co-pays.

    Part D

    • Part D is not mandatory, and if you already have a Medicare Advantage plan, you more than likely do not need Part D. If you already have drug coverage through a group plan, you will also not need Part D. If you don't have these and feel you need prescription drug coverage, you can purchase stand-alone Part D plans to use with original Medicare. Part D plans are offered according to service area and are also purchased from private insurance companies.

    Medigap Plans

    • Medigap plans are standardized by the federal government. The only difference between the same Medigap plans sold by different companies in Texas are the costs. In 2010, Texas allows standard Medicare supplement plans A through D, F, G and K through N. All offer the same basic benefits, which include payment for daily hospitalization costs from the 61st through the 90th day of a Medicare benefit period, payment of the hospice coinsurance for respite care and outpatient medications, the reasonable cost of the first three pints of blood per year and payment of your part of the Part B coinsurance. Some plans also have additional benefits, such as foreign travel emergency care, skilled nursing facility coinsurance coverage and payment of the Part B annual deductible. Plan F can be bought as a high-deductible as well as regular plan. Cost-sharing Plans K and L cover 50 or 75 percent coinsurance and have an annual out-of-pocket limit of $4,620 and $2,310, respectively.

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