Medicare in Texas

If you’re one of the thousands of Texans close to celebrating their 65th birthday, it’s never been more timely for you to understand the ins-and-outs of Medicare.  

Yes, changes to your health care coverage can be intimidating, but Medicare isn’t as complex as it might seem. Remember, Medicare is here to save you money in health care costs! By delaying your enrollment, you leave yourself susceptible to avoidable charges.

Read on as our experts explore Medicare Supplement Insurance and Medicare Advantage plans in Texas. 

Overview of Medicare in Texas

Texas is the second-most populous state in the U.S, with around 29 million residents. As such, many Texans are eligible for Medicare coverage. 

2020 Texas Medicare statistics:

• 4.6 million people in Texas are enrolled in Medicare.
• Over 1.7 million beneficiaries are enrolled in Medicare Advantage.
• Over 1.6 million beneficiaries are enrolled in Medicare prescription drug plans.

Texas Medicare Savings Program

Before we jump into the Medicare coverage options available to Texans, let’s look at some of the financial assistance programs available to help you afford Medicare coverage. 

With a poverty rate higher than the national average, a significant number of Medicare beneficiaries in Texas unknowingly qualify for Medicare Savings Programs. The four Medicare Savings Programs offer varying levels of financial assistance:

• Qualified Medicare Beneficiary Program provides financial assistance for Medicare Part A and Part B premiums. It can also cover the cost of deductibles and copayments. To be eligible, an individual must not earn more than $1,084 a month, while a married couple cannot earn more than $1,457 a month.

• Specified Low-Income Medicare Beneficiary Program helps to pay for the premium for Medicare Part B. Applying individuals must have an annual income below $1,296 per month and couples can qualify if their combined income is not above $1,744 per month.

• The Qualified Individuals Program also assists in paying for Part B premiums. An individual’s monthly income cannot exceed $1,456 while the combined monthly income of a married couple must be under $1,960 a month.

• The Qualified Disabled and Working Individuals Program helps pay for Part A premiums only. If eligible to claim, your monthly income must also be within $4,249 per month or less than $5,499 if you’re a married couple. 

Medicare Supplement Insurance in Texas

Original Medicare comes with out-of-pocket costs the plan holder is responsible for, including deductibles, copayments, and coinsurance. Medicare Supplement Insurance plans (also known as Medigap plans) fill in these gaps by covering a portion of the expenses.

Some Medicare Supplement plans in Texas also offer additional benefits, such as emergency medical care outside the U.S.

Medicare Supplement plans in Texas only work with Original Medicare and are not compatible with Medicare Advantage. Supplement plans also cannot provide coverage for prescription drugs, but beneficiaries can enroll in a stand-alone Medicare Part D plan instead.

Options for Texas Medigap Plans

Providers in Texas offer ten different Medicare Supplement plans: Plan A, Plan B, Plan C, Plan D, Plan F, Plan G, Plan K, Plan L, Plan M, and Plan N. 

All of the plan categories are standardized under Medigap, so the same plan will have the same benefits regardless of the insurer. However, the cost and out-of-pocket expenses will vary from company to company.

When comparing Medicare supplement insurance plans in Texas, it’s important to remember that the plans with the lowest premiums often have higher out-of-pocket expenses. 

Texas Medicare Supplement Plan Features

With your Medicare Supplement plan, you can visit any of the 93% of healthcare providers who accept Medicare. Your enrollment allows you to see any of these doctors, regardless of which insurance company you have a policy with.

No referrals required are required for you to see a specialist, either – you can book your own appointments. Sometimes specialists will ask for a referral, but you will need to explain that your Medigap plan doesn’t require a referral. 

Finally, once enrolled in a Medicare Supplement plan in Texas, it cannot be canceled by the insurer. So long as you keep paying the monthly premium, your plan will automatically renew, and you’ll be able to reap the benefits year on year. 

Leaving Employer Coverage for Texas Medigap Plans

Some Texas residents delay Medigap plan enrollment because they are still employed and are covered through a group health plan. To access your 6-month open enrollment period for Medigap plans once you retire, you need to delay enrolling in Medicare Part B until you retire. 

Alternatively, if you enroll in Part A and Part B while working, you will be eligible to buy Medigap plans once you retire under guaranteed issue rules. The law gives you the right to purchase certain Medigap plans within 63 days of the end of your prior coverage. 

If you fail to enroll in a Medigap plan during this period, you may pay a higher premium and possibly be denied coverage for your pre-existing medical conditions. 

Medicare Advantage Plans in Texas

Medicare Advantage combines the benefits of Original Medicare (Part A and Part B) and specific supplemental plans in a single plan. Medicare Advantage plans have at least the same coverage as Part A and Part B, plus Part D and other healthcare services not found in Original Medicare.

These plans can be purchased from Medicare-approved private carriers in Texas. Each plan can come with different extra benefits, and they will have different costs as well.

Part D Coverage with Texas Medicare Advantage

Some Medicare Advantage plans in Texas provide prescription drug coverage alongside Original Medicare benefits. Medicare Advantage plans including this coverage are known as Medicare Advantage Prescription Drug plans. 

Medicare Advantage holders should get prescription drug coverage through a Medicare Advantage plan instead of a stand-alone Medicare Prescription Drug Plan (Part D). If you join a Part D plan while enrolled in a Medicare Advantage plan, you’ll be disenrolled and returned to Original Medicare. 

Texas Medicare FAQ

How Much is Medicare Supplement Plan G in Texas?

Medicare Supplement Plan G provides the most comprehensive coverage and is the plan of choice for many Texans. The premiums vary by person and are based on things like age and location. However, compared to other states, Medicare Supplement Plan G is moderately priced in Texas. 

When is the Best Time to Apply for a Medicare Supplement Plan in Texas?

The best time to enroll in a Medicare Supplement plan in Texas is during your open enrollment period. This six-month window begins on the first day that your Part B coverage is effective. Enrollment in this period means you cannot be denied coverage or charged higher premiums due to preexisting health conditions.

What Medigap Plans are Available in Texas?

All 10 Medicare Supplement Insurance plans are available in Texas, but the availability of which will depend on the carriers in your area.

If you have any questions about Texas Medicare in 2020, and your eligibility for financial assistance, speak to one of our licensed agents today. Our agents will discuss your Medicare options and help find a plan that works for you. Call us today at 1-844-236-0228.

Interested in a quote for Texas Medicare Insurance? Call 1-844-236-0228 to speak with a licensed agent.