The Ultimate Guide to Medicare Supplement Plans in Texas
Read on to learn more about how seniors in Texas manage their out-of-pocket Medicare expenses.
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Many seniors find Medicare’s out-of-pocket costs overwhelming. Luckily, this is where Medicare Supplement Insurance Plans come in.
In this article, we will cover the benefits of Medicare Supplement Plans in Texas, which ones are most popular, when the best time is to apply and how much you can expect to pay.
Let’s Recap: What Are Medicare Supplement Plans?
A Medicare Supplement Plan (also known as a Medigap policy) is health insurance coverage you can buy from private companies.
These plans have been designed to help seniors pay for the remaining out-of-pocket costs that Medicare Parts A and B don’t cover.
Terms You Need to Know:
Deductible: This refers to the set amount you pay for health care services before your insurance begins to pay. For example, if you have a $1,200 deductible you have to pay $1,200 before your insurance kicks in.
Coinsurance: The percentage of costs you pay after your deductible has been met.
Copayment: A set rate you must pay for doctor visits, hospital stays and prescriptions.
Out-of-pocket expenses: This term refers to costs that are not covered by Medicare and that you must pay for yourself. For example, a fee for a visit to the dentist.
There are ten standardized Supplement Plans in Texas that private insurance companies can sell. Each plan can be identified by a letter: A, B, C, D, F, G, K, L, M, and N.
The amount of coverage you receive will depend on which Medicare Supplement Insurance Plan you choose. This could include:
Part of the expense that Original Medicare doesn’t cover, known as the deductible.
20% of the amount you’re responsible for paying, this is called coinsurance.
Any other additional medical costs.
It’s important to note that if you have Medicaid or a Medicare Advantage Plan, it is illegal for an insurance company to sell you a Medicare Supplement Insurance Plan.
If you would like to take a more detailed look at Medicare Supplement Plans and what they offer, be sure to read this article.
Key Takeaways:
Medicare Supplement Insurance Plans help cover the expenses that Original Medicare Part A and B don’t cover.
There are ten different Medicare Supplement Plans you can choose from in Texas. They can be identified by a letter: A, B, C, D, F, G, K, L, M and N.
If you already have Medicaid or a Medicare Advantage Plan, an insurance company cannot sell you a Supplement Plan.
When Is the Best Time to Enroll in a Medicare Supplement Plan in Texas?
Although you can enroll for Texas Medicare Supplement Plans at any time of the year, the recommended time to do so is during the Open Enrollment Period.
This is because you are likely to get better Medicare premiums, have more options available to you and you will not need to go through medical underwriting.
What Is Medical Underwriting?
This is a process where you will have to answer questions about your medical history.
Insurance companies will then use this information to set your premium and may deny your application for Medicare coverage altogether.
This means you could be at risk of paying more for a Medicare Supplement coverage or unable to join a plan at all.
When Does the Open Enrollment Period (OEP) Begin?
In general, this window only happens once in your life when you turn 65 (unless you collect Social Security Disability Income) and lasts for six months.
The six-month window begins on the first day of the month that your Medicare Part B (Medical Insurance) is effective.
The OEP is one of many Medicare Enrollment Periods that seniors have to try and make sense of. We’ve put together this table to outline the differences between each one:
| Enrollment Period | Description |
|---|---|
| Open Enrollment Period | This six-month period begins on the first day of the month when you are 65 or older and enrolled in Medicare Part B. This date will be different for everyone and depends on the month that you sign up. |
| Fall Medicare Open Enrollment Period | During this window, you can change your Medicare Supplement Insurance Plan without losing any medical coverage. This window takes place every year from October 15th to December 7th. |
| Initial Enrollment Period (IEP) | This is your first chance to sign up for Medicare once you are eligible and begins three months before your 65th birthday. During the IEP you can sign up for Medicare Parts A and B, a Medicare Advantage Plan or a Part D Prescription Drug Plan. |
| General Enrollment Period | From January 1st to March 31st you can sign up for Medicare Parts A and B, as well as a Medicare Advantage Plan if you missed the deadline. |
| Special Enrollment Period | This period refers to specific situations where you can enroll outside the regular enrollment periods (for example, if you move states or if your healthcare coverage under an employer ends). The dates for the Special Enrollment Period differ from person to person. |
For more information, read our guide to Medicare Open Enrollment Period 2022.
What Are the Most Popular Medicare Supplement Plans?
As we mentioned before, there are ten different Medicare Supplement Insurance Plans that you can choose from. They can be identified by a letter: A, B, C, D, F, G, K, L, M and N.
The table below summarizes the basic benefits that each plan covers.
Where you see a percentage, the Medicare Supplement Plan covers that percentage of the benefit and you must pay the rest.
| Benefits | A | B | C | D | F | G | K | L | M | N |
|---|---|---|---|---|---|---|---|---|---|---|
| Medicare Part A Coinsurance and hospital costs up to an additional 365 days after Medicare Benefits are used | 100% | 100% | 100% | 100% | 100% | 100% | 100% | 100% | 100% | 100% |
| Medicare Part B Coinsurance or copayment | 100% | 100% | 100% | 100% | 100% | 100% | 50% | 75% | 100% | 100% |
| Blood (the first 3 pints) | 100% | 100% | 100% | 100% | 100% | 100% | 50% | 75% | 100% | 100% |
| Part A Hospice Care Coinsurance or copayment | 100% | 100% | 100% | 100% | 100% | 100% | 50% | 75% | 100% | 100% |
| Skilled Nursing Facility Care | 100% | 100% | 100% | 100% | 50% | 75% | 100% | 100% | ||
| Part A Deductible | 100% | 100% | 100% | 100% | 100% | 50% | 75% | 50% | 100% | |
| Part B Deductible | 100% | 100% | ||||||||
| Part B Excess Charges | 100% | 100% | ||||||||
| Foreign travel Emergency (up to plan limits) | 80% | 80% | 80% | 80% | - | - | 80% | 80% |
Some of these Medicare plans have important details you should be aware of. For example:
Plans F and G have a high-deductible option in some states. This means that if you choose one of these plans, you must pay a deductible fee of $2,370 before your insurance pays anything.
Plans K and L have out-of-pocket limits of $6,220 and $3,110. Once you have paid these amounts and the Part B deductible of $233, the plan will pay 100% of your covered services for the rest of the year.
Plans C and F will not be available to people who are newly eligible for Medicare Supplement Plans on or after 1 January 2020.
Plan N will pay 100% of the Part B coinsurance. You will have to pay up to $20 for doctor visits and $50 to go to the emergency room (as long as you are not admitted to the hospital).
Let’s Take a Look at the Most Popular Plans in Texas
Of the Medicare Supplement Plans available in Texas, research shows that Plans F, G, and N were the most popular in 2019.
Medicare Supplement Plan Enrollment Numbers (2019)
Plan F: 465,813
Plan G: 315,608
Plan N: 62,030
This is a popular choice among many seniors because it covers almost all of the benefits that Medicare Part A and B don’t pay for.
There is a standard and high-deductible version of Plan F. As of 2021, this amount was $2,370.
This means that you would have to reach or pay the amount of $2,370 before the plan begins to cover your medical expenses.
Due to the fact that Plan F offers such comprehensive coverage, the premiums are generally more expensive than the other Supplement Plans.
If you’d like to find out more about the eligibility requirements of Medicare Supplement Plan F and how much it could cost you, read this article.
(Source: Pexels)
Medicare Supplement Plan G
Plan G is another popular choice to lower Medicare’s out-of-pocket costs. Like Plan F, this plan also has a high-deductible option of $2,370.
The main difference between Plans F and G is that Plan G does not cover the Medicare Part B deductible.
Remember:
Medicare Part B covers outpatient services like specialist consultations, vaccines, screenings and walkers.
A deductible is a set amount you cover for health care before your insurance begins to pay.
Medicare Part B has an annual deductible of $233 and a minimum monthly premium of $170.10 which is based on income.
This means you would have to pay or reach the $233 annual deductible amount before Medicare covers anything.
Once this amount has been met, you will not have to cover any outpatient services.
For more information on what Medicare Plan G covers and what you can expect to pay in monthly premiums, take a look at this article.
Medicare Supplement Plan N
Plan N also covers most of the Medicare benefits, except the Part B deductible and excess charges.
Excess charges refer to circumstances when medical providers do not accept the Medicare-approved amount for the service.
This means you would have to cover those out-of-pocket expenses yourself.
Remember, because the Part B Deductible is not covered you would have to pay or reach the $233 annual fee before Medicare pays for outpatient services.
Our article on Medicare Plan N outlines everything you need to know about this Supplement Plan.
This includes what it covers, how to enroll, and more information about what you can expect to pay.
If you are still unsure or have any questions about Texas Medicare Supplement Plans, contact one of PolicyScout’s friendly Medicare consultants.
How Much Do Medicare Supplement Plans Cost in Texas?
Although the benefits of Medicare Supplement Plans are standardized, the price of the monthly premiums can vary significantly.
In general, there are three ways that an insurance company can set their premiums.
These are:
Community-rated: This premium is not based on your age. This means that the same monthly premium is charged to everyone. However, the price will vary according to inflation.
Issue-age rated: This premium will be based on the age you are when you buy the policy. Therefore, the premium is lower for people who buy it at a younger age and won’t change as you get older.
Attained-age rated: This premium is based on your current age and will go up as you get older. Although these premiums might be the least expensive at first, they will eventually become the most expensive and are also affected by inflation.
It’s important to note that your location and lifestyle habits will also be considered when a health insurance company sets your premium.
Let’s look at an example to give you an idea of how much Medicare Supplement Plans could cost you in Texas.
Meet Ruth
Ruth is a 65-year-old woman living in Austin, Texas. Her postcode is 78705 and she is a non-tobacco user. She is trying to decide between Medicare Supplement Plans B, D, and N.
(Source: Pexels)
This is roughly what she can expect to pay:
Plan B
The premiums range from $102 to $311. This does not include the $170.10 standard monthly premium for the Part B deductible.
If she chooses this plan, she will not have any copayments or coinsurance. However, she will have to meet the $233 Medicare Part B deductible.
This plan does not cover the Part B excess charges. This means that Ruth could pay up to 15% more if she visits a doctor who does not accept Medicare.
If Ruth ever needed care in a skilled nursing facility, Plan B would not cover these expenses.
A Recap of Key Terms:
Deductible: This refers to the set amount you pay for health care services before your insurance begins to pay.
Coinsurance: The percentage of costs you pay after your deductible has been met.
Copayment: A set rate you must pay for doctor visits, hospital stays and prescriptions.
Plan B Benefits:
❌ Skilled Nursing Facility
✅ Part A Deductible
❌ Part B Deductible
❌ Part B Excess Charges
❌ Foreign Travel Emergency
For Medicare Plan D, the monthly premiums range from $108 to $241. This also does not include the $170.10 standard Part B deductible.
Similar to Plan B she will not have any copayments or coinsurance, but she will have to meet the $233 Medicare Part B deductible.
She will also have to cover the Part B excess charges if she visits a doctor who does not accept Medicare.
With Plan D, she will have foreign emergency travel benefits to a lifetime maximum benefit of $50,000. However, she will first have to pay or meet a $250 deductible for these benefits to kick in.
Plan D Benefits:
✅ Skilled Nursing Facility
✅ Part A Deductible
❌ Part B Deductible
❌ Part B Excess Charges
✅ Foreign Travel Emergency
Plan N
If Ruth chooses Medicare Supplement Plan N, she can expect a monthly premium of between $70 and $400.
Like the plans above, this does not include the $170.10 standard Part B deductible.
When Ruth visits the doctor or the emergency room, she will have to cover copayments of $20 and $50.
Ruth will also have to meet the $233 Medicare Part B deductible and can expect to pay excess charges for visits to doctors who don’t accept Medicare.
Similar to Plan D, Medicare Plan N also includes foreign travel emergency benefits.
Plan N Benefits:
✅ Skilled Nursing Facility
✅ Part A Deductible
❌ Part B Deductible
❌ Part B Excess Charges
✅ Foreign Travel Emergency
The table below summarizes the costs and benefits of each of the Medicare Supplement Plans Ruth is interested in:
| Plan B | Plan D | Plan N |
|---|---|---|
| Monthly premiums range from $102 to $311. | Monthly premiums range from $108 to $241. | Monthly premiums range from $70 to $400. |
| This plan excludes the $170.10 standard monthly premium for the Part B deductible. | This plan also excludes the $170.10 standard monthly premium for the Part B deductible. | This does not include the $170.10 standard monthly Part B premium. |
| There are no copayments or coinsurance for approved Part B (outpatient) services. | Ruth will also not have any copayments or coinsurance for Part B (outpatient) services. | If Ruth visits the doctor or hospital, she will have to meet copayments of $20 and $50. |
| A $233 Medicare Part B deductible has to be met before any insurance kicks in. | She will also have to meet a $233 Medicare Part B deductible and excess charges. | The $233 Medicare part B deductible will have to be met, as well as Part B excess charges. |
| Plan B does not cover Part B excess charges. Ruth could pay 15% more if she visits a doctor who does not accept Medicare. | Plan D has foreign emergency travel benefits to a lifetime limit of $50,000. A $250 deductible will have to be met or paid for her coverage to begin. | Plan N also includes foreign travel emergency benefits. Similar to Plan D, she will have to pay a $250 deductible for these benefits to kick in. |
If you’d like to get an idea of how much you could expect to pay for Medicare Supplement Insurance, visit the official website of the federal Medicare program.
As you can see from the examples above, the premiums for Medicare Supplement Insurance are varied.
This is why you should compare the price of the Medicare Supplement Plan you want from a few different insurance companies.
This will allow you to compare the price of the plan you want and choose the one that works best for your healthcare needs and budget.
Where Can I Find Out More about Medicare and Supplement Insurance?
At PolicyScout, we know that making sense of Medicare and all the different Supplement Plans can seem impossible.
That’s why our Medicare Hub is filled with information to help make this process easier.
If you’d like to contact someone to discuss your options, you can speak to one of our friendly Medicare consultants for no charge.
You can contact us by phone at 1-888-912-2132 or email us at Help@PolicyScout.com