Texas: The Lone Star State

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Sun City, Texas Medicare Plans

We have great insurance companies offering Medicare Supplement plans for Sun City residents. Many offer the most popular plans like Plan F and Plan G.

Let us assist with the basics. Texas Medicare plans include 10 standardized options, lettered A – N. Each insurance company must offer at least Plan A, but companies can offer any of the other plans as well.

The Benefit Link is located in the Dallas / Fort Worth area, so we can provide you great information on Medicare supplement plans for residents in Sun City, Texas.

As you may already know, Medicare only covers 80% of your outpatient costs. It also leaves you paying deductibles. The Part A hospital deductible alone was $1316 in 2017.

All Texas Medicare supplement plans cover the other 20% of your outpatient expenses. Some Medicare supplement plans also cover the hospital deductible.

People who choose Medicare Supplement Plan F have no out of pocket spending beyond their monthly premium. For this reason, we call it first dollar coverage. While Plan F has been popular for a long time, Plan F is priced competitively.

Many Plan G policies may have lower rate increases from year to year than Plan F policies. It’s worth checking out so that you can consider which Texas Medigap plan best fits your needs and budget.

The best time to buy a Medicare supplement is during the 6 months after you enroll in Part B. This open enrollment window allows you to purchase any Texas Medigap policy without health underwriting. After this window expires, you may have to answer health questions when you apply

Our agency works with some of the best Texas Medicare Plan F and Plan G insurance companies, such as AARP, Aetna, Bankers Fidelity, Blue Cross Blue Shield, Cigna, Humana, Mutual of Omaha, Transamerica, and United Healthcare.

You can find a complete list of our Medicare insurance providers here.

Texas Medicare Supplement Plan Features

Medicare supplement plans in Texas have some common features. First, you can choose any doctor, no matter who your Medicare supplement carrier is. There are over 880,000 healthcare providers accepting Medicare in America. You can see any of these doctors at any time, regardless of which insurance company you purchased your Medigap policy from.

Another feature is that there are no referrals required. These plans have no networks, so you are not required to see a primary care physician first to get a referral to see a specialist. You can book your own appointments with doctors hassle-free.

All Medicare supplement plans in Texas are also guaranteed renewable. Your coverage can never be cancelled based on a health condition that you develop. As long as you are paying your monthly premiums on time, your Medicare supplement will remain in place and be there for you when you need it.

Leaving Employer Coverage for Texas Medigap Plans

Some people may delay enrollment into a Medicare supplement because they have other creditable coverage, such as group health benefits. These people may then later be eligible to buy a supplement outside of their open enrollment window under guaranteed issue rules.

In Texas, to qualify for guaranteed issue, you must provide proof that you involuntarily lost your other health insurance coverage.

If you can provide this proof, the law allows you the right to purchase certain Medicare supplement plans within 63 days of the end of your prior coverage. The insurance company cannot place any restrictions on pre-existing conditions if you apply during this window.

So if you continue to actively work past age 65, and you remain enrolled in your employer’s group health insurance plan. Later when you retire and leave that plan, the loss of that coverage will create a special enrollment window of 63 days. During this time, you can purchase a Medigap policy without fear of being turned down for health reasons.

You may find that leaving the employer coverage for Medicare is actually cheaper for you. For this reason, you should carefully review your coverage options when you first enroll in Medicare Part B.

Compare costs for your employer insurance against the cost of Medicare and a Medigap plan. Consider all factors – cost, health status, etc – before making your choice.

Medicare Savings Programs in Texas

For certain low-income people, Medicare premiums can be a hardship. If you find it difficult to pay for Medicare Parts B and D, you can consider applying for Medicare Savings Programs in Texas. This program helps to pay for some or all of the monthly premiums, copayments and deductibles that you might experience on Medicare. There are different levels of qualification.

It’s easy to apply for a Medicare Savings Program by contacting the state Medicaid office or visit www.yourtexasbenefits.com. This helpful website will help you learn about the benefit programs offered and to find out if you should apply for benefits. You can also find a benefits office near you where you can speak with a representative. People already enrolled in a savings program can also use this site to renew benefits.

Get Help with Texas Medicare Supplements

With so many options to choose from, it can be overwhelming to try to find the right coverage. We can make this easier for you in several ways. First, our agents will explain Original Medicare to you so that your understand your base benefits. Then we can help you narrow down to which main type of coverage feels best for you.

Finally, we provide a comparison report for Medicare Supplements Texas so that you can see each company’s rates, financial ratings and even their history of Medigap rate increases. Decisions are easy when you have the right data.

Still have questions, or need more information on how to pick the plan that is right for you?

The Benefit Link is here to help! Give us a call and speak to a licensed insurance agent:

(972) BEN-EFIT

Use your retirement income wisely, find out if you qualify for Medicare discounts!

Medicare Supplement Plan A

Medicare Supplement Plan A is also referred to as Medigap Plan A. This plan is sometimes overlooked because it has fewer benefits than other Medigap insurance plans.

What does Medicare Plan A cover though? It still covers the most important benefit, which is the 20% of outpatient medical care that Medicare doesn’t cover.

Make no mistake. Medicare Plan A pays this, so it is still a very good plan.

Medicare Part A coinsurance and coverage for hospital benefits	✔
Medicare Part B coinsurance or copayment	✔
Blood (first three pints)	✔
Hospice Care coinsurance or copayment	✔
Skilled Nursing Facility Care coinsurance	❌
Medicare Part A deductible	❌
Medicare Part B deductible	❌
Medicare Part B excess charges	❌
Foreign Travel Emergency (up to plan limits)	❌

Medicare Supplement Plan B

Medicare Supplement Plan B, also called Medigap Plan B, offers the same benefits as Plan A. In addition, it will also pay your Part A hospital deductible for you. This is a significant benefit as the deductible in 2017 is $1,316, and tends to go up slightly each year. Having Medigap Plan B means that you will never have to worry about that deductible going up.

Your hospital deductible is a per-incident deductible, not an annual one, so this is an important benefit. Medicare Plan B will pay the deductible even if you incur it more than once in the same year.

Medicare Part A coinsurance and coverage for hospital benefits	✔
Medicare Part B coinsurance or copayment	✔
Blood (first three pints)	✔
Hospice Care coinsurance or copayment	✔
Skilled Nursing Facility Care coinsurance	❌
Medicare Part A deductible	✔
Medicare Part B deductible	❌
Medicare Part B excess charges	❌
Foreign Travel Emergency (up to plan limits)	❌

Medicare Supplement Plan C

Medicare Supplement Plan C is a policy which covers nearly all of the Medicare gaps that you would usually be required to pay. The only exception is the Part B excess charges.

Excess charges are surcharges that your doctor can charge above and beyond what Medicare will reimburse. They are limited to 15% beyond what Medicare pays. Many doctors do not charge excess charges, but occasionally they do. If this concerns you, the Medigap Plan F or G might be a better choice for you than Medicare Plan C. Those two plans cover excess charges, so you won’t have to worry about asking.

Medicare Part A coinsurance and coverage for hospital benefits	✔
Medicare Part B coinsurance or copayment	✔
Blood (first three pints)	✔
Hospice Care coinsurance or copayment	✔
Skilled Nursing Facility Care coinsurance	✔
Medicare Part A deductible	✔
Medicare Part B deductible	✔
Medicare Part B excess charges	❌
Foreign Travel Emergency (up to plan limits)	✔

Medicare Supplement Plan D

Medicare Supplement Plan D is one of the ten Medigap options you can purchase to supplement your Original Medicare benefits. (It is not to be confused with PART D, which is for prescription drugs. You can read about Part D drug policies here.)

A Medigap Plan D policy covers most of the gaps in Medicare for you, with the exception of the Part B deductible and also any excess charges. An excess charge is an additional amount you will pay if a provider charges more than the Medicare allowed amount. You will pay out of pocket for these two minor items if you purchase a Medicare Plan D. However, the policy does cover all of the most important things, like the 20% of outpatient services that you would otherwise owe.

It’s important to compare pricing between Medigap Plan D and Plans F or G, which have richer benefits. This will help you determine if the savings is worth the additional financial exposure to you. Some people would rather pay more for their supplement if they know that all the gaps will be covered. Others don’t mind a little cost-sharing to get lower premiums.

Medicare Part A coinsurance and coverage for hospital benefits	✔
Medicare Part B coinsurance or copayment	✔
Blood (first three pints)	✔
Hospice Care coinsurance or copayment	✔
Skilled Nursing Facility Care coinsurance	✔
Medicare Part A deductible	✔
Medicare Part B deductible	❌
Medicare Part B excess charges	❌
Foreign Travel Emergency (up to plan limits)	✔

Medicare Supplement Plan F

Medicare Supplement Plan F has also been the #1 seller with The Benefit Link for many years. According to a report from America’s Health Insurance professionals, about 57% of all Medigap policies in force were a premium Medicare Plan F policy. (In recent years, Plan G has been the second most popular Medicare supplement plan, and you can read more on that below.)

A Medigap plan, or Medicare Supplement, pays after Medicare to help cover your deductibles, copays, and coinsurance that you would otherwise be responsible for. Medigap plans do not replace your Medicare Part B. You must be enrolled in both Part A and Part B first, then you are eligible to enroll in Medicare supplement Plan F.

When you add a Medicare Supplement Plan F or G to your Original Medicare benefits, your coverage will be quite comprehensive. By definition, Medigap Plan F is the Medicare supplement with the most benefits.

Medicare – Plan F

Medicare Part A coinsurance and coverage for hospital benefits	✔
Medicare Part B coinsurance or copayment	✔
Blood (first three pints)	✔
Hospice Care coinsurance or copayment	✔
Skilled Nursing Facility Care coinsurance	✔
Medicare Part A deductible	✔
Medicare Part B deductible	✔
Medicare Part B excess charges	✔
Foreign Travel Emergency (up to plan limits)	✔

Medicare Supplement Plan G

Did you know that Medicare Supplement Plan G is the second most popular Medicare supplement (next to Plan F) with our Baby Boomer clients? Today we’re going to tell you why. Everyone has heard of Plan F, but what is Medicare Supplement Plan G? What does Plan G cover?

Medicare Plan G coverage is very similar to Plan F. It offers great value for beneficiaries who are willing to pay a small annual deductible. After that, Plan G provides full coverage for all of the gaps in Medicare. It pays for your hospital deductible, copays and coinsurance. It also covers the 20% that Part B does’t cover.

Medicare Part A coinsurance and coverage for hospital benefits	✔
Medicare Part B coinsurance or copayment	✔
Blood (first three pints)	✔
Hospice Care coinsurance or copayment	✔
Skilled Nursing Facility Care coinsurance	✔
Medicare Part A deductible	✔
Medicare Part B deductible	❌
Medicare Part B excess charges	✔
Foreign Travel Emergency (up to plan limits)	✔

Medicare Supplement Plan K

Medicare Supplement Plan K offers you the same basic benefits as other supplements, but with lower premiums. For example, this plan will still cover preventive care services and give you an extra year in the hospital. However, you split the cost-sharing with the insurance carrier on certain items like the Part A deductible. You also agree to pay the Part B deductible and any excess charges.

Medicare Plan K also includes a cap on your spending called an out-of-pocket maximum. For instance, let’s say you have a year with a lot of medical treatments. If your out-of-pocket spending reaches the maximum limit, then your Medigap K policy will kick in to pay all of the rest for that year.

Medicare Part A coinsurance and coverage for hospital benefits	✔
Medicare Part B coinsurance or copayment	50%
Blood (first three pints)	50%
Hospice Care coinsurance or copayment	50%
Skilled Nursing Facility Care coinsurance	50%
Medicare Part A deductible	50%
Medicare Part B deductible	❌
Medicare Part B excess charges	❌
Foreign Travel Emergency (up to plan limits)	❌

Medicare Supplement Plan L

Medicare Supplement Plan L policy also includes a cap on your expenses. This is referred to as your out-of-pocket limit or maximum. Medicare sets this limit annually, and in 2018, the limit for Plan L is $2,620. This means that if in any one calendar year your spending reaches $2,480 in Medicare-approved covered expenses, then the Medigap insurance carrier pays the rest. The cap makes it much easier to agree to share in 25% of the costs on the items listed because you know that even if a year of bad health occurs, you won’t have more exposure than the maximum cap figure.

Medicare Part A coinsurance and coverage for hospital benefits	✔
Medicare Part B coinsurance or copayment	75%
Blood (first three pints)	75%
Hospice Care coinsurance or copayment	75%
Skilled Nursing Facility Care coinsurance	75%
Medicare Part A deductible	75%
Medicare Part B deductible	❌
Medicare Part B excess charges	❌
Foreign Travel Emergency (up to plan limits)	❌

Medicare Supplement Plan M

Medicare Supplement Plan M is one of the new supplements created by the Medicare Modernization Act. It first hit the Medicare insurance market in the summer of 2010. (Sometimes we hear people call it Medicare Part M or Medigap Part M, but the correct term is Plan M.)

Medicare Plan M provides the same basic benefits as other supplements. However, it has a slightly reduced monthly premium in exchange for your willingness to pay half of your hospital deductible and all of your annual outpatient deductible. By sharing in these deductibles as well as excess charges, you get the benefit of reduced premiums.

Plan M could be a good fit for someone who doesn’t expect to visit the hospital often and feels he can afford the occasional cost-sharing. However, it’s important to have a licensed agent who specializes in Medicare supplements to help you. He or she will evaluate the differences in premiums and make sure that the savings are worth the risk of some expenses.

Medicare Part A coinsurance and coverage for hospital benefits	✔
Medicare Part B coinsurance or copayment	✔
Blood (first three pints)	✔
Hospice Care coinsurance or copayment	✔
Skilled Nursing Facility Care coinsurance	✔
Medicare Part A deductible	50%
Medicare Part B deductible	❌
Medicare Part B excess charges	❌
Foreign Travel Emergency (up to plan limits)	✔

Medicare Supplement Plan N

Medicare Supplement Plan N has been popular since it was first introduced in 2010. Also called Medigap Plan N, this option was created for consumers who like the idea of paying a lower premium in exchange for taking on a small annual deductible and some copays.

All Medicare supplement Plan N policies are the same, no matter which insurance company you choose. You can find Plan N available in many states from various well-know insurance companies.

In 2015, AHIP reported that Plan N enrollment grew by 33% between 2013 – 2014.

(You will find that sometimes people refer to Plan N as Part N, but the proper term is Plan N. Medicare itself has Parts, but when you are referring to supplemental insurance, use the word Plans.)

Medicare Part A coinsurance and coverage for hospital benefits	$20 copay for office visits; $50 copay for ER
Medicare Part B coinsurance or copayment	✔
Blood (first three pints)	✔
Hospice Care coinsurance or copayment	✔
Skilled Nursing Facility Care coinsurance	✔
Medicare Part A deductible	✔
Medicare Part B deductible	❌
Medicare Part B excess charges	❌
Foreign Travel Emergency (up to plan limits)	✔