Medicare

What is Medicare?

Medicare is a fee-for-service, federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).  The government pays health care providers directly for services that fall under Parts A(Hospital) and B(Medical) of Medicare benefits. However, if you are looking for more coverage than Original Medicare, you can purchase a separate Medicare Supplement plan from Texas Benefits Advisors. A Medicare Supplement plan, commonly known as 'Medigap', is considered private insurance, and many Medicare recipients purchase to help cover all or most all of the gaps(deductibles, coinsurance, copays, and excess charges) in Medicare Parts A and B.

Medicare is divided into four categories....

• Part A (hospital insurance): Covers hospital care, emergency services, nursing home care, home health services and hospice.
• Part B (medical insurance): Covers medically necessary services and supplies used for diagnosing and treating medical conditions, and preventative services for illness prevention and/or early detection. Examples include doctor visits, ambulance services, mental health care, outpatient procedures and clinical research.
• Part C: Combines Parts A and B and often part D as well. Known as Medicare Advantage.
• Part D: Offers standalone prescription drug coverage.

Please visit our Learning Center for more helpful information about Medicare, and feel free to Contact Us for further assistance.

What are Medicare Supplements?

With Medicare on its own, Parts A & B each have their own deductible, and once met, Medicare generally pays 80% of covered benefits and you pay 20%. Overall, Medicare is actually pretty good coverage, but the problem you can run into is that there is no 'cap' or maximum out-of-pocket on your 20%.  With this, a lengthy hospital stay or development of a chronic medical condition could provide a significant out-of-pocket expense. Medicare Supplements were specifically designed to protect against this and minimize your financial exposure.

Leading up to the start of their Medicare coverage, most people are typically bombarded with tons of marketing material about Medicare, supplement plans, Part D prescription plans, among other things. This can make the task of getting setup with coverage quite daunting. The neat thing about Medicare Supplements is that they are completely standardized and defined by Plan letters(Plans A-N), so once you have an understanding of what the plan letters cover, it is the same coverage regardless of the insurance company you purchase it from. If you refer to the "Choosing a Medigap Policy" guide that is published by Medicare annually, it specifically states, "Cost is usually the only difference between Medigap policies with the same letter sold by different insurance companies."

Our goal at Texas Benefits Advisors is to educate and help you understand Medicare and all there is to know about Medicare Supplement plans. From there, we'll work with you to help determine the plan that makes the most sense for your situation, and then help you apply with the company that is offering the best rate in your area.

Medicare Supplement plans were standardized going back to 1992 and the current generation of plan letters(A-N) was set in 2010. The following table provides an overview of the available Plan letters, and the percentage of the described benefit that is covered. A blank box indicates that benefit is not covered.....



All insurance companies who sell Medicare Supplements in TX must offer Plan A, and then they can choose what other plan letters they want to offer. Plan F is the most comprehensive supplement plan, and because of this, it tends to be the most popular. Using Plan F as an example, regardless of the company you purchase it from, it provides identical benefits because of the standardization, and the only difference is the cost from company to company.

Note: Medicare Supplements do not provide prescription coverage. If you purchase a Medicare Supplement, you should also consider purchasing a standalone Medicare Part D prescription plan. If a Medicare recipient does not have a Part D plan, or have other creditable prescription coverage, they could be subject to a penalty by Medicare that would result in a higher premium when they eventually get a Part D plan. There are approximately 30 standalone Part D plans offered in TX with a wide range in price and coverage. Visit Medicare's Part D Plan Finder to help find the plan that's right for you.

Texas Benefits Advisors represents a number of A-rated Companies offering Medicare Supplements in Texas to help ensure you can get the Plan letter that is best for your situation, along with the best rate.  Please Contact Us for a free quote and to discuss any questions you have.

Benefits of Medicare Supplements & Working with Texas Benefits Advisors

Maintaining a Medicare Supplement in addition to your Medicare coverage provides security and a number of benefits. Working with Texas Benefits Advisors will help ensure you get the plan that's right for you now, and we'll ensure you continue to get the best rate into the future.....

• Minimize financial exposure due to unexpected medical needs
• Choose your doctor and hospitals. Supplements can be used anywhere Medicare is accepted nationwide
• No referrals to specialists
• No complicated claims paperwork
• Very little or no out-of-pocket expenses, depending on plan choice
• Annual reviews of coverage
• Knowledge of the different Medicare supplement companies and their underwriting practices
• Work with the insurance companies on your behalf to address customer service issues
• Guidance on Part D plans

Contact Texas Benefits Advisors today to see how we can help!

Applying for Medicare Supplement Coverage

The best time to apply for and purchase a Medicare Supplement plan is during your Medigap open enrollment period. This 6-month window usually begins the month you turn 65 and are enrolled in Medicare Part B. For example, if you turn 65 in February, this period lasts from February until July. If you delay the start of your Medicare Part B past age 65 for some reason, for example you're still working and maintain employer group coverage, you would still have this 6-month Medigap open enrollment period.

The importance of the open enrollment period is because it provides a guarantee-issue opportunity for you to apply for your plan of choice, and with your company of choice, without having to 'qualify' based on medical underwriting. During this opportunity, an insurance company cannot deny you coverage or charge you a higher rate due to medical history or any existing medical conditions. When completing an application during this period, you don't even have to complete a medical questionnaire.

We recommend that you start researching and applying for coverage a few months prior to the start of your Medicare. This will help ensure you have enough time to gather the information you need to make a decision, and to process your application and receive your policy and insurance card the day your coverage begins.

Note: Because Medicare Supplements are considered private insurance, you can apply for coverage at any time of the year and are not subject to Medicare's annual enrollment period.

When applying outside of your Medigap open enrollment period, an insurance company can deny coverage or approve at a higher rate after review of your application and medical history, unless you qualify based on certain guarantee-issue rights. A list of these rights can be found at the Medicare.gov website.

If you do not qualify automatically with a guarantee-issue right, the insurance company's underwriters will review a health history questionnaire we complete with you and may request additional medical records. A medical exam is not required. Different insurance companies have different underwriting guidelines, and what may be an acceptable risk to one may not be to another. Texas Benefits Advisors has developed a very good understanding of each insurance company's underwriting practices over the years, and we can provide you with a recommendation on the best course of action based on your unique needs.

Nowadays, applications take minutes to complete and can be done online or over the phone. Most companies will accept a voice- or e-signature so that you do not have to wait for hard-copy documents to arrive, sign, and mail back. We will be there with you every step of the way to update you on the status of your application. Upon approval of coverage you will receive your policy and insurance card to be used for your medical visits. From there, we will be your advocate and communicate with the insurance companies on your behalf to address any issues with your coverage. Through our annual reviews, we will always help ensure you have the best coverage at the best rate.

Texas Benefits Advisors would love the opportunity to help! Contact Us online, or call 512-829-4601.