What Are Medigap Plans?
Medigap plans are Medicare Supplement Insurance offered by Medicare-approved private insurance companies to help cover cost sharing requirements of Original Medicare Parts A and B.
While Medicare pays for a large percentage of the health care services and supplies you may need, you are still responsible for a portion of the costs in the form of deductibles, copays, and coinsurance. Medigap policies help with these costs and sometimes offer more coverage for excess charges and foreign travel health emergencies.
Medigap plans are standardized by Medicare and regulated by state laws and insurance commissioners. You pay a monthly premium for Medigap. Costs and availability of Medigap plans vary depending on several factors including your age and gender, the insurer, and your state of residence. Learn about Medigap in Texas so you can determine which plan best meets your needs.
- In 2019, there were more than 900,000 Medicare Supplement enrollees in Texas.
- Plans F and G are the most popular and comprehensive Medigap plan types in Texas. Plan F is no longer available to people who are eligible for Medicare after December 31, 2019.
- Monthly premiums for Plan G for a 65 year old female in Texas who doesn’t use tobacco range from $29 to $419.
- Texas requires Medigap insurers to offer at least Medigap Plan A to disabled Medicare beneficiaries under age 65.
Medicare Supplement Plans in Texas
|Compare ratings of some of Texas’s Medigap providers:|
|Insurance company||A.M. Best rating||NAIC complaint index||BBB rating||Consumer Affairs|
|UnitedHealthcare||A-||Below average||A-||Not rated|
What Medicare Supplement Plans Cover
Medigap policies serve as your secondary source of insurance after Medicare pays. Medigap fills in the “gaps” between what Medicare pays for covered services and what you are charged. Some plans offer extended coverage for Part B excess charges and foreign travel emergency costs.
There are ten standardized Medigap plans that are regulated by federal and state governments. Two of the ten plans (F and G) are the most comprehensive plans and also offer high-deductible versions. All plans are not available in all states.
Medigap policies may include the following benefits:
- Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up
- Part B coinsurance or copayment
- The first three pints of blood
- Part A hospice care coinsurance or copayment
- Skilled nursing facility care coinsurance
- Part A deductible
- Part B deductible (only certain plans for people eligible for Medicare before January 1, 2020)
- Part B excess charges
- Foreign travel emergency services
- Out-of-pocket limits
Do You Need a Medicare Supplement in Texas?
|Should you consider a Medicare supplement?|
|Yes, if you:
||No, if you:
What Medigap Plans Cost in Texas
Expect to pay between $29 to $604 each month for a Medigap plan A, G, or N in Texas if you enroll during your open enrollment period. Premiums will vary depending on your insurer and how your premium is rated.
Medigap policies can be rated in three ways:
- Community rated (or no age-rated): Your premium isn’t based on your age and may only increase due to inflation or other factors. Everyone, regardless of age, is charged the same premium.
- Issue-age rated (or entry age-rated): Your premium is based on your age when you buy the policy and won’t increase as you grow older. Your premium may only increase due to inflation or other factors.
- Attained-age-rated: Your premium is based on your age and can increase as you grow older and due to inflation and other factors.
Medigap vs. Medicare Advantage Plans
Medigap and Medicare Advantage Plans are very different. You are eligible for either type of plan when you are enrolled in Medicare Part A and B, but you cannot have both at the same time. Both Medigap and Medicare Advantage Plans are offered by Medicare-approved private insurance companies. You can only choose to join plans that are available in your area.
Compare your options:
|Plan type||Medigap||Medicare Advantage|
|What it is||Medigap is insurance designed to supplement Original Medicare and helps cover your out-of-pocket expenses, like deductibles, copays, and coinsurance you incur when you access your Medicare services. You pay a monthly premium for Medigap. Medigap plans are standardized across the U.S. Benefits, costs, and availability of plans vary depending on your age, gender, tobacco use, and state of residence.||Medicare Advantage Plans, on the other hand, are an alternative way to receive your Medicare benefits. These plans must offer all the services Original Medicare does, and frequently add on prescription drug coverage and other services, such as hearing, vision, and dental.|
|What it covers||Covers:
|What it works with||
|When it’s best||If you frequently access your Part A and B benefits, want your out-of-pocket expenses covered, and want to choose your providers.||If you want all of your health and drug coverage through one plan, want extra benefits, and are willing to follow your plan’s rules and network restrictions.|
Types of Medigap Plans in Texas
Every standardized type of Medigap plan is offered in Texas, but Plans F and G offer the most comprehensive coverage and are the most popular. Plans F and G also come in a high-deductible version. Here are some highlights and difference among some of the plans:
Compare Medicare Supplement Options
|Medigap Benefits||Plan A||Plan B||Plan C||Plan D||Plan F*||Plan G*||Plan K||Plan L||Plan M||Plan N|
|Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up||Yes||Yes||Yes||Yes||Yes||Yes||Yes||Yes||Yes||Yes|
|Part B coinsurance or copayment||Yes||Yes||Yes||Yes||Yes||Yes||50%||75%||Yes||Yes***|
|Blood (first 3 pints)||Yes||Yes||Yes||Yes||Yes||Yes||50%||75%||Yes||Yes|
|Part A hospice care coinsurance or copayment||Yes||Yes||Yes||Yes||Yes||Yes||50%||75%||Yes||Yes|
|Skilled nursing facility care coinsurance||No||No||Yes||Yes||Yes||Yes||50%||75%||Yes||Yes|
|Part A deductible||No||Yes||Yes||Yes||Yes||Yes||50%||75%||50%||Yes|
|Part B deductible||No||No||Yes||No||Yes||No||No||No||No||No|
|Part B excess charge||No||No||No||No||Yes||Yes||No||No||No||No|
|Foreign travel exchange (up to plan limits)||No||No||80%||80%||80%||80%||No||No||80%||80%|
|Out-of-pocket limit**||N/A||N/A||N/A||N/A||N/A||N/A||$6,620 in 2022||$3,310 in 2022||N/A||N/A|
* Plans F and G also offer a high-deductible plan in some states. With this option, you must pay for Medicare-covered costs (coinsurance, copayments, and deductibles) up to the deductible amount of$2,490 in 2022 before your policy pays anything. (Plans C and F aren’t available to people who were newly eligible for Medicare on or after January 1, 2020.)
** For Plans K and L, after you meet your out-of-pocket yearly limit and your yearly Part B deductible, the Medigap plan pays 100% of covered services for the rest of the calendar year.
*** Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don’t result in inpatient admission.
What’s the most popular Texas Medigap plan in 2022?
Plan F, because it pays the annual Part B deductible and is the most comprehensive plan available, is the most popular plan. However, because Plan F is only available to Medicare beneficiaries who were eligible before January 2020, Plan G is gaining in popularity. Plan G offers comprehensive coverage, except for the Part B deductible, and is widely available from most insurers.
When to Sign Up for Medicare Supplement Plans in Texas
In general, you will get the best price for Medicare Supplement Insurance if you purchase a plan as soon as you are eligible for Medicare and enrolled in Parts A and B.
Medigap Open Enrollment starts on the first day of the month that you turn 65 and are enrolled in both Parts A and B and lasts for six months. An insurance company is not allowed to use medical underwriting to decide whether to accept your application or change the price during this time.
To enroll in a Medigap Plan, contact the insurance company to make sure you are in your open enrollment period or have guaranteed issue rights. Complete the application and determine when you want your policy to start.
There are certain situations which may give you guaranteed issue rights to purchase a Medigap policy, regardless of your health conditions or any preexisting health conditions.
- Moving out of the coverage area while in a Medicare Advantage Plan or Medicare SELECT Plan
- Your existing Medicare Advantage Plan leaving Medicare coverage
- Your other insurance plan outside of Medicare is ending
- You are within your trial right period
- Your plan coverage ends through no fault of your own
How to Choose a Medigap Plan in Texas
Consider these factors as you compare Medicare Supplement Insurance plans available in your area:
|Monthly premium||This is in addition to your Part B monthly premium, so it affects your monthly cash flow. You pay whether or not you access your benefits. Your premium amount is determined based on the type of plan you get, your age, gender, tobacco use, and state of residence.|
|Benefits||Basic coverage for Part A copays and coinsurance and at least a portion of Part B copays and coinsurance, three pints of blood, and hospice care are offered with every type of plan. Other benefits may not be included, so check to see which benefits are most important to you.|
|Insurance provider||Look at ratings and past experience, either your own or other consumers, with the carrier you are considering. Contact a company representative to get an idea of their customer service and responsiveness.|
|Extra discounts||Some plans and insurers offer added perks or discounts once you become a member. You may have access to discounted hearing aid providers or eyeglass suppliers, for instance.|
Medicare Supplement Resources in Texas
If you’re feeling confused by the multitude of plan options available, getting in touch with trained, unbiased counselors can be a good first step. Texas is home to several organizations that can help you make an informed decision.
|Texas Legal Services Center||Website | (800) 622-2520, option 3||The Texas Legal Services Center is a nonprofit organization that provides free legal and public benefits assistance to residents aged 60 and older. Medicare beneficiaries can call the organization’s statewide Legal Hotline for Texans concerning personalized, unbiased advice and guidance about their available Medicare options, including Medicare Advantage coverage. The helpline is open Monday through Friday, from 9 a.m. to 5 p.m.|
|Texas Health and Human Services Department||Website | (800) 252-9240||The Texas Health and Human Services (HHS) Department oversees the statewide Health Information, Counseling, and Advocacy Program (HICAP). The department trains and certifies benefits counselors who can help Medicare-eligible individuals learn about their coverage options for Original Medicare, Medicare Advantage Plans, and Part D prescription drug plans as well as the applicable eligibility requirements and enrollment process. Seniors and eligible disabled individuals can visit the HHS website to access a directory of HICAP counseling partners across the state.|
|Texas Area Agencies on Aging||Website | (800) 252-9240||There are 28 Area Agencies on Aging (AAAs) offices located throughout Texas to help residents aged 60 and older access aging-related programs and resources. Free benefits counseling is one of the many services offered by AAAs, and it includes information and advice about Medicare, Medicare Advantage Plans, and prescription drug coverage. The Texas HHS Department oversees AAAs statewide, and the Department’s website offers a map and directory to help residents find the AAA serving their area.|
Learn More From Our Sources
- Medicare | Costs of Medigap policies | Last accessed January 2022
- Medicare | Find a Medigap policy that works for you | Last accessed January 2022
- Medicare | Guide to Choosing a Medigap Policy | Last accessed January 2022
- Medicare | How to compare Medigap policies | Last accessed January 2022
- Medicare | Texas Health and Human Services | Last accessed January 2022
- Medicare | What’s Medicare Supplement Insurance (Medigap)? | Last accessed January 2022
- Texas Health and Human Services | Area Agencies on Aging (AAA) | Last accessed January 2022
- Texas Health and Human Services | Where Can I Find Services? | Last accessed January 2022
- Texas Legal Services Center | HICAP | Last accessed January 2022