The Best Medicare Supplement (Medigap) Plans in Texas
- This review of Texas Medicare Supplement plans will provide you with useful information on the available options. Medigap plans offer assistance for Medicare recipients in managing costs not covered by Original Medicare.
If you have recently become eligible for Medicare, you may have many questions about Original Medicare (Part A and Part B) coverage and Medicare Supplement Insurance plans. Understanding how these plans (also called Medigap plans) work in combination with Original Medicare in the state of Texas can help you make the most positive decisions about your medical insurance needs.
Over one-third (38%) of Original Medicare beneficiaries in Texas are enrolled in a Medicare Supplement plan.1 You can find Medicare Supplement plans in Texas or wherever you live by comparing plans from several different insurance companies online.
What Are the Best Texas Medicare Supplement Plans?
There are 10 Medigap plans offered in the state of Texas, though plan availability may vary by area. Each of these plans is referred to by a letter and offers the same standardized benefits across all plans designated by the same letter. For instance, Medigap Plan A coverage is the same no matter which company offers this insurance.
All Medicare Supplement plans in Texas offer at least some coverage for Part A coinsurance costs. These Medigap plans must also pay for an additional 365 days of hospitalization costs on top of the coverage already provided by Medicare. The specific coverage available under each plan is listed in the chart below.
|Medicare Supplement Benefits||A||B||C1||D||F1||G||K||L||M||N|
|Part A coinsurance and hospital costs||✓||✓||✓||✓||✓||✓||✓||✓||✓||✓|
|Part B coinsurance or copayment||✓||✓||✓||✓||✓||✓||50%||75%||✓||✓|
|First 3 pints of blood||✓||✓||✓||✓||✓||✓||50%||75%||✓||✓|
|Part A hospice care co-insurance or co-payment||✓||✓||✓||✓||✓||✓||50%||75%||✓||✓|
|Co-insurance for skilled nursing facility||✓||✓||✓||✓||50%||75%||✓||✓|
|Medicare Part A deductible||✓||✓||✓||✓||✓||50%||75%||50%||✓|
|Medicare Part B deductible||✓||✓|
|Medicare Part B excess charges||✓||✓|
|Foreign travel emergency||80%||80%||80%||80%||80%||80%|
|1. Plans C and F are not available to new beneficiaries who became eligible for Medicare on or after January 1, 2020.
2. Plans F and G also offer a high deductible plan which has an annual deductible of $2,700 in 2023. Once the annual deductible is met, the plan pays 100% of covered services for the rest of the year. The high deductible Plan F is not available to new beneficiaries who became eligible for Medicare on or after January 1, 2020.
3. Plan K has an out-of-pocket yearly limit of $6,940 in 2023. Plan L has an out-of-pocket yearly limit of $3,470 in 2023.
4. Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to $50 for emergency room visits that don’t result in an inpatient admission.
View an image version of this table.
If you became eligible to enroll in Medicare on or after the cutoff date of January 1, 2020, you will not be able to enroll in Medigap Plans C or F. These plans were discontinued as part of the 2015 Medicare Access and CHIP Reauthorization Act and are only available to you if you were eligible for Medicare before January 1, 2020, whether or not you enrolled at that time.
Plans F, G and N are the most popular Medigap plans in Texas, especially among budget-conscious individuals and those on a fixed income. These affordable plans offer lower monthly premiums in exchange for somewhat higher deductibles. Plan N can reduce or eliminate copays for visits to the emergency room or to your regular physician, which can significantly reduce your out-of-pocket costs for these necessary medical services.
How Do I Enroll in a Texas Medigap Plan?
Your Medigap open enrollment period begins on the first day of the month in which you are 65 years old and are enrolled in Medicare Part B. This period lasts for 6 months. During this time, you can purchase any Medigap insurance plan available to you in the state of Texas without worrying about the impact of pre-existing conditions on your premiums or on your ability to obtain coverage. Insurance companies cannot refuse to sell you a Medicare Supplement Insurance policy during this period. They also cannot charge you higher rates for your insurance than those offered to healthy individuals for the same coverage.
If you choose not to enroll in Medigap coverage during your six-month Medigap open enrollment period, however, you may face serious difficulties in obtaining insurance for pre-existing conditions at an affordable rate. Insurance companies that offer Medigap plans are legally permitted to deny coverage or to charge higher rates to Medicare recipients who have serious medical problems. It is generally to your advantage to enroll in Medigap coverage during the first six months of your eligibility.
You may be able to obtain Medicare Supplement Insurance coverage on these highly favorable terms even after the six-month period has elapsed. If you qualify for guaranteed issue rights, you can often purchase Medigap insurance without being subjected to a risk assessment or underwriting process on the part of the insurer.
- You might be eligible for guaranteed issue rights if you signed up for a Medicare Advantage plan at age 65 and regretted this decision within a year of your enrollment. By switching your enrollment to Original Medicare and a Medicare Supplement Insurance policy during this first year, you can usually avoid the negative effects of pre-existing conditions on your ability to obtain affordable Medigap coverage.
- Additionally, if the company that initially provided you with Medigap insurance goes bankrupt, you will usually be allowed to choose replacement Medigap coverage without underwriting issues.
In some cases, you may have to wait for up to six months before receiving treatment for pre-existing conditions. This is generally waived for those who had existing insurance that covered these conditions for the last six months before enrolling in Medicare and Medigap coverage.
AHIP. (Mar. 2022). The State of Medicare Supplement Coverage: Trends in Enrollment and Demographics. https://ahiporg-production.s3.amazonaws.com/documents/202202-AHIP_MedicareSuppCvg-02_v03.pdf.