There are over 50 different Medicare supplemental insurance companies offering Medicare supplemental insurance in Texas.
Keep in mind, the benefits of all Medigap Plans are standardized by the U.S. Government. That means that all Texas Medigap plans of the same letter have the exact same benefits. However, the monthly premiums from one company to another can vary by over 100%.
For example, if you have a Medigap Plan G in Texas, your benefits are exactly the same as any other Medigap Plan G from any insurance carrier. But your price can be more or less than others with the same Medigap plan.
There are ten standardized Medigap plans in Texas. This table details the benefits of each Medigap plan in Texas and throughout the United States.
Under 65 Texas Medicare Supplement Plans
There is no federal mandate requiring insurance companies offer Medicare supplement plans to Medicare beneficiaries under the age of 65. As such, if Medicare supplement insurance is available for those under 65 it will be directed through state laws.
Medicare requires that a person be on Social Security Disability Income for a full 24-months prior to being automatically enrolled in Medicare. Some exceptions to this rule include those with End stage Renal Disease (ESRD) or ALS.
Some states do not offer Medicare supplement plans to anyone under the age of 65. In these states, the Medicare beneficiary’s only two choices are to just keep Original Medicare without a supplement and add a Part D prescription drug plan, or apply for an Advantage plan.
With a Medicare Advantage plan, Medicare beneficiaries must re-shop their plan each year during the annual open enrollment. We suggest choosing an Advantage plan that includes prescription drug coverage.
Texas Under 65 Medicare Supplement Law
Texas state law dictates that any insurance company that offers Medicare supplement plans in Texas to people 65 and over, must offer Medicare supplement Plan A to Medicare beneficiaries under the age of 65. They do not have to offer any other Medicare supplement plan. Many insurers only offer Medigap Plan A to under 65 Medicare beneficiaries in Texas, and no other plan. (Medicare Supplement Plan A is not the same as Medicare Part A)
If you stay with Original Medicare, we encourage all our clients to use https://partdshopper.com/ to shop for their Part D plan.
A Second Initial Enrollment Period (IEP)
Everyone who qualifies for Medicare under the age of 65 will have a second Initial Enrollment Period during the seven-month window around their 65th birthday, as if they were new to Medicare. During that second IEP, they can apply for any Medicare supplement available in their area with no health questions asked.
With all states that offer Medicare supplement plans for those under 65, the applicant must apply for the supplement within 180-days (six months) of the start of their Medicare Part B.
Under Age 65 Medicare Supplement Plan Prices
While the state mandates the insurance company offer such supplement plans, nothing in the law regulates price. Insurance companies in Texas may offer under age 65 supplements at a monthly premium substantially higher than the monthly premium offered to those age 65 and older.
For example, as of the writing of this article in 2023, under 65 Medigap Plan A monthly premiums in Texas are four times (400%) the monthly premium offered to a 65 year old.
* Medicare supplement plans C and F are not available to beneficiaries who first became eligible for Medicare on or after January 01, 2020.
** Medicare supplement plans D and G are only available to beneficiaries who were first eligible for Medicare on or after January 01, 2020.
Tobacco User Rates for Medicare in Texas
Medicare supplement insurance companies can charge a higher rate to tobacco users in Texas during a Medicare beneficiary Initial Enrollment Period or Guarantee Issue situations.
Tobacco use typically includes vaping.
People who use tobacco products or vape in Texas may have monthly premiums between 20% and 25% more for the monthly premium paid by a non-smoker.
How Are Medicare Supplement Plans Priced?
Medicare supplement plans can be priced using one of three methods; Attained Age, Issue Age or Community Rated.
The Medicare literature often leads people to believe that a person shopping for a Medicare supplement plan will be able to choose between one of these three Medigap plan payment methods. That is not typically the case. More on that below.
In addition, it is a common misconception that one Medicare supplement pricing method may offer a lower lifetime cost than another Medicare supplement pricing method. That is not true at all.
There is no pricing method that will turn a for-profit private insurance company into a philanthropic organization.
Each pricing method offers the Medicare supplemental insurance company the ability to increase your premiums by simply applying to the state insurance commissioner’s office for a price increase. No insurance company will price a policy in such a way as to intentionally reduce profitability, regardless of state law.
Medigap Plans in Texas are Priced “Attained Age”.
Some states have laws that require all Medicare supplement plans to be priced as
Issue Age, Community Rated or either of those two methods. States without a law mandating how Medigap coverage is priced are called “Attained Age states” because that is how most Medigap policies will be priced when not mandated to use one of the other two methodologies.
Keep in mind that according to the CDC, approximately half of those that live to age 65 will live past age 80. Insurance companies are aware of the statistics and know that using a pricing method where the premium is higher early to save money in later years will mean higher lifetime prices for most consumers who will never experience the later years.
The best Medicare supplement plans in Texas are priced as Attained Age.
As I mention in a number of videos, the most important factor that impacts your lifetime medigap plan cost is not the pricing method (attained age vs community rated) or which Medicare supplement plan you decide is best for you. The most important decision is your choice of which of the private insurance companies you choose to manage your Medicare benefits.
What is Attained Age Pricing?
Texas attained age Medigap insurance policies are some of the lowest priced Medicare supplement plans in the country.
An Attained Age Policy is the easiest pricing method to understand. Each year, on your policy anniversary, the price of your Attained Age policy will automatically increase by a small amount, usually between 2% and 3%. Your new price reflects your new attained age. With this method the insurer can better price a policy for its specific demographic risk and inflation.
Your Medicare supplement coverage does not change.
Attained Age policies in Texas typically offer coverage at the lowest lifetime cost than Community Rated or Issue Age policies in that state.
If state law does not mandate a pricing structure of Issue Age or Community Rated, then the state is an Attained Age state.
Attained Age Medicare supplement plans in Texas will typically start at a much lower price than any other pricing method. With the right company, the Attained Age price increases should be very manageable over your lifetime. For example, at a 3% annual Attained Age price increase, the policy premium would double over 24 years.
The private insurance company can also apply to the state for a price increase as long as the price change fits within federal guidelines.
When a price increase is approved, most of the insurance companies we work with will not adjust your price until your policy anniversary and only after providing you a 45-day notice.
Warning:
Beware of Medigap policies priced as Community Rated or Issue Age in an Attained Age state. In these cases, the pricing structure is most commonly a sales technique to get the consumer to believe they are getting a policy with fewer price increases. That is not the case.
In fact, one popular insurance company I am aware of will call their policy “Community Rated” yet they have mandatory 3% annual price increases in addition to price increases due to inflation, often resulting in two price increases per year.
MedigapSeminars.org
Texas Medigap insurance companies are not required to offer all the available Medicare supplement plans in Texas. A typical Medicare provider will offer only the most popular Medigap plans in Texas.
That is where Medigap Seminars Insurance Agency comes in. We help you choose the company with the best probability of maintaining a stable price over your lifetime. You can get a free price quote and personal recommendation by using our Medicare Supplement Quote Request form.
If you want the best supplement plans in Texas, you will need to research all available plans. Please use our Medicare supplement quote request form. We do research the available Medicare supplement plans in Texas and recommend the the Medicare supplement plan that is right for you.
High Deductible Medigap Plans in Texas
The High Deductible Medigap Plan G and High Deductible Medigap Plan F are not typically a good value in Texas. When it comes to value, high deductible plans are not the best Medicare supplement plans in Texas.
Because Texas is an Attained Age state, there are two features of the high deductible plan that compound against the Medicare beneficiary each year.
The first feature is the deductible. The high deductible plan is linked to the consumer CPI-U. As the CPI-U increases each year, so does the Medicare supplement plan deductible. That means every year you must to pay more in medical bills before your Medicare supplement plan insurance pays anything.
The second feature is the fact that in an Attained age state, your Medicare supplement plan premium increases each year. Considering the additional increase in the deductible, this means that each year you will pay more for less coverage with a high deductible plan.
Because the deductible increases each year, your Medicare benefits decrease each year.
Another weakness of the high deductible plan in Texas is the deductible for inpatient Part A services. Medicare Part A has a per event or benefit period deductible of $1,600. With the high deductible Plan G or F you will pay that amount or more when an inpatient or outpatient in a hospital.
This means that one trip to the hospital will wipe out many years of premium savings you thought you had with the high deductible plan. Most people on Medicare find Plan N a better value.
Don’t just think of the value of the high deductible plan in terms of of the 20% Medicare Part B copayments or Part B deductible. The Part B deductible is almost insignificant. It is the Part A deductible and coinsurance that should concern you.
Medicare Supplement Plan G in Texas
Medicare Supplement Plan G in Texas is the most popular Medicare supplement insurance plan in Texas. Plan G offers the most comprehensive coverage and lowest out of pocket costs for medical bills of any Medigap plans in Texas for those who are new to Medicare.
With Medicare supplement Plan G your maximum annual out of pocket is limited to the amount of the Medicare Part B deductible, less than $250 a year.
Inpatient hospital costs are covered at 100%. You can be an inpatient in a hospital for a year and not pay a diem. Plus, you can still see any medical provider that accepts Medicare.
Because Medigap Plan G has the most coverage, Plan G premiums are typically higher than Plan N.
Still, this is a very popular plan for RV’rs, snowbirds and others who simply want the peace of mind of knowing their Medicare bills are covered.
Medigap Plan N in Texas
Like Goldilocks and the three Bears, Medigap Plan N is often the “just right” combination of Medicare coverage and price when comparing all the Medigap plans in Texas. Plan N is the plan many Texas enrollees consider the best value.
Plan N is among the Medigap plans considered to be full-coverage. This means that between what Medicare pays and your Plan N, your medical costs for inpatient care should be at zero, just like Plan G.
Plan N is the second most popular plan in Texas for Medicare supplemental insurance. It’s has almost the comprehensive coverage of Plan G, with out of pocket expenses for medical bills limited to just a few hundred dollars.
Plan N in Texas, with the right insurance provider, has among the most stable prices in the U.S. Plan N also provides coverage for foreign travel emergency services (as does Plan G and the Plan G high deductible).
Which Medicare Supplement is Right for Me?
The best place to start when researching health insurance and Medicare plans in Texas is getting price quotes. Use this quote request form and we will email you prices for the Medicare plans available and recommended in your area.
I would also encourage you to watch the video on this page as it discusses in detail how to identify the best Medicare supplement plans based on your needs and budget.
Texas Medicare Advantage Plans
Medicare Part C (aka Advantage plans) are a pseudo-privatized version of Original Medicare (Medicare Part A and Part B). They are managed by a private for profit insurance provider and meant to provide you with Medicare benefits roughly equal to Original Medicare. Advantage plans add an annual maximum out-of-pocket limit on Medicare related services approved by the insurance company. An Advantage plan replaces your Traditional Medicare Part A and Part B.
Most Advantage plans include prescription drug coverage, but prescription drug coverage is not included in the limits of out of pocket costs. Maximum out of pocket costs illustrated in the Summary of Benefits do not include costs for prescription medications.
In 2023 it was reported by Medicare that there are 3,998 different Medicare Advantage Plans in the United States. All have different benefits and costs.
Are All Advantage Plans In Texas an HMO or PPO?
While there are many different types of Advantage plans, nearly 98% of Advantage plans are structured as either a Preferred Provider Organization (PPO) or Health Maintenance Organization (HMO).
How Can I Learn More About Advantage Plans?
We encourage anyone considering a Medicare Part C Plan to watch two of our videos as part of their research. The first is Medicare Explained; the Secrets of Who & Why which explores the demographics of those who choose between Advantage and Medicare supplement plans.
The second is Medicare Advantage Plans Explained which details the pros and cons of Advantage Plans.
When To Buy A Medicare Advantage Plan
Medicare Advantage Plans can be purchased during your Initial Enrollment, the Annual Election Period, the Annual Medicare Advantage Plan Open Enrollment or in Special Election Periods. There is never any medical underwriting or pre-existing condition exclusions.
Your Initial Enrollment Period is the seven month window around the month you turn 65. It includes the three months before your birthday month, your birthday month and the three months after your birthday.
There is one exception. If your birthday falls on the first day of a month the entire Initial Enrollment Period moves forward by one month. You can use our enrollment calculator to find your Initial Enrollment Period.
The Annual Election Period is every year between October 15 and December 07. Changes during this period take effect as of the following January 01. You can use this period to purchase or change your Advantage Plan. Or, you can go back to Original Medicare.
The Annual Medicare Advantage Open Enrollment is from January 01 through March 31. You can use this period to make one change in your Advantage Plan or go back to Original Medicare and get a Part D plan if you do.
Improve On Your Medicare Advantage Coverage
According to the Medicare Advocacy group, if the consumer wishes to match their Medicare Part C coverage to that of a Medicare supplement, you must add ancillary insurance products to your line-up.
For example, with a Medicare Advantage plan you will pay 20% of your cancer treatment up to your maximum out of pocket. You can add Cancer Protection Insurance to your portfolio and receive a tax-free lump-sum check when first diagnosed with cancer.
Or, did you know that on average a Medicare Advantage policyholder pays more for inpatient care than a person with Medicare Part A & B? You can add a hospital indemnity insurance policy to provide you the cash you may need if you have an inpatient hospital stay. Ask us for details on what is available in your area.
How to Shop for a Medicare Advantage Plan
At Medigap Seminars Insurance agency we have some of the most advanced
Medicare Advantage tools in the industry designed to help us match the Texas Advantage plan to your needs and situation.
1 – Are Your Doctors In Network?
In order to shop for an Advantage Plan you will need to provide us with a list of the doctors you see regularly and note which one is your primary. That way we make certain your doctors are in-network. In addition, we will need a list of your prescriptions so we can make certain you know what your prescription cost will be for the coming year.
When we help people shop for Advantage plans we look at the health benefits, costs and network first. That is the most important part to get right.
2 – Are Your Prescriptions Covered?
Next we look at your current prescription medications to make certain your prescriptions are covered and you do not overpay for medications.
3 – Do You Need Extra Benefits?
Then we will also review with you the extra benefits that are offered like dental, hearing and vision coverage, fitness programs and more.
With our help, you won’t have to call up each insurance company or go from one website to another. Our software matches your situation with the plans best qualified for your needs and then ranks them for you.
To get started, contact us and let us know how we can help. Our personal guidance is free. Check out our reviews too!
Medicare Part D Prescription Drug Plans
Medicare Part D is the primary part of Medicare to cover prescription drugs. It covers prescription drugs you would normally pick up at a pharmacy or through mail order.
There are two ways you can get Medicare Part D prescription drug coverage. The first is through a plan bundled with an Advantage Plan. Most Advantage Plans come with a bundled Part D prescription drug plan.
The second method is a Stand-Alone Part D Prescription plan (PDP) that can be used when Original Medicare is your primary healthcare, like when you have a Medicare supplement.
The Part D structure and rules are the same regardless of how you purchase your plan.
Don’t Make this Part D Mistake
It is important to understand that if your Medicare Advantage HMO or PPO does not come with a Part D plan, you may not purchase a stand-alone PDP plan. Doing so will cancel your Advantage plan.
When Can You Apply for Part D?
You can apply for Medicare Part D during your seven-month Initial Enrollment Period or during a Special Enrollment Period.
If you are changing from an Advantage plan back to Original Medicare you can also use the Annual Election Period (October 15 – December -7) or Advantage Plan Open Enrollment (January 01 through March 31) to apply for a Part D plan.
Medigap Seminars created https://partdshopper.com/ to help clients search for and enroll in a stand-alone Part D plan that fits your needs. All the plans available through this site are plans recommended by Matthew Claassen.
Sources:
https://www.kff.org/medicare/issue-brief/medicare-advantage-2023-spotlight-first-look/
https://medicareadvocacy.org/ma-and-selling-extra-products/
Insurance Agent Medicare supplement guides from Mutual of Omaha, Allstate, Aetna and other insurance companies.
Matthew Claassen
Matthew Claassen, CMT and CEO of Medigap Seminars Insurance Agency. Medigap Seminars is an award winning premier national Medicare Insurance Brokerage, ranked among the top in the U.S.A. Matthew is considered a leading national expert on Medicare and Social Security. Mr. Claassen is a distinguished member of the Forbes Business council, an invitation only organization of business leaders and entrepreneurs. He and his team have received awards from many of the countries largest insurance companies including Mutual of Omaha, Aetna, Humana, Cigna, United American, United Healthcare and others. His videos have become the most popular Medicare educational videos on YouTube with millions of views. As a financial analyst Matthew lead a team of researchers to win the 2009 Best Equity Research & Strategy Award from The Technical analysis magazine.
