More than four million people in Texas are enrolled in Medicare, which is a national health insurance program of the federal government. Designed for seniors of age 65 or older, the plan may also be available to younger people having certain disabilities or people having end-stage renal disease. People residing in Texas have several medicare plan options depending upon the area where they live. People looking for Medicare plans can obtain its benefits either through Original Medicare or through a private health plan approved by Medicare like Medicare Advantage. Some of the Medicare options available for Texas residents include:
Original Medicare is the federally administered Medicare program and is similar in every state of the country. So, Original Medicare plan available in Texas is same just like other states including Part A, hospital insurance and Part B, medical insurance. medicare Part A covers inpatient hospital care, skilled nursing facility care, hospice care along with limited home health care whereas Medicare Part B covers outpatient services such as doctor visits, preventive services, and durable medical equipment. Besides these, Original Medicare offers limited prescription drug coverage, as Medicare Part A covers prescription drugs, which one received as part of their treatment as a hospital inpatient and Medicare Part B covers medications administered to beneficiaries as an outpatient like by injection or infusion. Prescription drugs which the beneficiaries take at home are not covered in most of the cases.
Residents of Texas can avail Original Medicare regardless of their health status or income level, if they are U.S. citizen or permanent legal residents of the U.S. for at least five continuous year. Residents get automatically enrolled in Medicare Part A, if they or their spouse have worked for at least ten years and paid their Medicare taxes, otherwise residents will owe a premium for their Part A coverage. However, Medicare beneficiaries need to pay a premium for Part B coverage. In addition to these, beneficiaries also have to pay co-payments and coinsurance costs before availing Medicare Part A and Part B benefits.
Medicare Part C or Advantage Plans
Medicare Part C or Advantage plan is an alternative way of receiving Original Medicare benefits offered by private insurance companies having contract with the Centers for Medicare & Medicaid Services. One-third of Medicare beneficiaries in Texas have access to a Medicare Advantage plan and there are around 54 Medicare Advantage plans available in the state offering a variety of benefits, premiums and cost-sharing structures. Medicare Part C include all the benefits offered under Original Medicare except for the hospice care that is covered only under Medicare Part A. Many Medicare Advantage plans even include additional benefits like routine dental and vision care, wellness program, and prescription drug coverage. Beneficiaries in order to enroll in Medicare Advantage plan must be enrolled in Medicare Part A and Part B and must live in the plan’s service area. Enrollees need to pay their Medicare Part B premium to Medicare and Medicare Advantage plan premium directly to the private carrier. Beneficiaries out-of-pocket expenses for services covered under Original Medicare are limited by the Medicare Advantage plans. Every Advantage plan has an annual out-of-pocket spending limit, and once the beneficiaries reach this limit, their Advantage plan pays 100% of the healthcare costs for the rest of the year. However, Original Medicare doesn’t have maximum spending limit to cap beneficiaries annual out-of-pocket costs. Different Types of Medicare Advantage Plans available in Texas:
- Private Fee-for-Service
- Special Needs Plans
- Medical Savings Account
Medicare Advantage Prescription Drug Plans in Texas
Medicare Advantage plan, which includes drug coverage is known as Medicare Advantage Prescription Drug plan, as it includes health and prescription drug benefits under a single plan. Medicare Advantage Prescription Drug plans are offered by private insurance companies having contract with Medicare. These plans usually cover the most commonly prescribed drugs and so, medicare beneficiaries before enrolling in his plan should check the plan’s formulary or list of drugs to ensure that the drugs used by them are included in plan’s formulary. Every Medicare Advantage Prescription Drug plan must include two or more medications in each category like at least two drugs of antibiotic category and two drugs of antidepressant category. All the drugs are placed into different tiers and generic drugs are usually in a lower tier and brand drugs are placed in a higher tier. Drugs in lower tier come with lower co-payments and coinsurance costs while drugs in higher tier have higher out-of-pocket costs. Two Medicare Advantage Prescription Drug plans may cover the same drugs with different out-of-pocket costs so, enrollees should take time to research the plan in order to save money.
Medicare Part D Plans in Texas
Medicare Part D in Texas is a part of federal program offering prescription drug coverage for Medicare beneficiaries. This Medicare plan is highly popular among residents of Texas as around 73% of Medicare beneficiaries opt for Medicare Part D coverage in Texas. These plans are offered by private insurance companies having contract with Medicare. Medicare Part D is a stand-along plan that works along Original Medicare to help enrollees lower their prescription drug costs. This plan have network of pharmacies in Texas, who help beneficiaries lower the drug costs that are covered under the plan. However, Medicare Part D plans have co-payment, coinsurance and even annual deductible that insured have to pay for prescription medications covered under the plan. Not every Medicare Part D plan is all the same and the costs along with premiums, deductibles and coinsurance might differ from plan to plan. Each Medicare Part D plan does not cover the same list of prescription drugs, as every plan has its own formulary of covered medications. However, every Part D plan has to include two drugs in each category, so enrollees are advised to compare the plans available in their area and check the medications included in the plan’s formulary to ensure that their medications are included in the plan’s formulary.
Medicare Supplement Plans or Medigap Plans in Texas
Medicare Supplement or Medigap are insurance plans designed to fill the gaps of Original Medicare like deductibles, coinsurance and co-payments. Offered by private insurance companies, there are ten standardized Medicare Supplement insurance plans denoted by the letters A through N, where plans E,H, I and J are no longer sold. Private insurance companies offering Supplement plans do not necessarily have to offer every Medigap plan but they must offer at least Plan A. Every Medicare Supplement plans offers different basic benefits but plan of same letter include the same standardized basic benefits irrespective of the insurance company and the location. Like Medicare Supplement Plan G in Texas will cover the same benefits as Plan G in Florida. Medicare Supplement plans do not cover dental, vision, hearing-aids, or long term care but These must cover at least a part of the following basic benefits:
- First thee pints of blood used in a medical procedure
- Medicare Part A coinsurance costs for an additional 365 days after Medicare benefits get over.
- Coinsurance or co-payments of Medicare Part A hospice care
- Coinsurance or co-payments of Medicare Part B