Navigating health insurance in Texas, especially after you turn 65, can feel overwhelming. For many people, Medicare offers essential health coverage, but it doesn’t cover everything. That’s where Medigap comes in.
In Texas, approximately 4.6 million people are enrolled in a Medicare plan, with 931,000 people enrolled in a Medigap plan. In this guide, we’ll walk you through what Medigap is, the types of plans available, and how you can choose the best policy for your unique needs.
What is Medigap?
Medigap, also known as Medicare Supplement Insurance, is a type of private insurance designed to cover the “gaps” in Original Medicare. These gaps include copayments, coinsurance, and deductibles that Medicare Parts A and B don’t fully cover. Some Medigap policies may even cover care when you travel outside the U.S., which can be useful for retirees who love to travel.
Here’s a quick breakdown of how Medigap works:
- It supplements Medicare Parts A and B
- Private insurers sell Medigap plans, but these are standardized by federal law
- You must have Original Medicare (not Medicare Advantage) to buy Medigap
- It only covers one person per policy. If both you and your spouse need coverage, you’ll need separate Medigap policies.
- There are various plans to choose from, from Plan A – Plan N, so you have to do your due diligence and compare what each plan covers according to your needs,
There are currently 55 licensed insurers in Texas that sell Medigap plans.
What Does Medigap Cover?
The benefits provided by Medigap vary depending on the plan type you choose. As mentioned above, there are 10 standardized Medigap plans, labeled A through N, that you can choose from. All offer different levels of coverage, however, here’s a summary of what Medigap policies can help with:
- Part A coinsurance and hospital costs
- Part B coinsurance or copayments
- Blood transfusions (first 3 pints)
- Hospice care coinsurance
- Skilled nursing facility coinsurance
- Foreign travel emergency care (for some plans)
Note: Plan F and Plan G are the most comprehensive, but Plan F is no longer available to new Medicare enrollees after 2020.
Choosing the Right Medigap Policy for You
With so many Medigap options, choosing the best policy can feel overwhelming. Here are some tips to help you find the right one:
- Assess Your Healthcare Needs
Ask yourself questions like:
- How often do you visit doctors or specialists?
- Do you travel frequently, especially abroad?
- Are you willing to pay a higher premium to avoid out-of-pocket costs?
If you expect frequent medical visits or want peace of mind when traveling, a plan with more comprehensive coverage, such as Plan G or Plan N, may suit you.
- Compare Monthly Premiums
Medigap premiums vary by provider and location. While all plans are standardized, some insurers charge more for the same plan, therefore, it’s worth shopping around for the best price. Some policies may have lower premiums but higher out-of-pocket costs, so balance affordability with the amount of care you anticipate needing.
- Understand Pricing Models
Medigap insurers use three different pricing methods:
- Community-rated: Everyone pays the same premium, regardless of age.
- Issue-age-rated: Premiums are based on your age when you first buy the policy and don’t increase as you age.
- Attained-age-rated: Premiums start low but increase as you age.
Knowing which pricing model your insurer uses can help you predict your costs over time.
- Check Ratings & Reviews
Check each provider’s customer reviews and complaints about their customer service and claims process. These should give you a pretty good idea about how they operate and if people recommend them.
- Enroll at the Right Time
The best time to buy Medigap is during your Medigap Open Enrollment Period, which lasts six months and starts when you’re both:
- 65 or older, and
- Enrolled in Medicare Part B.
During this period, insurers can’t deny you coverage or charge higher premiums due to pre-existing conditions. Waiting until after this window could result in higher costs or limited options.
Where to Find the Best Medigap Policy
Here are a few resources to help you compare and choose the right Medicap policy:
- Medicare.gov – Use the Medigap Policy Search Tool to find plans available in your area.
- State Health Insurance Assistance Program (SHIP) – Offers free counseling to help you compare plans.
- Licensed Insurance Brokers – They can guide you through the process and recommend policies tailored to your needs.
- Direct Insurers – Many private insurers, like AARP, Humana, and Blue Cross Blue Shield, provide detailed information about their Medigap offerings online.
Work With an Expert Who Can Help You Navigate the Medicare & Medigap World
Medigap plays a vital role in covering what Medicare doesn’t, giving you peace of mind by reducing your out-of-pocket healthcare costs. Choosing the right plan depends on your medical needs, budget, and lifestyle. Start by understanding what each plan offers, compare prices, and enroll during the open enrollment period to secure the best deal. However, that’s easier said than done.
If you still feel uncertain, don’t hesitate to speak with an experienced Medicare agent who can simplify the process and guide you toward the most suitable option.
Emily Trevino, Senior Managing Partner at Wise Insurance, leverages her extensive background in biology and business finance to master Medicare, health insurance, and retirement planning. With over a decade in the field, Emily has co-authored “Medicare Breakdown – The Alphabet Soup of Medicare,” marking her as a pivotal figure in insurance education. Her commitment extends through active participation in the National Association of Benefits and Insurance Professionals (NABIP) and speaking at major industry events. Emily’s drive for community service and personal resilience shines through her adventurous pursuits and dedication to societal well-being. Connect with Emily on LinkedIn to explore the future of informed insurance decisions.
