Numerous senior citizens in the US rely on government-backed programs to financially protect them whenever they come face to face with a medical emergency. Several surveys reveal that 41% of working-age US citizens – almost 72 million people – are currently dealing with medical debt and owe more than $10,000.
Medical debt isn’t limited to a single demographic but equally affects every single US citizen who is afflicted with a chronic ailment or has disabilities.
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Even after a lifetime of careful financial planning and saving diligently, people are still prone to medical debt due to the soaring healthcare costs, rising unemployment cases, and improper health coverage.
This is why the US government initiated the Medicare health insurance program to finally give people a chance to prevent spending their lifelong savings in the event of a health emergency.
This reliable health insurance program offers comprehensive coverage and provides for a wide range of medical treatments ranging from diagnosis to prescription medication. You become automatically enrolled in the Medicare program when you reach the age of 65 years old.
Younger people also qualify for Medicare if they have been diagnosed with amyotrophic lateral sclerosis (ALS), renal failure, or have other debilitating disabilities. With a well-rounded health coverage plan, you will never have to worry about facing a medical debt or paying excessive medical bills out of your savings again.
But finding a robust healthcare plan that provides ample coverage meeting all of your specific needs and requirements is not as simple as it seems. You might require an expert’s insight to go through the intimidating process of signing up for Medicare.
This is where our well-experienced insurance agents come in. At Integrity Now Insurance Brokers, our Medicare insurance agents are annually accredited by America’s Health Insurance Plan (AHIP) and can help you devise comprehensive healthcare plans that are within your budget.
We make sure to go above and beyond for our clients and land them sturdy health insurance plans well suited to their needs and financial situation. We partner with numerous Medicare insurance agencies in Texas that we carefully select based on their proven track record and well-rounded insurance plans. Get in touch with us today by giving us a call and we will help you compare quotes and get reliable healthcare plans in no time.
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Medicare Options in Texas
Every person enrolling in Medicare must choose between one of the following Medicare programs.
Original Medicare
Original Medicare, also known as traditional Medicare is regulated by federal law and is one of the most popular healthcare options among the people of Texas.
The Original Medicare plans consist of two parts: Part A and Part B.
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Medicare Part A plans include coverage for services like skilled nursing facilities, inpatient hospital care (excluding custodial or long-term care), inpatient care in a religious non-medical healthcare institution, psychiatric care, home healthcare, and hospice care.
Part B plans cover laboratory tests, certain medical equipment, physician services, blood work, mental health services, diagnostic X-rays, outpatient hospital services, and physical, occupational, and speech therapy.
Medicare also recently started to provide ample coverage for individuals who have been diagnosed with a cognitive impairment like Alzheimer’s disease and other forms of dementia.
This healthcare treatment enables patients to go through clinical trials, get medical and non-medical treatments, and receive other additional benefits to live a higher quality of life.
These benefits include cognition evaluation, function evaluation, measurement of neuropsychiatric symptoms, prescription medications, identifying caregivers and caregiver needs, assessing care directives, and providing referrals to community services for the beneficiary and their caregiver.
The Original Medicare Plan does not provide coverage for prescription drugs, so many Medicare beneficiaries in Texas like to sign up for the Part D plan that specifically includes coverage for drugs.
Medicare Advantage – Part C
The Medicare Advantage or Medicare Part C is offered by private insurance agencies that have been approved by Medicare.
This comprehensive healthcare plan will pay companies who offer Medicare a fixed amount every month to cover your medical expenses. These private insurers have contracts with Medicare to combine all the Part A, Part B, and Part D plans into a single policy.
Some of these plans also include additional benefits like dental, vision, hearing, discounted gym memberships, and other health and wellness programs.
As of 2022, there are 337 Medicare Advantage plans available for eligible enrollees in Texas. To make sure you’re in the know about all the new Medicare Advantage plans in Texas before applying, browse through the Medicare website to learn more.
Texas’s Medicare Advantage program offers four different types of plans.
Health and Maintenance Organization
The HMO is a popular insurance structure in Texas that provides ample health coverage through a network of physicians for a monthly or annual fee.
The HMO is a collective of medical insurance providers that offer comprehensive health insurance plans with various medical benefits provided by a recommended network of healthcare providers that work under contract with them.
Since the healthcare providers have patients directed to them, these contracts allow the costs and premiums to be significantly reduced.
To qualify for Medicare Part C plans, a primary care provider (PCP), a specialty referral, and approvals for certain treatments and drug prescriptions are required.
Preferred Provider Organization (PPO)
The PPO is another popular health insurance plan that consists of medical professionals, primary and specialty physicians, and hospitals that are in contract with the insurance providers.
To qualify for this plan, no PCP or specialty referral is required. Prescription drug coverage is included in most plans and opting for an out-of-network provider will cost higher premiums and charges.
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Private Fee-For-Service (PFFS)
This Medicare Advantage health plan is offered by State-licensed organizations that have contracts with the Centers for Medicare & Medicaid Services (CMS).
The PFFS plan pays in-network providers on a fee-for-service basis so the providers aren’t on the brink of financial risk. This service also does not restrict the member’s choices among the providers that have the lawful authorization to offer their services.
Any provider who agrees to the terms and conditions of Medicare is eligible for these Medicare benefits. Prescription medication coverage is included in most plans but you can also sign up for a drug plan separately.
PCP and a specialty referral are not required and there are higher premiums when opting for an out-of-network provider.
Special Needs Plan (SNP)
The special needs plan only allows membership to people who have been diagnosed with specific chronic conditions and characteristics. This plan includes tailored healthcare benefits, drug formularies, and provider choices that have been specifically chosen to meet the special needs of these individuals.
To become eligible, you need to be enrolled in Medicare Part A or Part B plans or have a chronic condition like AIDs/HIV, diabetes mellitus, cancer, auto-immune disorders, cardiovascular diseases, or a neurological disorder.
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PCP and a specialty referral are required and drug coverage is included in most plans.
Medicare Part D
In case your base healthcare plan does not provide coverage for prescription medication, you can always sign up for the Medicare Part D plan which specifically provides coverage for drugs and charges a monthly and annual deductible and other out-of-pocket expenses.
The costs of your Part D plans depend on the plans you’re signing up for.
Part D Deductible
A lot of the Part D policies charge an annual deductible. The maximum deductible you will have to pay in 2022 is $480.
Initial Coverage Limit
Medicare beneficiaries will be responsible for paying 25% of the total cost-sharing while the rest of the 75% will be covered by the plan.
Coverage Gap
The Medicare part D coverage gap begins after your drug plan has paid a certain amount for your prescription medication. In 2022, this limit is $4,430. This amount changes annually and after your plan reaches the coverage gap, you will be expected to pay 25% of the plan’s costs for any brand-name drugs enlisted in your plan’s formulary.
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Medigap Supplement – Supplemental Healthcare
Medigap or Medicare Supplement plans are a secondary health insurance plan that is funded by private insurance companies.
The Original Medicare only provides coverage for 80% of the inpatient and outpatient care. This is why many people in Texas like to purchase Medigap to get coverage for any gaps left in the Original Medicare plan.
Each policy in this program is labeled from A to N. To become eligible for Medigap you;
- Must already be enrolled in the Original Medicare plan
- Must be 65 years old or older
- Under 65 and regularly receiving disability benefits from Social Security or the Railroad Retirement Board
- Under 65 but diagnosed with amyotrophic lateral sclerosis
- Under 65 and diagnosed with end-stage renal disease(ESRD)
Medigap provides all the basic benefits of the traditional Medicare plan including additional coverages like coverage for Part A and Part B deductibles, hospice care copayments and coinsurances, Medicare preventive care deductibles, and three pints of blood.
Medigap also pays for any foreign travel medical emergencies, skilled nursing facility deductibles, Part B excess charges, and out-of-pocket yearly limit.
Medigap insurers use three methods to set their premiums.
Issue Age Rating
This method for calculating premiums depends on the enrollee’s age and is less costly for younger buyers. The overall costs are never affected by the individual’s age.
Attained-Age Rating
In this approach, the premiums get higher as the person advances in age. These premiums are less costly for younger subscribers and many insurance companies tend to use this method to set premiums.
Community Rating
This method has been mandated in 8 US states while many insurers tend to avoid it. Premiums do not get affected by the enrollee’s age.
When going through the lengthy process of signing up for Medicare, it’s not uncommon for many people to feel overwhelmed and intimidated. But our Medicare insurance agents are dedicated to simplifying this process for you. We make sure to go the extra mile for our clients and help them devise the most efficient healthcare plans that are within their budget and meet all of their needs.
To learn more about the different Medicare plans available in Texas, you can go through our resources and find comprehensive guides on how to sign up for Medicare. You can also use our Medicare plan finder tool to check out all the Medicare Advantage plans available in your area.
Medicare Enrolment in Texas
Medicare immediately registers you to receive healthcare benefits if you have received at least four payments from the Railroad Retirement Board or Social Security before your 65th birthday. If your registration has been delayed, you can always reach out to your local Social Security office and apply online.
You can apply for Medicare in the following time frames.
Initial Enrolment
The initial enrolment period starts three months prior to and ends three months after your 65th birthday. You can initiate your application process during this time frame, or change and upgrade your current plan.
General Enrolment
If you missed the initial enrolment period, you can sign up for Medicare during the general enrolment period which begins on January 1st and ends on March 31st. During this time, you can opt for Part A, Part B, Medicare Advantage, Medigap, and Part D plans.
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Medicare Advantage Open Enrolment
The open enrolment period for Medicare Advantage begins from October 15 to December 7. Open enrolment enables subscribers to enroll, cancel, or make changes to their current Part C plan.
Special Enrolment
If your existing insurance plan gets terminated or you lose your eligibility due to any unforeseen circumstances, you will be granted a special enrolment period during which you can enroll into a healthcare plan again.
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Why Choose Medicare Hope Insurance at Integrity Now Insurance Brokers?
Our Medicare insurance agents at Integrity Now Insurance Brokers are certified, high-qualified, and have years of experience when it comes to helping clients land well-rounded health insurance plans.
Our independent Medicare insurance agents offer free of charge assistance and will guide you line by line through every insurance policy to help you find the one that is best suited to your needs and requirements.
With our access to top-rated Medicare insurance providers, we assure you that you are in safe hands. You can rely on us to connect you with the best insurance agencies that are right for you.
Book a one-on-one consultation today by giving us a call and our representative will help you compare quotes and provide you with all the details that you require.
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