The Lone Star State has 10 standardized Medigap plans to choose from. These plans are nearly identical to that of 46 other states. This standardization makes understanding TX Medicare Supplement (Medigap) rules and regulations simple. Here’s the Texas Medigap policy overview:
Texas Medigap policy essentials
Texas Medigap plans, just like all Medigap plans, are designed to fill in the “gaps” of costs not covered by Medicare Part A & B. There are no doctor networks when it comes to Medigap as any doctor or facility that accepts Medicare MUST accept standard Medigap. Here is a good Medigap overview that you should read first.
Here are the simple Texas plan essentials you need to know:
- 8 standardized plans for persons Medicare eligible as of 2020
- Plans F and C are still available to those Medicare eligible before 2020
- Plans are identical to the majority of other states
- 65 and older have Medigap guaranteed enrollment if they sign up when first eligible
- 65 and under on Medigap with a disability do not have guaranteed issuance
- If you miss your Medigap open 6-month enrollment, you can be denied or charged more.
- 7 qualifying “Texas Medigap guaranteed issuance period” events outside of open enrollment
- No annual switching period (see below for more)
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How much do TX Medigap plans cost?
You know how they say, “Everything is bigger in Texas”? Well, this isn’t the case with your Texas Medigap plan’s monthly costs. Medigap in Texas is priced about average when compared to most of the country.
Medigap monthly premiums vary by insurance provider and are based on zip code, gender, when you enroll, and which Medigap plan you select. Click here to see instant prices for Medigap plans from top insurance providers. Medigap Texas prices are regulated so no one can offer the same plan from the same provider lower than Senior65.com.
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Are there Texas Medigap discounts?
There sure are TX Medigap discounts available. Click on each to learn more:
Is it Easy to Switch Medigap plans in Texas?
Not exactly. Once you are outside your Medigap initial enrollment period where everyone is approved, you will usually have to answer health questions first to be approved for Medigap. Most people think there is an annual open enrollment period each year which allows for “free switching” (AKA “Birthday Rule“) between Medigap insurance companies but this does not exist in Texas.
NOTE: The AEP Open Enrollment period (Oct 15 – Dec 7) isn’t for Medigap in your state. In Texas, Medigap switching is allowed year-round but usually requires medical underwriting. On your Med Supp application, expect around 20 questions about your health status. Your answers will influence whether you receive the best rate or a higher rate. Certain pre-existing conditions may result in a denial for the new plan.
There are only a few exceptions that allow for guaranteed issued Medigap switching. Feel free to call us at 800-930-7956. There is never a charge or hidden fee to work with us and no one can sell the same Medigap plan for less than Senior65.com can.
Texas Medigap plans side-by-side
Approved Texas insurance providers can offer some or all of the A-N standardized plans listed below. Plans C and F are only available to those eligible for Medigap before 2020. Here are 8 plans available to those who qualified for Medicare Part B after Jan 1, 2020, but most of our new clients select Plan G.
| Benefits | A | B | D | G* | K | L | M | N |
|---|---|---|---|---|---|---|---|---|
| Medicare Part A Deductible ($1,632) | 100% | 100% | 100% | 50% | 75% | 50% | 100% | |
| Part B Deductible ($240) | ||||||||
| Medicare Part A Hospital Coinsurance and 365 additional hospital days | 100% | 100% | 100% | 100% | 100% | 100% | 100% | 100% |
| Medicare Part B Coinsurance | 100% | 100% | 100% | 100% | 50% | 75% | 100% | 100% |
| First 3 Pints of Blood for a Transfusion | 100% | 100% | 100% | 100% | 50% | 75% | 100% | 100% |
| Medicare Part A Hospice Coinsurance or Copay | 100% | 100% | 100% | 100% | 50% | 75% | 100% | 100% |
| Skilled Nursing Facility Coinsurance | 100% | 100% | 50% | 75% | 100% | 100% | ||
| Medicare Part B Excess Charges | 100% | |||||||
| Foreign Emergency Healthcare | 80% | 80% | 80% | 80% | ||||
| Max Out-of-Pocket | $7,060 | $3,530 |
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*Medigap Plan G High deductible offers the same coverage as Plan G but with a deductible of $2,800.
Texas Medicare Excess Charges
Medicare Part B excess charges occur when doctors don’t accept the Medicare-approved amount, charging up to 15% more. The good news is that if you enroll in the Medigap Plan G, it covers 100% of the excess fees. Learn all in our Excess Charges Guide.
Texas Medigap plans if you move to another state
Why would you ever want to leave Texas? If you did, you can still keep your Medigap plan if you move to another state. Medigap plans access Medicare’s national network no matter where you live (Source). It will work in your new state and there is no need to reapply in most cases. Your TX Medigap price may increase if you end up living in another state in the future.
Next Steps
For further questions about Texas Medigap plans call one of our licensed agents a call at 800-930-7956.
Our agents can NOT charge you a fee for a quote or enrollment.