Medigap - Frequently Asked Questions

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How do Medicare Plans Work?

Answer
Original Medicare
The Original Medicare Plan is a fee-for service plan managed by the Federal Government.  In general, with the Original Medicare Plan:

1. You use your red, white, and blue Medicare card when you get health care.
2. You can go to any doctor or supplier that accepts Medicare and is accepting new Medicare patients, or to any hospital or other facility.
3. You pay a set amount for your health care (a deductible) before Medicare pays its part.  Then, Medicare pays its share, and you pay your share (your coinsurance or copayment) for covered services and supplies (unless you have a medigap policy or other supplemental insurance that may pay for these costs.)
4. You may have a Medigap policy or other supplemental coverage that may pay deductibles, coinsurance, or other costs that aren’t covered by the Original Medicare Plan.

Medigap Policies
Medigap policies are health insurance policies sold by private insurance companies to fill “gaps” in Original Medicare Plan coverage.  In general, with a Medigap policy:

1. You get help paying for some of the health care cost that the Original  Medicare Plan doesn’t cover.
2. You also get benefits not covered by Original Medicare, like emergency health care outside the United States.
3. You pay a monthly premium to the private health insurance company that sells you the policy.  Medicare and the Medigap policy both pay their shares of covered health care costs.

Medicare Health Plans (like HMOs and PPOs)
Medicare Advantage Plans are health plan options that are approved by Medicare but run by private companies.  They are part of the Medicare Program and called “Part C.”  When you join a Medicare Advantage Plan, you are still in Medicare.  With Medicare Advantage Plans:

1. Some of the plans require referrals to see specialist.
2. In many cases, the premiums or the cost of services (co-pays and deductibles) can be lower than they are in Original Medicare Plan or the Original Medicare Plan with a Medigap policy.  Medicare Health Plans charge different premiums and have different cost of services, so it is important to check with the plan before you join.
3. The plans provide all of your Part A (hospital) and Part B (medical) coverage and must cover medically-necessary services.
4. They often have networks, which means you may have to see doctors who belong to the plan or go to certain hospitals to receive covered services.
5. They generally offer extra benefits, and many include prescription drug coverage.
6. In many cases, your cost for prescription drug coverage can be lower than in the stand-alone Medicare Prescription Drug Plans.  Some of these plans coordinate your care, using networks and referrals, more than others.  This can help manage your overall care.

Medicare Prescription Drug Plans
Medicare Prescription Drug Plans are offered by insurance companies and other private companies approved by Medicare.  They add coverage to:

1. Generally, you pay less for your prescriptions.
2. You will get a plan member card after you enroll.  You use this card when you go to the pharmacy to get your prescriptions filled.

You will pay the copayment, coinsurance, and/or deductible, if any.

Other facts about Medigap:

• Medigap policies help pay some of the health care costs that the original Medicare plan doesn't cover.
• Medigap insurance is specifically designed to supplement Medicare's benefits.
• Medigap policies must follow federal and state laws.
• Medigap plans also must be guaranteed renewable, and cannot be canceled as long as you keep paying the premiums.

For questions on Medigap, or to find out how we can help you reduce the cost of your Texas Medicare supplement insurance premium, please use the free quote form on the right, or call 281-238-6038 now.