Medicare Supplement Plan F in Texas, which is sometimes referred to as a Medigap policy, is the most comprehensive and best Medigap health insurance available. Although Medicare Part A and Part B cover hospitalization and medical expenses such as doctor’s office visits and general health care, the Federal Medicare program of health insurance called Original Medicare Part A and Part B has deductibles, copayments, and coinsurance, along with certain plan limits on how much it will pay for some basic benefits to its beneficiaries.
A Medicare Supplemental Plan F policy in Texas pays for all of these things, leaving the beneficiaries with zero out-of-pocket costs for medical expenses other than the Medicare Part B premium and the monthly premium to the insurance company for the Plan F health insurance. It is important to understand that a Medicare Supplement insurance Plan F is simply a supplement to Medicare parts A and B; the beneficiaries must be Medicare beneficiaries who are enrolled in Parts A and B before purchasing a Medigap Plan F policy to supplement their benefits.
Compare plans carefully before purchasing one to best enhance your Medicare coverage while reducing out-of-pocket expenses. In addition to checking out the standard and high-deductible Plan F, you may also want to check out Plan A, Plan N, and more. Once you know what each plan covers and how much each plan costs, you can make the right choice.
What does Medigap Plan F cover in Texas?
In general, a Medigap policy covers your Medicare Part A deductible for hospital costs for hospital stays, Medicare Part B deductible, Medicare Part B copayments, Medicare Part A coinsurance for hospice, and Medicare Part B coinsurance for doctor’s office visits and other medical services.
For Medicare benefits for Part A, it primarily covers the Medicare Part A deductible:
- The deductible for the first 60 days of hospitalization
- The deductible per day for days 61 to 90 of hospitalization
- The deductible per day for days 91 to up to 425 days of hospitalization
- The deductible per day for skilled nursing facility care from days 21 to up to 100 days
- Hospice care coinsurance/copayments
- The cost of the first 3 pints of blood required for transfusions per year
For Medicare benefits for Part B, your Plan F coverage covers:
- The Part B deductible is $233.00 per year
- The 20% Medicare Part B coinsurance payment for healthcare, including for doctor’s office visits
- 100% of Medicare Part B excess charges
- 80% of emergency room medical care up to a maximum of $50,000 required during foreign travel
What is Not Covered By Medigap Plan F in Texas?
Medicare Supplement plans like Plan F in Texas do not cover anything that is not covered as Medicare benefits under Medicare Part A and Part B, such as dental work, visual aids like glasses, or prescription drug plans. However, beneficiaries of Medigap Plan F and other Medicare Supplement plans can enroll in separate stand-alone Medicare Part D, which has prescription drug benefits, or after they compare the plans, they can purchase separate policies with dental, vision, and prescription drug coverage. These supplemental Medigap plans also do not cover your Medicare Part B premium.
How Much Does Medigap Plan F cost?
Due to its comprehensive coverage and the best benefits, Medicare Supplement Plan F rates in Texas tend to be higher than many other Medicare Supplement plans. On average, the monthly premium for these Medigap plans ranges between $159 to $236. The exact premium may depend on the company you buy the policy from, your age, your sex, your geographic location, and your general health at the time of enrollment so it is important to compare various plans before selecting the best one with the most benefits and lowest cost. Generally, insurance companies use one of three methods to set premiums for Medicare Supplement and Medigap plans:
- Community rated
- Issue age
- Attained Age
Community rated simply means your age is not a factor in setting premiums for Medicare Supplement plans. Issue age means your age is used as a factor in determining your premium, which means your premium tends to go up each year as you get older. Attained age means the age at which you first sign up for the policy is used as a factor in determining your premium, meaning if you buy Medicare Supplement plans at age 65 your premiums will always be lower than if you sign up at age 75.
Medicare Plan F vs Medicare Plan G
Medicare Supplement Plan G is very similar to Medicare Plan F; when we compare plans, the only difference is that Plan G does not cover the yearly Part B deductible of $233.00 for general health care and doctor’s office visits. Correspondingly, Plan G usually has a lower premium than the Medicare Supplement Plan F rates; for example, a person whose Medicare Supplement Plan F rates would be $326 per month would pay a $290 monthly premium for a Plan G. Thus, over a year, the Plan G would cost $432 less than the Plan F, considerable savings even after paying the $233.00 annual deductible. It is a good idea to consult an expert insurance agent to discuss and compare whether Plan F or Plan G is the best for you since Medicare Supplement plan premiums vary by individual, location, and insurance company. The best Medicare Supplement Plan F in Texas and G are different for each person. Neither Plan F or Plan G has a network of providers; both are accepted by any doctor, hospital, or another healthcare provider that accepts Medicare and provides Medicare benefits. The Medicare Access and CHIP Reauthorization Act of 2015 set the framework for how these policies would be handled between the U.S. government and private insurance companies.
When Can I Enroll in Medicare Plan F in Texas?
The best time to enroll in a Medigap Plan F in Texas is as soon as you become eligible for Medicare after you enroll in Original Medicare when you turn 65 during your initial Medicare enrollment period. The six months following your 65th birthday is called the Medigap Open Enrollment Period; if you enroll in a Medicare Supplement insurance plan during that period, you can automatically be enrolled in a Medicare Supplement plan without the need to answer any questions from the insurance company about your current health status. Outside of that open enrollment period, individuals can apply at any time for a Medicare Supplement insurance policy, but the insurance company can require medical underwriting for approval. If you enroll outside of your open enrollment period and have health conditions it would be helpful to speak to one of our Medicare Supplement specialists to assist with making comparisons and selecting the best Medicare Supplement Plan F for your specific situation that provides the benefits you need. Every company handles underwriting differently for each specific medical condition and thus their Medigap Plan F rates can vary dramatically; it is important to compare them carefully before enrolling.