Medicare Supplement Insurance Handbook and Rate Guide
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Medicare is a federal health insurance program that pays most of the health care costs for people who are 65 or older. It will also pay for health care for some people under age 65 who have disabilities.
You can buy Medicare supplement insurance to help pay some of your out-of-pocket costs that Medicare won’t pay. Because it helps cover some of the “gaps” in Medicare coverage, Medicare supplement insurance is often called Medigap insurance.
Not everyone needs a Medicare supplement policy. If you have other health coverage, the gaps might already be covered. You probably don’t need Medicare supplement insurance if
- You have group health insurance through an employer or former employer, including government or military retiree plans.
- You have a Medicare Advantage plan.
- Medicaid or the Qualified Medicare Beneficiary (QMB) Program pays your Medicare premiums and other out-of-pocket costs. QMB is one of several Medicare Savings Programs that help pay Medicare premiums, deductibles, copayments, and coinsurance.
If you have other health insurance, ask your insurance company or agent how it works with Medicare.
Original Medicare is sometimes called Medicare fee-for-service or traditional Medicare. You may go to any doctor or hospital that accepts Medicare. Medicare supplement policies only work with original Medicare.
Medicare Part A (hospital coverage) pays for
- in-patient hospital services
- skilled nursing facility care after a hospital stay
- home health care
- hospice care
- all but the first three pints of blood each calendar year.
Medicare Part B (medical coverage) pays for
- medical expenses
- home health care
- clinical laboratory services
- outpatient hospital treatment
- durable medical equipment and supplies
- preventive health services, including exams, health screenings, and shots.
Medicare Part D (prescription drug coverage) pays for generic and brand-name prescription drugs. You can get prescription drug coverage by either joining a stand-alone prescription drug plan or by buying a Medicare Advantage plan that includes drug coverage. If you have group health insurance, your health plan might already cover prescriptions. Ask your plan’s sponsor whether the plan has creditable prescription drug coverage.
Insurance companies approved by Medicare offer Part D coverage.
The Centers for Medicare and Medicaid Services (CMS) publishes the Medicare & You handbook that describes Medicare coverages and health plan options. CMS mails the handbook to Medicare beneficiaries each year. The handbook is also available online at www.medicare.gov or by calling 1-800-MEDICARE (1-800-633-4227).
Services Medicare Doesn’t Cover
- Long-term care. Medicare only pays for medically necessary care provided in a nursing home. Skilled care refers to help for conditions that require a medical professional, such as a nurse or a therapist. Medicare doesn’t cover:
- Custodial care, if it’s the only kind of care you need. Custodial care can include help with walking, getting in and out of bed, dressing, bathing, toileting, shopping, eating, and taking medicine.
- More than 100 days of skilled nursing home care during a benefit period following a hospital stay. The Medicare Part A benefit period begins the first day you receive a Medicare-covered service and ends when you have been out of the hospital or a skilled nursing home for 60 days in a row.
- Homemaker services
- Private-duty nursing care
- Most dental care and dentures
- Health care while traveling outside the United States, except under limited circumstances
- Cosmetic surgery and routine foot care
- Routine eye care, eyeglasses (except after cataract surgery), and hearing aids.
What You’ll Have to Pay with Original Medicare
For Medicare parts A and B, you generally have to pay monthly premiums, as well as deductibles, copayments, and coinsurance. You also pay the full cost of services not covered by Medicare.
- Premiums are amounts you pay to keep your Medicare coverage. Most people don’t have to pay a Part A premium, but everyone must pay the Part B premium. The premium amounts may change each year in January.
- A deductible is the amount you must pay for medical expenses before Medicare begins to pay.
- A copayment is what you might have to pay to receive a covered health service.
- Coinsurance is the percentage of the cost of a service that you pay after Medicare pays its portion of the cost.
Doctors hospitals, and suppliers who have accepted assignment charge only the Medicare-approved amount for a service or supply. You must pay any deductibles, coinsurance, and copayments that are due.
Doctors and hospitals who don’t accept assignment may charge as much as 15 percent more than the Medicare-approved amount. You must pay the remaining charges. The amount you owe is shown on the Medicare Summary Notice that you receive each quarter. If you were charged more than the 15 percent and paid it, your doctor or hospital must refund the excess charges to you within 30 days. You can also look at your Medicare claims online at www.MyMedicare.gov.
If you think a doctor or hospital has overcharged you, use your Medicare Summary Notice to find the charges. Use the contact information for the company in the notice to report the overcharge to Medicare. The notice will also show you any deadlines to complain or appeal charges and denied services.
Medicare has a directory of doctors, hospitals, and suppliers that work with Medicare. The directory lists doctors and hospitals who accept assignment on Medicare claims. For a list of doctors who accept assignment in your area, call Medicare or visit its website and select “Find doctors & other professionals.”
Medicare Advantage Plans
You may have the option to join a Medicare Advantage plan, also called Medicare Part C. To be eligible, you must have both Medicare parts A and B and live in an area that has a plan. If you enroll in a Medicare Advantage plan, you are no longer in original Medicare, but still have the same rights and protections as the Medicare program.
Medicare has contracts with insurance companies and managed care plans to offer Medicare Advantage plans in specific geographic areas. Medicare pays the plan a set amount each month, and the plan provides Medicare parts A and B services. You will continue to pay your monthly Medicare Part B premium, and you must pay any premium the Medicare Advantage plan charges. You will also pay any copayments, deductibles, and coinsurance the plan requires.
Medicare Advantage options vary by ZIP code and county. The options available in Texas include:
- managed care plans, such as health maintenance organizations (HMOs), preferred provider organizations (PPOs), and provider-sponsored organizations (PSOs).
- private fee-for-service plans
- Medicare special needs plans.
Medicare Advantage plans usually have more benefits than original Medicare. For instance, some Medicare Advantage plans may cover dental and vision services. However, Medicare Advantage might not be the best option for some people. Your choice of doctors and hospitals in a Medicare Advantage plan are limited. If you have other insurance, such as a group retirement plan, ask your group plan if it works with a Medicare Advantage plan or with original Medicare.
Because Medicare negotiates contracts with Medicare Advantage plans each year, the plans available and the benefits they provide can change each year. If your plan discontinues services, you will have to find a new plan in your area or return to original Medicare. To learn what plans are available in your area, call Medicare or visit the Medicare web page and select “Find health & drug plans.” You may also call the Texas Department of Insurance Consumer Help Line at 1-800-252-3439 or 512-463-6515 in Austin.
Medicare’s open enrollment period is October 15 to December 7. During this period, you should review your coverage and make any changes.
Medicare Supplement Insurance
Medicare supplement insurance fills in the gaps between what original Medicare pays and what you must pay out-of-pocket for deductibles, coinsurance, and copayments.
Medicare supplement policies only pay for services that Medicare says are medically necessary, and payments are generally based on the Medicare-approved charge. Some plans offer benefits that Medicare doesn’t offer, such as emergency care in a foreign country.
Medicare supplement policies are sold by private insurance companies that are licensed and regulated by TDI. Medicare supplement benefits, however, are set by the federal government.
Important! Your Medicare supplement policy is renewed automatically each year to ensure you have coverage year after year. That’s different from Medicare Advantage, which lets you change plans each year. If you drop your Medicare supplement policy, you may not be able to get it back or you may not be able to buy a new policy.
Medicare Select is a type of Medicare supplement policy that usually requires you to use doctors and hospitals in the plan’s network for your routine care. If you use out-of-network hospitals -- other than in an emergency -- you’ll have to pay more of the cost. If you no longer want network restrictions, the company must offer you a standard Medicare supplement policy with similar benefits. If you move out of the service area, you will have a guaranteed right to buy another Medicare supplement plan from any company.
The 10 Standard Medicare Supplement Insurance Plans
There are 10 Medicare supplement insurance plans. Each plan is labeled with a letter of the alphabet and offers a different combination of benefits. Plan F also offers a plan with a high-deductible option. Plans K, L, and M have a different cost-sharing component.
Every company must offer Plan A. If they offer other plans, they must offer Plan C or Plan F.
The 10 Medicare supplement plans (plans A, B, C, D, F, G, K, L, M, and N) offer these benefits:
- Pays your daily copayments for hospitalization expenses from the 61st through the 90th day of the Medicare benefit period.
- Pays the Medicare Part A copayments for any hospital confinement beyond the 90th day in a benefit period, up to an additional 60 days during your lifetime. (These are your inpatient reserve days. You may use these days when you require more than 90 days in the hospital during a benefit period. When you use a reserve day, it is subtracted from your lifetime total and can’t be used again.)
- Pays the Medicare Part A coinsurance plus coverage for 365 additional days after Medicare benefits end.
- Pays the skilled nursing facility care coinsurance.
- Hospice: Pays the copayment for outpatient drugs and the coinsurance for inpatient respite care. Plans K and L pay this cost at a different rate. You must meet Medicare’s requirements, including getting a doctor’s certification of terminal illness.
- Medical expenses: Pays your portion of the 20 percent Part B coinsurance for Medicare-eligible expenses for medical services -- including doctor bills, hospital or home health care, and specified copayments for certain services under the prospective payment system -- after you have met your Part B deductible. Plans K, L, and N required you to share in the payment of coinsurance.
• Blood: Pays for the first three pints of blood each year under Medicare parts A and B.
- Plans B, C, D, F, G, and N pay the entire Part A deductible. Plans K, L, and M pay a percentage of the Part A deductible. Out-of-pocket limits apply to plans K and L.
- Plan N requires a $20 copayment for most office visits and $50 for emergency room visits.
- Plans C and F pay the Part B deductible.
- Plans C, D, F, G, M, and N pay for skilled nursing facility care copayments from the 21st day through the 100th day in a benefit period for post-hospital skilled nursing facility care eligible under Medicare Part A. This is not custodial care. Plans K and L pay a portion of the cost until you meet the annual out-of-pocket limits. The plan will then pay 100 percent.
- Plans C, D, F, and G pay for emergency care while traveling outside the United States. They pay 80 percent of the charges that Medicare would pay if you were in the United States. Care must begin during your first 60 days outside the United States. The calendar year deductible is $250. The lifetime maximum benefit is $50,000.
- Plans F and G pay Medicare Part B excess doctor charges that Medicare doesn’t pay. They pay 100 percent of the excess fees, which are limited to 15 percent above the Medicare-approved amount.
This chart summarizes the benefits offered with each plan: Standard Medicare Supplement Insurance Plans.
Plans K, L, M and N
Basic benefits for plans K and L include similar services as other plans, but the cost-sharing (copayments and coinsurance) is at different levels. In exchange for lower premiums, Plan K has a 50 percent coinsurance and an annual out-of-pocket limit of $4,800 in 2013.
Plan L has a 75 percent coinsurance and an annual out-of-pocket limit of $2,400 in 2013. The limits apply to the deductible, copayments, and coinsurance amounts. For example, with Plan K, the hospital deductible amount of $1,184 in 2013 would be split between you and the Medicare supplement company. Once you reach the annual out-of-pocket limits, the company pays your expenses for the rest of the year.
Plan M pays 50 percent of the Medicare Part A deductible. Plan N pays the 20 percent coinsurance, but requires you to pay a $20 copayment for doctor visits and $50 for emergency room visits that don’t require you to stay overnight.
Although the premiums for some of these plans may be lower, you will pay higher out-of-pocket costs if you see doctors and hospitals often.
Plans E, H, I, and J were sold until 2010. These plans work differently. You don’t have to give up your current plan. Even though the premiums have increased significantly, companies don’t have to sell you a different Medicare supplement plan.
Right to Keep Your Medicare Supplement Policy
Federal rules usually allow you to keep your Medicare supplement policy if you move, including moving out of state. There are exceptions to this if
- you have a Medicare Select plan
- you have plan that includes added benefits, such as vision or discounts that are only approved and available where you bought the plan
- you move to a state that doesn’t offer the 10 standard plans
- you have an area rated policy, your premiums can change.
If you have an area rated policy, your premiums might change.
Companies must get approval from their state departments of insurance to offer additional benefits.
Alternatives to Medicare Supplement Insurance
Before you consider buying a Medicare supplement policy, know if you have other options for paying for your Medicare out-of-pocket costs. The following plans and programs might help you pay costs.
Employee Group Plans
If you stay at your job after your 65th birthday, you might still have group health insurance through your employer and may not need Medicare Part B until you retire. Likewise, if you have health coverage through a spouse’s plan, you may be able to delay enrollment in Medicare Part B. You should verify with Social Security if you can delay Medicare Part B enrollment without a penalty. If your group insurance continues after retirement, you may not need a Medicare supplement policy.
Some employers offer their retirees coverage through a group Medicare supplement policy or a Medicare Advantage employer-sponsored plan. Because health plans work differently, talk to your employer’s benefits coordinator to learn how well the plan covers the gaps in Medicare parts A, B, and Part D prescription coverage. Then make a decision about Medicare supplement insurance.
COBRA Coverage from an Employer Plan
Federal and state law allows employees who leave their jobs to continue their employer-sponsored group health coverage for a certain amount of time. In some cases, you may also continue family coverage through your former employer. If you choose COBRA coverage, you must enroll in Medicare Part B in the first eight months after your employment ends to avoid paying a penalty. You will have two opportunities to buy a Medicare supplement policy. One begins when you first enroll in Part B you will have another opportunity when your COBRA coverage ends under guaranteed issue rights.
Medicare Advantage Plans
Depending on where you live, you may have the option to choose a Medicare Advantage plan. If you are in a Medicare Advantage plan, you don’t need and can’t use a Medicare supplement policy. Medicare Advantage plans provide at least the same benefits as Medicare.
If your Medicare Advantage plan ends its contract in your service area, you have the right to buy Medicare supplement plans A, B, C, F (including Plan F with a high deductible), K, or L, regardless of your medical history or condition. If your Medicare Advantage plan ends, it must give you written notice of your options and tell you how long you have to buy a Medicare supplement policy. The written notice is your proof to the Medicare supplement company of your right to buy Medicare supplement. In Texas, this right is limited to Plan A for people under age 65.
The Medicare open enrollment period from October 15 to December 7 doesn’t apply to Medicare supplement plans. If you drop your Medicare supplement policy, you may not be able to buy a new one.
Medicaid and Medicare Savings Programs
If your income and assets are below a certain level, you might be eligible for Medicaid. Medicaid is a state-administrated federal program that pays for health coverage for people with low incomes. If you qualify for Medicaid, the state will pay your Medicare premiums and out-of-pocket costs. Medicaid will also pay for some services not covered by Medicare. If you receive Medicaid, you don’t need Medicare supplement insurance.
Medicaid-sponsored Medicare Savings Programs may pay Medicare premiums, deductibles, and coinsurance amounts for eligible Medicare beneficiaries. These programs allow Medicare beneficiaries to use their savings to cover other expenses or to buy more coverage.
The Medicare Savings Programs are
- the Qualified Medicare Beneficiary (QMB) program
- the Specified Low-Income Medicare Beneficiary (SLMB) program
- the Qualified Individuals (QI)
- the Qualified Disabled Working Individuals (QDWI) program.
The federal QMB program pays the Medicare Part B premium and covers all Medicare deductibles and copayments for people with incomes below a certain level. You don’t need Medicare supplement insurance if you are in the QMB Program. QDWI pays Medicare Part A premiums. The other plans pay only the Medicare Part B premium.
Texas Health Insurance Pool
The health pool offers health insurance to Texans who can’t find coverage because of their medical condition and to certain people who have recently lost the health care coverage at their job. All pool coverage ends on March 31, 2014.
Your Rights with a Medicare Supplement Plan
Open enrollment for Medicare supplement plans is the one-time only, six-month period during which you may buy a Medicare supplement plan. Companies must sell you a policy - even if you have health problems - if you are at least 65 and apply within six months after enrolling in Medicare Part B. You must have both Medicare parts A and B to buy a Medicare supplement plan.
You can use your open enrollment rights more than once during this six-month period. For instance, you may change your mind about a policy you bought, cancel it, and buy any other Medicare supplement policy.
Although a company must sell you a policy during your open-enrollment period, it may require a waiting period of up to six months before it starts covering your preexisting conditions, unless you are 65 or older and had prior coverage.
Preexisting conditions are conditions for which you received treatment or medical advice from a doctor within the last six months.
Even if you don’t enroll in Medicare Part B right away when you turn 65, you will still receive an open enrollment period when you enroll in Part B. People often delay enrolling for several reasons, including because they still have creditable coverage from an employee group health plan.
Texans with Disabilities
People under age 65 who receive Medicare because of disabilities have a six-month open enrollment period beginning the day they enroll in Medicare Part B. This open enrollment right only applies to Medicare supplement Plan A.
Companies that sell Medicare supplement plans in Texas may not deny you a Plan A policy because you have preexisting conditions. Companies may offer the other plans to Texans with disabilities, but they are not required.
Note: During the first six months after you turn 65 and are enrolled in Medicare Part B, you will have a right to buy any of the 10 plans.
Guaranteed Issue Right
You may have the right to buy a Medicare supplement policy outside of your open enrollment period if you lose certain types of health coverage. To be eligible for the guaranteed issue right, you must provide proof that you lost your health care coverage.
For people over age 65, the guaranteed issue right applies to Medicare supplement plans A, B, C, F (including Plan F with a high deductible), K, and L.
Texans under age 65 with disabilities who enroll in Medicare Part B also have guaranteed issue rights, but they are only eligible for Medicare supplement coverage through Plan A. This guaranteed issue right also applies to people on Medicare who lose Medicaid because of a change in their financial situation.
The guaranteed issue right is good for 63 days from the date coverage ends or from the date of notice that coverage will end, whichever is later. Companies may not place any restrictions, such as preexisting condition waiting periods, or exclusions, on these policies.
For more information about the situations that allow a guaranteed issue right, read Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare or call TDI and ask about guaranteed issue rights to buy a Medicare supplement plan.
30-Day “Free Look”
You can return your Medicare supplement policy within 30 days and get your money back with no questions asked. Be sure to keep a record of the date you received the policy. Read the policy as soon as you get it. If you return the policy to the company, use certified mail with a return receipt to prove that it was returned within the 30-day time limit.
The 30-day "free look" period doesn’t apply to Medicare Advantage. If you drop Medicare supplement to join a Medicare Advantage plan, you may not be able to get your Medicare supplement policy back.
All Medicare supplement policies are guaranteed renewable. A company may not cancel your policy or refuse to renew it unless you made intentional false statements on your application or you didn’t pay your premium.
The amount of the premium is not guaranteed. An insurance company may raise your premium as often as once a year on a class basis. In addition, if you have an attained-age policy, a company may raise your premium on your birthday.
Medicare Supplement Claims
Your doctors and hospitals must submit Medicare claims to the insurance company or the Medicare contractor for you. In most cases, Medicare sends the claim to the Medicare supplement plan company and the company pays the doctor or hospital. If you receive a bill, review your Medicare Summary Notice and what your company paid to see if you owe anything.
Medicare supplement policies pay only for services that Medicare considers medically necessary. If Medicare denies a claim, you have the right to appeal the decision. The appeals process and deadline to request an appeal are described in your summary notice.
Texas law requires insurance companies to pay claims promptly. If your Medicare supplement company refuses to pay a claim for a Medicare-approved charge or delays payment of your claims, you, your doctor, or your hospital may file a complaint with TDI.
Group Medicare Supplement Insurance
Your rights with a group Medicare supplement policy are essentially the same as with an individual policy. Because the group might make decisions that are out of your control, you have the following additional protections:
- If the group changes insurance companies, the new company must offer coverage to everyone who was covered. The new Medicare supplement policy must cover preexisting conditions that the policy covered.
- If you leave the group, the insurance company must offer to provide uninterrupted Medicare supplement coverage with an individual policy or continuation of your group insurance.
- If the group cancels its coverage, the insurance company must offer you either an individual policy with the benefits you had with the canceled policy or offer you a different policy that meets Texas requirements.
Shopping Wisely for Medicare Supplement Insurance
- Buy during your Medicare Part B open enrollment. The best time to buy a Medicare supplement policy is during your Medicare open enrollment period because companies must sell you any plan they offer without looking at your past or present health conditions. Remember that certain situations may give you a guaranteed issue right to buy a policy.
- Shop around. Prices can vary considerably. Use the rate guide section of this handbook to understand what factors companies use to set premiums and to compare rates.
- Consider other factors. Price should not be your only consideration. You can learn a company´s complaint record and A.M. Best financial rating by calling TDI´s Consumer Help Line. Both can tell you a lot about the service you can expect from a company. Also ask family and friends if they have had any experiences with the companies you are considering.
- Consider your needs. Although it is illegal to sell you more than one Medicare supplement policy, insurance companies may offer other policies with benefits that work differently than Medicare supplement coverage. These include cancer, specified disease, hospital indemnity, and long-term care policies. Any duplication of benefits must be disclosed in writing. In general, duplicate coverage is a waste of your money because you are paying twice for the same coverage.
- Make sure the agent and company are licensed. You can verify company and agent licenses by calling TDI´s Consumer Help Line.
- Try to buy from an agent you know and trust. Ask friends or family for recommendations.
- Ask questions and take notes when you talk to an agent. These could help you later if there is a dispute over what you were told about a policy.
- Don't buy a policy on the agent's first visit. Invite someone you trust to be present during the second visit. An agent shouldn't object.
- Be careful dropping plans. If you decide to drop your Medicare supplement plan to join a Medicare Advantage plan, your agent needs to cancel the policy.
- If an agent tries to rush you, be suspicious. Tell the agent you need more time.
- Read what you are asked to sign before you sign it. Never sign a blank application form.
- Get the names and addresses of the agent and the insurance company. Know how to contact the agent and the company with questions.
- Answer all questions on the application accurately. If an agent helps you complete the application, make sure the information is correct and complete before you sign. Leaving out information or lying could enable the company to deny your claims or cancel your policy.
- Don’t pay cash or make a check out to an agent. Make checks payable only to the insurance company. Always pay by check or money order so you have a clear record of payment. Ask for a receipt on the company's letterhead that the agent has signed.
- Before making a lump-sum payment, ask the agent or company about reimbursement of unearned premium. This is especially important during the open enrollment period when you have the right to change companies. Unearned premium is what you paid in advance for premiums that the company hasn’t used to buy coverage.
- Read your policy carefully when you receive it. You can return a Medicare supplement policy for any reason within 30 days and receive a full refund.
- Pay premiums on time. A company may cancel a policy if you don’t pay your premiums. Read your policy’s notice on payment of premiums, grace periods, and cancellations.
Agents and companies who engage in any of the following activities are breaking the law:
- Knowingly making misleading statements to encourage you to drop a policy and buy a replacement from another company. This is called twisting.
- Using high-pressure tactics, including the use of force, fright, or threat to pressure you into buying a policy.
- Getting sales leads through advertising that hides the fact that an agent or company may try to sell you insurance. This is called cold lead advertising.
- Using misleading advertisements made to look like mail from the government by using eagles or similar graphics or a return address with a name that sounds like an official government agency or bureau.
- Acting as a representative of Medicare or a government agency.
- Selling you a Medicare supplement policy that duplicates Medicare benefits or health insurance coverage you already have. An agent is required to review and compare your other health coverages.
- Suggesting that you falsify an answer on an application.
If you believe that an agent or company has engaged in unfair and illegal practices, file a complaint with TDI.
The companies in the rate guide are licensed to sell their Medicare supplement plans in Texas. Companies that offer Medicare Select only sell in certain areas of the state.
For information about a company’s plans, call the company at the toll-free number listed in the guide or call an agent. Check your phone book for the phone numbers of agents in your area. If a company has a website, the address is included in the guide.
The rate guide includes only companies that are actively selling Medicare supplement plans. If you can’t find your plan in the guide, your company may no longer be selling the plan you purchased. Be careful switching plans because a company can charge you more through underwriting or could refuse to sell a policy even if you dropped your old policy to buy a new one.
Organization of the Rate Information
The rate guide is organized into separate rate tables for each of the 10 Medicare supplement plans. The tables include an alphabetical listing of the companies selling that particular plan, along with policy information and rate estimates for people of various ages.
Information in the Rate Tables
Rates: The rates are estimates that companies give to TDI. The first number in the range is the lowest estimated annual premium and the second number is the highest estimated annual premium. Your premium should fall somewhere within the range.
The exact premium you will pay will likely be different from the estimates and will be based on your individual circumstances. Rates also vary if you pay monthly or quarterly. The rates listed assume that you pay your annual premium in one lump sum. To learn the exact premium you would pay, call your agent or the company.
If you have an issue-age policy, your premiums are based on your age at the time your policy is issued.
Companies may increase issue-age policy premiums once during your first year of coverage. After that, the company may not increase the premium for 12 months. If you have an attained-age policy, your premium could increase within the first 12 months and will increase on your birthday. Few, if any, companies in Texas offer community rated policies, which charge the same rate to all policyholders.
Some companies base rates on the ZIP code where you live. Medicare supplement rates are set by insurance companies, and are subject to approval by TDI. Companies can obtain approval for rate increases at any time during the year.
Age: Rates are shown for people buying a plan at ages 65, 70, and 75. You should compare costs at different ages. For people under 65 with disabilities, only one rate estimate is given.
Preexisting conditions: In most cases, an insurance company may impose a waiting period of up to six months before it covers preexisting medical conditions. The number of months you must wait before a policy covers preexisting conditions is shown in the column labeled “Preex Wait” in the rate tables.
If you move from one Medicare supplement policy to another, the time you were covered under your prior policy will be credited toward your preexisting condition waiting period. If you have had a policy for at least six months, your new policy will not have a waiting period for preexisting conditions. If you are 65 or older, had an employer health insurance plan for at least six months, and purchase a Medicare supplement policy within 63 days of leaving your employer plan, you should not have a waiting period for preexisting conditions.
Group plans: You must be a member of a group, association, or organization to get group insurance coverage. In general, rates for group coverage are lower than rates for individual policies. Group plans in the rate guide are listed by plan letter after the individual policies.
Disability under age 65 and other plans: This table lists companies that offer additional plans to people under age 65 with disabilities. Since Texas law requires companies selling Medicare supplement policies to offer Plan A, people with disabilities must meet a company’s guidelines to be eligible for any of the additional plans the company offers.
Rate Table Key
Rates and policies vary according to several factors. Each one is given a different symbol in the guide:
AA Attained Age means the price of this policy will automatically increase each year on your birthday. This increase will be in addition to any general premium increase by the company. In most cases, plans not marked with AA are Issue Age policies. Issue Age means your premiums are based on your age at the time you buy.
AR Area Rated means the company has different rates for different areas of the state. Call the company or ask the agent to learn the rates charged in your area.
GR Gender Rated means the company charges different rates for females and males.
NS Nonsmoker means the company charges smokers higher premiums than nonsmokers.
MS Medicare Select means health care services are provided only through a specific list of network doctors and hospitals under contract with the insurance company. Medicare Select policies are not available in every area. You must live in the plan’s service area to join.
Preex Wait Preexisting waiting period shows the number of months of coverage that may be excluded unless it's waived by prior coverage. This may never be longer than six months.
Helpful Telephone Numbers and Websites
For basic Medicare eligibility and benefits questions or information about Medicare Advantage plan options available by county or ZIP code, call Medicare at 1-800-MEDICARE (633-4227) or visit Medicare’s website at www.medicare.gov and select the “Health & Drug Plans” icon.
For Medicare claims or denial of service, use the contact information in the Medicare Summary Notice. The Health Information Counseling and Advocacy Program (HICAP) can assist you with a denial of services or costs. To reach a benefits counselor at the Area Agencies on Aging or to learn about Medicare education events in your area, call the Texas Department of Aging and Disability Services (DADS) at 1-800-252-9240 or visit its website at www.dads.state.tx.us.
For information about your rights and public assistance benefits, call the Legal Hot Line for Texans at 1-800-622-2520 or visit its website at www.tlsc.org.
For information about Medicaid or Medicare Savings programs that help Medicare beneficiaries with low incomes, dial 211 or call the Texas Health and Human Services Commission Office of the Ombudsman Customer Service Line at 1-888-834-7406.
For answers to general insurance questions, for information on filing an insurance-related complaint, or to report suspected insurance fraud, call the Consumer Help Line at 1-800-252-3439 or 512-463-6515 in Austin between 8 a.m. and 5 p.m., Central time, Monday-Friday, or visit our website at www.tdi.texas.gov.
For printed copies of consumer publications, call the 24-hour Publications Order Line at 1-800-599-SHOP (7467) or 512-305-7211 in Austin.
To report suspected arson or suspicious activity involving fires, call the State Fire Marshal’s 24-hour Arson Hotline at 1-877-4FIRE45 (434-7345).
This publication has been created or produced by Texas with financial assistance, in whole or part, through a grant from the Centers for Medicare & Medicaid Services, the Federal Medicare agency.
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