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Medigap Coverage

Medicare Supplements - solid coverage from trusted companies.

* Age at Start Date

Initial Enrollment Period

The Initial Enrollment Period (IEP) for Parts A and B is 7 months, starting 3 months before the month of your Medicare eligibility and ending 3 months after the month of eligibility. The month of eligibility is the month of your 65th birthday, if you become eligible for Medicare because you are turning 65 years old.

You simply choose the company and plan that you want with no underwriting.

Special Election Period

You may enroll in a medicare supplement plan without medical underwriting for any of the following reasons:

  • Loss of coverage
  • Moved to new area or state
  • Trial Right: You joined a Medicare Advantage Plan when you were first eligible for Medicare Part A at 65, and within the first year of joining, you decide you want to switch to Original Medicare

Simply Want to Change?

If for some reason you just want to change plans or companies you need to understand that it is most likely that you will have to complete a full health questionnaire as part of your application and have your application underwritten by the company. There is no guarantee that the policy will be issued by the new company. DO NOT cancel your existing coverage until your new policy has been issued.

Texas Medigap Coverage

From Houston to Plano, San Antonio to Corpus Christi, Dallas/Ft. Worth to Austin, El Paso to Arlington, Amarillo, Beaumont, Brownsville, Denton, Frisco, Garland, Irving, Laredo, Lubbock, Pasadena or Waco it is important that you find the medicare coverage that fits your life and your lifestyle. We feel that the best care is received when you have your choice of Doctors, and you and your Doctor make your medical decisions. Medigap plans in Texas are available with no medical underwriting during your initial enrollment period. This is when you become eligible for Medicare Part B. You may however, apply to a company and fill out the medical underwriting questions at any time.

Medicare Supplemental Insurance (Medigap or MedSup) is specifically designed to supplement Medicare's benefits and is regulated by federal and state law, It must be clearly identified as Medicare Supplemental Insurance and it must provide specific benefits that help fill the gaps in your Medicare coverage. Other kinds of insurance may help you with out-of-pocket health care costs but they do not qualify as Medigap plans.

In Texas there are a lot of companies that sell Medigap Plans and we represent many of them. It's important to us that we can offer the best value to our clients.

What is Medicare?

Medicare is a national health insurance program for people 65 years of age and older, certain younger disabled people and people with permanent kidney failure. Medicare is run by the Centers for Medicare & Medicaid Services. The Social Security Administration helps CMS by enrolling people in Medicare and by collecting Medicare premiums.

Medicare is divided into two parts: Hospital Insurance (Part A) and Medical Insurance (Part B). Part A helps pay for care in a hospital, skilled nursing facility, some home health care, and hospice care. Part B helps pay for doctor bills, outpatient hospital care and other medical services not covered by Part A. Your Medicare card shows the Medicare coverage you have--Hospital Insurance (Part A), Medical Insurance (Part B), or both--and the date your coverage started.

The 2016 Medicare Part A deductible is $1,288 and the 2016 Part B deductible is $166. Part B annual increases are based on Part B medical cost increases and are related to income levels.

How much does Medigap coverage cost?

"The Cost of Medigap policies can vary widely. There can be big differences in the premiums that insurance companies charge for exactly the same coverage."

From the page 19 of the Federal Choosing A Medigap Policy Brochure

Medicare Premiums for 2016:

Part A: (Hospital Insurance) Premium

  • Most people do not pay a monthly Part A premium because they or a spouse has 40 or more quarters of Medicare-covered employment.
  • The Part A premium is $226.00 per month for people having 30-39 quarters of Medicare-covered employment.
  • The Part A premium is $411.00 per month for people who are not otherwise eligible for premium-free hospital insurance and have less than 30 quarters of Medicare-covered employment.

Part B: (Medical Insurance) Premium

Most existing beneficiaries will be "held harmless" and will pay $104.90 in 2016. Beneficiaries not subject to the “hold harmless” provision will pay $121.80, as calculated reflecting the provisions of the Bipartisan Budget Act signed into law by President Obama last week. Medicare Part B beneficiaries not subject to the “hold-harmless” provision are those not collecting Social Security benefits, those who will enroll in Part B for the first time in 2016, dual eligible beneficiaries who have their premiums paid by Medicaid, and beneficiaries who pay an additional income-related premium. These groups account for about 30 percent of the 52 million Americans expected to be enrolled in Medicare Part B in 2016. 

If your income is above $85,000 (single) or $170,000 (married couple), then your Medicare Part B premium may be higher than $121.80 per month. 

Medicare Deductible and Coinsurance Amounts for 2016:

Part A: (pays for inpatient hospital, skilled nursing facility, and some home health care) For each benefit period Medicare pays all covered costs except the Medicare Part A deductible (2016 = $1,288) during the first 60 days and coinsurance amounts for hospital stays that last beyond 60 days and no more than 150 days.

For each benefit period you pay:

  • A total of $1,288 for a hospital stay of 1-60 days.
  • $322 per day for days 61-90 of a hospital stay.
  • $644 per day for days 91-150 of a hospital stay (Lifetime Reserve Days).
  • All costs for each day beyond 150 days

Skilled Nursing Facility Coinsurance

  • $161 per day for days 21 through 100 each benefit period.

Part B covers Medicare eligible physician services, outpatient hospital services, certain home health services, durable medical equipment

  • $166.00 per year. (Note: You pay 20% of the Medicare-approved amount for services after you meet the $166.00 deductible.)

Enrollment in Medicare is handled in two ways: either you are automatically enrolled or you must apply. If you are getting Social Security or Railroad Retirement Board benefits before you turn 65, you are automatically enrolled and your Medicare card will be mailed to you about three months before your 65th birthday. If you are not receiving retirement benefits, you must apply by contacting a Social Security Administration office or, if appropriate, the Railroad Retirement Board. You should apply three months before your 65th birthday to avoid a possible delay in the start of your coverage. If you have been a disabled beneficiary under Social Security or Railroad Retirement for 24 months, you will automatically get a Medicare card in the mail.

Additional Medigap Information

  1. Medigap Plan F offers a high deductible option. You must pay for Medicare-covered costs up to the high-deductible amount ($2,180 in 2016) before your Medigap policy pays anything
  2. 100% part B coinsurance except up to $20 copayment for office visits and up to $50 copayment for ER.
  3. You must also pay a separate $250 deductible for foreign travel emergency and there is a $50,000 lifetime maximum benefit.
  4. After you meet your out-of-pocket yearly limit and your yearly Part B deductible ($166 in 2016) the plan pays 100% of covered services for the rest of the calendar year (This applies only to plans K & L) - [Excess charges do to apply to maximum out of pocket]
  5. Modified Plan F offers an individual assistance program, as well as coverage for preventive dental care (available in some states)
  6. 2016 Out of Pocket Limit for Plan K is $4,960.
  7. 2016 Out of Pocket Limit for Plan L is $2,480.

Initial Enrollment

  • You must be enrolled in both Medicare Part A and Medicare Part B and live in the plan's service area to be eligible for these plans.
  • You are first eligible during the 7-month Initial Coverage Enrollment Period (ICEP), the 3 months before your 65th birthday, the month of, and 3 months after. CAUTION: You only have one choice so take your time, ask for help and choose wisely.
  • You must continue to pay your Medicare Part B premium in addition to any plan premium shown below.

About Information Presented

  • This is a web site from CDA Insurance LLC. CDA Insurance LLC is not an insurance carrier, we are an agency that represents many companies offering products to the general public and also to medicare recipients. We do our best to assure that all information presented on our web site is current and accurate.
  • CDA Insurance LLC is not associated with Medicare or the Center for Medicare and Medicaid Services. This is not a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE or consult www.medicare.gov.
  • A Medicare Supplement plan is a health insurance plan provided by a private company that fills in the “gaps” in original Medicare coverage. CDA Insurance LLC is an agency that sells Medicare Supplement plans to medicare beneficiaries. Submitting our online quote request form does NOT affect your current enrollment, nor will it enroll you in a Medicare Supplement plan or other Medicare plans. To apply for coverage you must submit an application for the company and plan that you want.