What is Medicare?

Medicare is a national health insurance program for people age 65 or older, people of all ages with disabilities, and people with End-Stage Renal Disease (ESRD) or Lou Gehrig's Disease (ALS).

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.

Medigap plans in Texas are available without medical underwriting during your initial enrollment period. The initial enrollment period is the time you become eligible for Medicare Part B. Outside of the initial enrollment period you may apply at any time by answering medical underwriting questions.

In Texas there are multiple companies that sell Medigap plans and we represent the majority of them. It is important to us that we offer the best available products and value to our clients.

Medicare Supplemental Insurance

Medicare Supplement Insurance, also referred to as Medigap and Medsupp, is specifically designed to do just that; supplement Medicare's benefits. Medicare supplement plans are regulated by both Federal and State law. The insurance plans must be clearly identified as Medicare Supplemental insurance and it must provide specific benefits that help fill the gaps in Original Medicare coverage. There are other insurance plan types that may help you with out-of-pocket health care costs, but they do not qualify as Medigap plans.

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What is Medicare?

Medicare is a national health insurance program for people age 65 or older, people of all ages with disabilities, and people with End-Stage Renal Disease (ESRD) or Lou Gehrig's Disease (ALS). 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:

Doctor

Hospital Insurance
(Part A)

helps pay for care in a hospital, skilled nursing facility, some home health care, and hospice care.

Deductible
$1,632

Part A Premium
Doctor

Medical Insurance
(Part B)

helps pay for doctor bills, outpatient hospital care and other medical services not covered by Part A.

Deductible
$240

Part B Premium

* Part B annual increases are based on Part B medical cost increases and are related to income levels.

Medicare Deductible and Coinsurance Amounts for 2024

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 (2024 = $1,632) 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 $1,632 for a hospital stay of 1-60 days.
  • $408 per day for days 61-90 of a hospital stay.
  • $816 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

  • $204 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

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

  • Medigap Plan G offers a high deductible option. You must pay for Medicare-covered costs up to the high-deductible amount ($2,800 in 2024) before your Medigap policy pays anything.
  • 100% part B coinsurance except up to $20 copayment for office visits and up to $50 copayment for ER.
  • You must also pay a separate $250 deductible for foreign travel emergency and there is a $50,000 lifetime maximum benefit.
  • After you meet your out-of-pocket yearly limit and your yearly Part B deductible ($174.70 in 2024) 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].
  • Modified Plan F offers an individual assistance program, as well as coverage for preventive dental care (available in some states).
  • 2024 Out of Pocket Limit for Plan K is $7,060 .
  • 2024 Out of Pocket Limit for Plan L is $3,530.

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 the 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.