Medicare Supplements Overview


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To understand how Medicare Supplements work it’s important to first understand how Medicare works and the various supplementary options available to you. You can gather a lot of this information through the 4 Medicare guides (shown below) updated each year by the Centers for Medicare & Medicaid Services (CMS):


Medicare at a Glance	Medicare & You	Choosing a Medigap Policy	Guide to Medicare Preventive Services

Medicare consists of two primary medical benefit offerings labeled as Part A & Part B. These services are available to adults age 65 and older and people under age 65 who have qualified for Medicare due to a disability. Medicare has recently also offered Part D which is Medicare’s prescription drug plan benefit and Plan C which is called Medicare Advantage.

Medicare Supplement Information Center

2008 Medicare Part A & Part B Information

Standard Medicare Supplement Plans Chart

Medicare Supplement Guaranteed Issue Events Chart

Medicare FAQ

2008 Medicare Part A & Part B Information

The following is a listing of the Medicare premium, deductible, and coinsurance rates that will be in effect in 2008.

Medicare Premiums for 2008:

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 $433.00 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

$96.40 per month *
* Your monthly premium will be higher if you file an individual tax return and your annual income is more than $82,000, or if you are married (file a joint tax return) and your annual income is more than $164,000.

* The chart below shows the Part B monthly premium amounts based on income. These amounts change each year. There may be a late-enrollment penalty.

You Pay	If Your Yearly Income is
	Single	Married Couple
$96.40	$82,000 or less	$164,000 or less
$122.20	$82,001-$102,000	$164,001-$204,000
$160.90	$102,001-$153,000	$204,001-$306,000
$199.70	$153,001-$205,000	$306,001-$410,000
$238.40	Above $205,000	Above $410,000

You Pay	If You Are Married but You File a Separate Tax Return From Your Spouse and Your Yearly Income is
$96.40	Under $82,000 or less
$199.70	$82,001-$123,000
$238.40	Above $123,000

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Medicare Part A & Part B Deductible and Coinsurance Amounts for 2008:
Part A: (pays for inpatient hospital, skilled nursing facility, & some home health care)

For each benefit period Medicare pays all covered costs except Medicare Part A deductible (2008 = $1024) during the first 60 days & 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 $1024 deductible for a hospital stay of 1-60 days.
$256 per day for days 61-90 of a hospital stay.
$512 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

100% Coverage For Days 1-20
$128.00 per day for days 21 through 100 each benefit period.
All costs beyond 100 days

Part B: Covers Medicare eligible physician services, outpatient hospital services, certain home health services, and durable medical equipment. days.

For each benefit period you pay:

$135 Calendar Year Deductible
After annual deductible, you pay 20% of the Medicare approved amount for services.

Medicare was never designed to pay all of your hospital and medical expenses. At Texas Health & Life, our primary focus is to help you select the Texas Medicare Supplement insurance plan that is best suited for your personal situation. We invite you compare and save on your Medicare Supplement Insurance coverage. As one of the leaders in Medicare Supplement Insurance in Texas you can depend on us to provide you with an easy-to-understand overview of Medicare and Medicare Supplements and guide you to selecting the best policy for you at the lowest rate available from multiple Texas Medigap providers.

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Standard Medicare Supplement Plans Chart

STANDARD MEDICARE SUPPLEMENT PLANS

CORE BENEFITS

K**

L***

Hospital coinsurance:
Days 61 to 91

●

Hospital coinsurance:
Days 91 to 150

●

Hospital Payment in full:
365 additional days

●

Part A and Part B blood deductible:
First three pints of blood

●

50%

75%

Part B 20% coinsurance:
Physician and other services

●

50%

75%

ADDITIONAL BENEFITS

K**

L***

SNF coinsurance:
Days 21 to 100 - $119 per day in 2006

●

50%

75%

Part A Hospital Deductible:
$952 in 2006

●

50%

75%

Part B Annual Deductible:
$124 in 2006

●

Part B Excess Charges:
Coverage for up to 115% percent of Medicare's approved charge (Medigap policy will either pay 80% or 100% of excess charge)

100%

80%

100%

Foreign Travel Emergency:
$250 deductible, 80% of the cost of emergency care during the first two months of the trip, $50,000 lifetime limit

●

At-Home Recovery:
Maximum benefit of $1,600 annually

●

*Effective 1/1/06, plans H, I, and J can no longer be sold with prescription drug benefits. Beneficiaries who purchased these plans before 1/1/06 are allowed to renew them and to retain the plans’ prescription drug benefits.

** Plan K covers 100% of cost sharing for Medicare Part B preventive services and 100% of all cost sharing under Medicare Parts A and B for the balance of the calendar year once an individual has reached the out-of-pocket limit on annual expenditures of $4,000 in 2006.

** Plan L covers 100% of cost sharing for Medicare Part B preventive services and 100% of all cost sharing under Medicare Parts A and B for the balance of the calendar year once an individual has reached the out-of-pocket limit on annual expenditures.

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2008 MEDIGAP DEDUCTIBLE AMOUNT FOR HIGH DEDUCTIBLE POLICY OPTIONS
CMS released the 2008 deductible amount for Medigap high deductible plans F & J; effective January 1, 2008, the annual deductible amount for those two plans is $1,900. The high deductible amount for Medigap plans F and J is updated each year and is based on the August CPI-U figures released by the Bureau of Labor Statistics. The full text of the announcement is available on the CMS website at: http://www.cms.hhs.gov/Medigap/. This figure represents the out-of-pocket expense, excluding premiums, that a beneficiary must incur before the policy begins paying any benefits. Under the high deductible option, policies pay 100% of covered out-of-pocket expenses once the deductible has been satisfied in a year. Note, the high deductible option for benefit packages F or J was added by Section 4032 of the Balanced Budget Act of 1997, Sec. 1882(p) of the Social Security Act, 42 U.S.C. 1395ss(p).

Medicare Supplement Guaranteed Issue Events Chart

Guaranteed issue right situation… Your Medicare Advantage Plan is leaving the Medicare Program, stops giving care in your area, or you move out of the plan’s service area.	You have the right to buy … Medigap Plan A, B, C, or F, K, or L that is sold in your state by any insurance company. For this right you must switch to the Original Medicare Plan.	When you apply for a Medigap policy… You can apply up to 60 calendar days before the date your health care coverage will end. You must apply no later than 63 days after your health care coverage ends.
You are in the Original Medicare Plan and have an employer group health plan or union coverage that pays after Medicare pays, and that coverage is ending. This includes retiree or COBRA coverage. Note: in this situation state laws may vary.	Medigap Plan A, B, C, F, K, or L that is sold in your state by any insurance company.If you have COBRA coverage you can either buy a Medigap policy or wait until the COBRA coverage ends.	You must apply 63 calendar days after the latest of these three dates. date the coverage ends, date on the notice that coverage is ending (if you get one), or date on claim denial, if this is the only way you know that your coverage is ending.
You are in the Original Medicare Plan and have a Medicare SELECT policy. You move out of the Medicare SELECT plan’s service area.You can keep your Medigap policy or you may want to switch to another Medigap policy.	Medigap Plan A, B, C, F, K, or L that is sold by any insurance company in your state or the state you are moving to.	You can apply up to 60 calendar days before the date your health care coverage will end. You must apply no later than 63 days after your health care coverage ends.
Trial Right: You joined a Medicare Advantage Plan or PACE when you are first eligible for Medicare Part A at age 65 and within the first year of joining, you decide you want to switch to the Original Medicare Plan.	ANY Medigap policy that is sold in your state by any insurance company.	You can apply up to 60 calendar days before the date your health care coverage will end. You must apply no later than 63 days after your health care coverage ends. Note: Your rights may last for an extra 12 months under certain situations.
Trial Right: You dropped a Medigap policy to join a Medicare Advantage Plan (or to switch to a Medicare SELECT policy) for the first time; you have been in the plan less than a year and want to switch back.	The Medigap policy you had before you joined the Medicare Advantage Plan or Medicare Select policy, if the same insurance company you had before still sells it. If it included drug coverage, you can still get that same policy, but without the drug coverage.If your former Medigap policy isn’t available, you can also buy a Medigap Plan A, B, C, F, K, or L that is sold in your state by any insurance company.	You can apply up to 60 calendar days before the date your health care coverage will end. You must apply no later than 63 days after your health care coverage ends. Note: Your rights may last for an extra 12 months under certain circumstances.

Your Medigap insurance company goes bankrupt and you lose your coverage, or your Medigap policy coverage otherwise ends through no fault of your own.	Medigap Plan A, B, C, or F, K, or L that is sold in your state by any insurance company.	You must apply 63 calendar days from the date your coverage ends.
You leave a Medicare Advantage Plan or drop a Medigap policy because the company hasn’t followed the rules, or misled you.	Medigap Plan A, B, C, or F, K, or L that is sold in your state by any insurance company.	You must apply 63 calendar days from the date your coverage ends.

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Medicare Supplement / Medigap
Frequently Asked Questions

Why do I Need a Medicare supplement or “Medigap” policy?
You may need to supplement Medicare Coverage for one or more of the following reasons:

Medicare was never designed to pay all the health care costs of the elderly.
Medicare coverage has many gaps.
Medicare deductibles increase every year.

What are Medigap policies?
Medicare supplemental insurance policies sold by private insurance companies to fill "gaps" in Original Medicare Plan coverage. Except in Massachusetts, Minnesota, and Wisconsin, beneficiaries may choose from 12 standardized policies labeled Plan A through Plan L. Medigap policies work only with the Original Medicare Plan. View the Standard Medicare Supplement Plans Chart for information on what’s covered by each plan.

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How do I get a quote for Medigap (Medicare Supplement Coverage)?
Simply click here to request your quote! One of our Medigap agents will contact you at your convenience, or for faster service call us toll free in at 1-877-363-3442.

When is Medicare’s Initial Enrollment Period?
The Initial Enrollment Period begins 3 months before the month a beneficiary turns 65 and ends 3 months after the month the beneficiary turns 65. If beneficiaries wait until they are 65 or sign up during the last 3 months of the Initial Enrollment Period, their Medicare Part B start date will be delayed.

What is the Medigap open enrollment period?
The 6-month period that begins the first day of the month in which a beneficiary is both age 65 or older and enrolled in Medicare Part B. During this period you right to purchase a Medicare supplement policy is guaranteed.

What is the Medigap open enrollment period? What are guaranteed issue or “Medigap Rights”?
A beneficiary's rights, in certain situations, in which insurance companies are required by law to sell a Medigap policy. In these situations an insurance company can't deny the beneficiary insurance coverage or place conditions on a policy, must cover all preexisting conditions, and can't charge more for a policy because of the beneficiary's past or present health problems. (See: Choosing a Medigap Policy: Guide to Health Insurance for People with Medicare).

What is Medicare’s “General Enrollment Period?”
If a beneficiary did not enroll in Part B when first eligible for Medicare, he or she may sign up during the General Enrollment Period that runs from January 1 through March 31 of each year (January 1 through June 30 in 2002). The cost of Part B may go up 10 percent for each 12-month period that the beneficiary could have had, but did not have, Part B. The beneficiary may have to pay this extra amount as long as they have Part B.

What is the "Part B" Medicare monthly premium for 2008?
The Medicare Part B premium amount for 2008 has been announced by the Department of Health and Human Services (HHS). This premium paid by beneficiaries enrolled in Medicare Part B, covers physician services, outpatient hospital services, certain home health services, durable medical equipment and other items. The Medicare Part B monthly premium will be $96.40 in 2008, increase of $2.90 from the 2007 $93.50 premium.

Will Medicare cover my medical expenses outside of the U.S.?
Persons living or traveling outside the United States usually cannot benefit from Medicare. This is because, generally speaking, the program provides protection against the cost of hospital and medical expenses incurred in the United States.
There are rare emergency cases where Medicare can pay for care for those who travel to Canada or Mexico. Also, Medicare can sometimes pay if a Canadian or Mexican hospital is closer to your home than the nearest U.S. hospital that can provide the care you need.

If you get emergency treatment in a Canadian or Mexican hospital or if you live near one, ask someone who works at the hospital about Medicare coverage, or have the hospital help you contact the Medicare Intermediary.

Health insurance protection may be very important to anyone temporarily abroad who plans to return to the United States. If you plan to return to the United States shortly after you are eligible for the medical insurance program, you may wish to enroll during your first enrollment period. If you expect to be abroad for a longer period of time, you may wish to enroll during a later general enrollment period.

Which type of Medigap plan is best for me?
This depends on your personal preferences, needs and requirements. Consideration should be given to benefits, cost, your economic situation, and current health. An e-Medigap agent can answer your questions and provide you with the information you need to make a wise healthcare choice.

Where can I get more information?
Click here to go to our Quote Request form or call (877) 363-3442 to speak with one of our agents between 8a-6p M-F.