Texas Medicare Benefits 

Ok, so now you look up and you are turning 65 in a few months, or maybe even you’re over 65 but still confused about all this Medicare talk. It’s ultra confusing. What’s a senior to do? You have lived all your life preparing for these retirement years, we know that. That’s why we are providing information in an effort to allow you to understand exactly what your getting into with Medicare and to hopefully make all this easier to understand.

 Part A

Medicare has several components, some provided free of charge based on taxes you or your spouse paid back while you were working, and some parts that require a monthly fee. Let’s first talk about the free one, we all like free when we are on a fixed income. Part A of your Texas Medicare Benefits is commonly referred to as your hospital insurance. Again, this is the free coverage and if you never elect any other options you at least will have some hospital coverage if anything bad happened to you medically. There are some limits on this coverage and in no way should be considered unlimited. I would like to post a chart for you to review, however it seems the only approved charts are more dedicated to sales brochures and not designed for information purposes. 

Sample of Texas Part A Benefits 2013 

Deductible: $1184

After 61 Days in Hospital: You pay $296 Day

After 91 Days in Hospital: You pay $592 Day

After 151 Days in Hospital: No Coverage

You also receive a limited amount of Skilled Nursing Facility Care 

That sums up Part A for the most part, there are other benefits provided that I did not mention like hospice care and a few other covered charges but for the most part it is considered hospital coverage. Also, the deductible is “per benefit period” not calendar year that most people under 65 are accustomed to. A benefit period means out of hospital or no skilled nursing or other facility for 60 days. After that a new deductible start up again.

 Part B Coverage

The next component of Texas Medicare Benefits is known as Part B coverage. This one you must purchase from the federal government and in most cases is taken from your monthly Social Security check. Most times you are auto enrolled in this benefit but we recommend about 3 months before turning 65 you contact Social Security and confirm that benefit is elected. 

Currently the monthly cost of Part B is $104.90 a month for 2013. You could pay more based on income so again, contact Social Security for your exact amount and this charge can go up every year. Last year (2012) the premium was $99.90. 

Part B of Texas Medicare is a benefit you should strongly consider. This benefit is what Medicare calls medical insurance and pays some of your medical test and doctor visits. Also, if you’re thinking of purchasing Texas Medicare Supplement coverage, which is also known as a MediGap policy you must have Part B.

Long and the short of it, Part B has a $147 yearly deductible and also only pays out at 80% leaving you with digging in your wallet for the remaining 20%. That could get a little pricey considering the cost of current medical procedures. Again, this benefit is not mandatory but without it you will be stuck with almost all your out patient cost so we suggest electing this benefit. If you choose not to elect this benefit when you are first eligible and choose not to there will be a penalty to join at a later date. This monthly premium penalty should also make you think twice about not electing the coverage.

 Texas Medicare Part D

Back in 2003 the President pushed a plan called Medicare prescription drug program. They call it Texas Medicare Part D, these plans are offered by private insurance companies and they also have a premium penalty if you choose not to sign up upon turning 65 or become eligible. 

These plans are easy to do and you can change year to year always searching the best plan for the upcoming year. The bottom line on Part D coverage, you can choose plans that have prescription co-pays at the local pharmacy. There are a few pitfalls with this benefit and congress is attempting to address some of them in the Health Care Reform law just recently passed by congress like the big one called the doughnut hole. The doughnut hole is a brief period a senior could find themselves without benefits until additional money has been spent by you. One of these days they will get that thing closed and for that heavy prescription using seniors will be better off. 

Ok, you wake up one morning and your spouse ask you what you want for you birthday which lets say is about 4 or 5 months away, then it dawns on you WOW!, your turning 65 in a few months, besides possibly retiring from work you have a few things that will happen related to insurance, lets discuss them. 

First, you will start to notice that a few trees must have been destroyed because every insurance company and agent known to man is sending you information in the mail attempting to jam a Texas Medicare Supplement policy down your throat. I have visited with folks turning 65 that have received no less that 25 pounds of mail devoted to MediGap coverage, none of it all that easy to understand but they send it anyway. Oh, you also notice you phone may start ringing day and night. Why is all this happening? Simple, you are reaching that magic age to elect a supplemental policy without any medical underwriting. It’s almost comical. 

Here is what you should do. First, relax and take your time. We suggest starting your search somewhere around 3 months before you turn 65 and hopefully you can have a policy in place to start the first day of the month you turn 65 about 2 months before you hit that magic age. Take al look at your choices, some websites provide instant Texas Medicare Supplement Quotes like this one. Another option is find a qualified independent broker to handle the process for you, that way they can “hold your hand” through this potentially confusing maze. They should be able to find you the lowest cost option based on what type of coverage you want. From there, as long as you have elected Part B of Medicare you can sit back and enjoy all you have worked hard for.