Each Texas Medicare Supplement Insurance policy option is made up of a certain combination of basic benefits. Use the following chart to determine which plan has the right benefits for you.
How to read the chart:
If an X appears in the column of this chart, the Medigap policy covers 100% of the described benefit. If a row lists a percentage, the policy covers that percentage of the described benefits. If a row is blank, the policy doesn’t cover that benefits. Note: The Medigap policy covers coinsurance only after you have paid the deductible (unless the Medigap policy also covers the deductible).
|Medicare Part A Coinsurance||X||X||X||X||X||X||X||X||X||X|
|Medicare Part B Coinsurance||X||X||X||X||X||X||50%||75%||X||X***|
|Blood (1st 3 Pints)||X||X||X||X||X||X||50%||75%||X||X|
|Part A Hospice Care Coinsurance or Copayment||X||X||X||X||X||X||50%||75%||X||X|
|Skilled Nursing Facility Coinsurance||X||X||X||X||50%||75%||X||X|
|Medicare Part A Deductible||X||X||X||X||X||50%||75%||50%||X|
|Medicare Part B Deductible||X||X|
|Medicare Part B Excess Charges||****100%||****100%|
|Foreign Travel Emergency||X||X||X||X||X||X|
|Out of Pocket Limit $4940||Out of Pocket Limit $2470|
*Plan F also offers a high-deductible plan. If you choose this high-deductible version, this means you must pay for Medicare-covered costs up to the deductible amount of $2140 (in 2013) before your Medigap plan pays anything.
**After you meet your yearly Part B deductible ($147 in 2015), the Medigap plan pays 100% of covered services for the rest of the calendar year.
***Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don’t result in an inpatient admission.
****Pays 100 percent of the excess fees, which are limited to 15 percent above the Medicare-approved amount
Texas Medicare Supplement Glossary of Terms:
Part A Coinsurance – Pays the daily hospital coinsurance for days 61 – 150, plus an additional 365 days at 100% of Medicare eligible expenses
Part B Coinsurance – this covers the 20% that Medicare doesn’t cover for Part B (outpatient) expenses
Blood – pays for the first 3 pints of blood that Medicare doesn’t cover
Skilled Nursing Coinsurance – Covers the coinsurance for Skilled Nursing facility on days 21 – 100 up to $157.50 per day in 2015.
Part A Deductible – pays this deductible ($1260 in 2015)
Part B Deductible – pays the annual deductible for Part B (outpatient) services, which is $147 in 2015.
Excess Charges – Part B excess charge benefit pays some or all of the difference between what your doctor charges and Medicare’s approved amount, depending on which plan you choose.
Foreign Travel Emergency – pays 80% of the cost of your foreign emergency care after a $250 deductible. Maximum lifetime benefit is $50K.
Part A Hospice Care Coinsurance or Copay – pays for Medicare-approved hospice benefits except for small copay for prescription medicines for patient comfort
Part B Preventive Care Coinsurance – pays your coinsurance for Medicare Part B covered preventive care, such as annual routine physical, immunizations, mammograms, pap smear, colorectal screenings, prostate screenings, and bone density tests.