Your Basic Medicare Benefits

 

Texas Medicare Part A and Part B are designed to provide you with some health coverage, but you are responsible for certain out of pocket expenses that can be unlimited.

What Medicare covers is only a portion of your health insurance costs. Some of the costs that you alone would be responsible for under Medicare in 2014 are shown here:

  • Part A deductible ($1216)
  • Part B deductible ($147)
  • Daily copayments for hospital stays over 60 days as follows: $304/day for days 61-90 and $608/day for days 91-150
  • $152/day for days 21 – 100 in a skilled nursing facility
  • In general, 20% coinsurance for all your outpatient needs, such as doctor visits, lab work, CT scans, chemotherapy, radiation, dialysis etc.

For this reason, most people purchase private health insurance policies for additional protection. There are two main types of Medicare insurance: a Medicare supplement insurance policy or a Medicare Advantage Plan, also referred to as Medicare Part C.

A Part C Medicare Advantage plan is optional coverage, so unlike Part A & B which you must enroll in at Social Security, Part C is something you enroll in with the help of an insurance agent. When you enroll in a Medicare Advantage plan, that policy rolls your Medicare A & B benefits into one health insurance card that you present at the time of medical service, and this tells the doctor to bill your Part C policy instead of Medicare.

Medicare Part D (prescription drug coverage) pays for a significant portion of your retail prescription drug costs. You must join a prescription drug plan to get this coverage.

Some Part D plans are standalone pharmacy cards that you will use at the service counter when you are picking up prescriptions your doctor has prescribed. Most people who have Medicare with a supplement will enroll in a standalone Part D drug card.

However, you can also get your Part D benefits included in a Part C Medicare Advantage plan if you like. Your agent can explain how this works.

This can all seem very confusing at first. So many moving letters and parts! Don’t worry – we can make Medicare easy for you. Give us a call to speak with a helpful, friendly licensed insurance agent who can spend time explaining the basics to you until you feel like you’ve got a solid grasp on your benefits under Medicare.

We can then offer you assistance in determining your Texas Medicare supplemental insurance options. For help, call our office or fill out our information request form for
Texas Medicare insurance.