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).

Medigap Benefits A B C D F* G K** L** M N
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 $5120 Out of Pocket Limit $2560

 

*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 $2200 (in 2017) before your Medigap plan pays anything.

**After you meet your yearly Part B deductible ($183 in 2017), 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 $164.50 per day in 2017.

Part A Deductible – pays this deductible ($1317 in 2017)

Part B Deductible – pays the annual deductible for Part B (outpatient) services, which is $183 in 2017.

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.

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