Your trusted guide to
Medicare Insurance in Texas
Navigating your Medicare options can be complex. We provide expert guidance to help you find the right health plan for your retirement needs.
What it covers
Your four Medicare choices
Medicare is the federal health insurance program for people who are 65 or older, as well as for some younger individuals with disabilities.
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Original Medicare
This includes Part A (Hospital Insurance) and Part B (Medical Insurance). You can go to any doctor or hospital in the U.S. that accepts Medicare, but you are responsible for deductibles and co-insurance.
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Medicare Advantage (Part C)
These plans are offered by private insurance companies approved by Medicare. They combine your Part A and B coverage into a single plan, and often include Part D and other benefits like dental and vision.
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Medicare Supplement (Medigap)
If you choose Original Medicare, you may want to add a Medicare Supplement policy. These plans help cover expenses that Original Medicare doesn’t, such as co-payments, co-insurance, and deductibles.
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Part D (Prescription Drug Coverage)
This coverage helps pay for prescription medications. It can be purchased separately if you have Original Medicare or it may be included in a Medicare Advantage plan.
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Why it matters
Understanding Medicare
Medicare is the federal health insurance program for people who are 65 or older, as well as for some younger individuals with disabilities. It’s designed to help cover a wide range of medical costs, but choosing the right plan for your needs is critical.
Many people sign up for Advantage Plans thinking they are Supplements, they are not.
The detail
Part A, Part B and Part D in the agency’s own words
Medicare Part A
Medicare Part A covers your hospital expenses. This includes hospital stays, skilled nursing care, hospice, and home health-care services. You may have to pay various deductibles, coinsurance, and copayments. You earn Part A by paying taxes toward Medicare while working for 10 years (or 40 quarters). If you did not earn Part A, you will pay a premium.
Medicare Part B
Medicare Part B covers services that treat illnesses or conditions such as doctor’s office visits, lab work, x-rays, and outpatient surgeries. It also covers preventive services like cancer screenings and flu shots. Most people pay a premium for Part B. Even if you are enrolled in a Medicare Advantage plan that provides your Part A and Part B benefits, you will still pay your Part B premium.
Medicare Part D
Original Medicare doesn’t cover prescription drugs. Although Medicare Part D coverage is optional, it can be valuable if you take medications. You will pay a late-enrollment penalty if you don’t sign up for Medicare Part D Coverage when you are first eligible.
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Answers
Medicare questions
Answers to the questions our office is asked most. If yours is not here, call and ask us.
Assuming you have met the work-related eligibility requirements, you may begin enrollment into Medicare 90 days in advance of the month you turn 65.
Medicare does not have spousal or dependent coverage. Medicare is individual. If your spouse has reached age eligibility (65), then they can enroll in Medicare of their own accord 90 days in advance of the month they turn 65.
Maybe. If the employer group has 20 eligible employees or more, and you’re going to continue to work, then yes it’s an option. But there are many things to consider.
Part A is typically in place, and a paid-up benefit when you turn 65. Part B is not, unless you have enrolled in Social Security prior to age 65. If you have not filed to receive Social Security benefits, then you need to proactively enroll in Part B benefits and begin paying for them.
Yes. However, you will not have prescription coverage, and you will face unlimited exposure to those costs due to the gaps in Original Medicare.
You usually can. It’s important to be sure your doctor accepts Medicare. Some don’t.
Yes, for up to 100 days, after a required three-day hospital stay.
No. But some Advantage plans offer limited dental coverage.
No, a retiree plan will typically wrap around Medicare primary benefits.
Part D is the Prescription Drug plan Medicare introduced in 2006.
In addition to having a huge gap in coverage, you will likely face a penalty from Medicare. A Part B penalty can be 10% of your Part B premium for each 12-month period outside of Medicare, and up to 1% of the national average of a Part D plan for each month absent Part D.
Part C is another name for Medicare Advantage. Also named MA, MSA, or MA-PD (when prescriptions are included).
Online at SSA.gov or in person at a local Social Security office.
This is a Medicare term that establishes previous coverage being at least as good as Medicare’s. Typically is in play for Part D to avoid penalty.
No.
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Next step
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Tell us what you want covered. If your current policy is already the right one, we will tell you that too.