The Centers for Medicare & Medicaid Services (CMS) administers Medicare, the nation's largest health insurance program, which covers nearly 40 million Americans. MEDICARE PART A Medicare hospital insurance provided for those who are eligible for monthly Social Security benefits that pays for some of your inpatient hospital expenses, care in a skilled nursing facility (does not include custodial care facilities), some hospice care, and some home health care.  There are limits to the plan, deductibles and other costs that you may incur out of pocket. MEDICARE PART B Medicare medical insurance that helps pay for medically necessary doctors’ services, outpatient hospital care, and some medical services that aren’t covered by Medicare Part A.  You have to elect this benefit and pay a monthly premium. MEDICARE PART C Medicare Part C is known as Medicare Advantage Plans. This is a plan offered by a private company that contracts with Medicare to provide you with all your Medicare Part A and Part B benefits. Medicare Advantage Plans are HMOs, PPOs, or Private Fee-for-Service Plans. If you are enrolled in a Medicare Advantage Plan, Medicare services are covered through the plans, and are not paid for under Original Medicare.  You can choose a Medicare Advantage plan that includes Medicare prescription drug coverage (MA-PD) or one that does not (MA). MEDICARE PART D This optional plan provides prescription drug coverage through private companies and organizations. You may choose any of the standalone Medicare-approved drug plans (or Medicare Advantage HMO, PPO or PFFS plans) that offer drug coverage in your area.

Medicare Part A & B Premium and Deductible Information—2008 Hospital Deductible $1,024 / benefit period Hospital Coinsurance Days 0-60: $0 Days 61-90: $256 / day Days 91-150: $512 / day Skilled Nursing Facility Coinsurance Days 0-20: $0 Days 21-100: $128 / day Part A Premium (for voluntary enrollees only) With 30-39 quarters of Social Security coverage: $233 / month With 29 or fewer quarters of Social Security coverage: $423 / month Part B Premium & Deductible Standard Premium: $96.40 / month Deductible: $135 / year

LEARN MORE Medigap / Medicare Supplemental Insurance: Many companies sell Medicare supplement policies in Texas. Privately purchased health insurance that fills in the "gaps" in Medicare coverage. They are designed to supplement the coverage of the Medicare program minimizing deductibles and copayments for covered services such as hospital and doctor bills; it does not provide help with long term care costs. A Medigap company may have a competitive price in one part of Texas, but not in another. Look for competitive Medicare supplement rates as this can make your out of pocket expenses more affordable. Purchasing a Medicare Supplement should be one of the simplest insurance purchases you ever make with affordable rates and major carriers.

Protect Yourself Texas Medicare Supplement-Texas Medigap-Prescription plans

Shopping Wisely for Texas Medigap Insurance

Read what you are asked to sign before you sign it. Never sign a blank application form. If an agent tries to rush you, be suspicious! Tell the agent you need more time. If you buy insurance by mail, ask if the company has a local agent or a toll-free number you can call if you have questions. Try to buy from an agent you know and trust. Ask questions and take notes when you talk to an agent. These could help you later if there is a dispute over what you were told about a policy. Make sure the agent and company are licensed. You can verify company and agent licenses by calling TDI’s Consumer Help Line. Don’t buy a policy on the agent’s first visit. Invite someone you trust to be present during the second visit. An agent shouldn’t object. Answer all questions on the application accurately. If an agent helps you complete the application, make sure the information is correct and complete before you sign. Omitting or falsifying information could cause the company to deny your claims or cancel your policy. Do not pay cash or make a check out to an individual agent. Always pay by check or money order so you have a clear record of payment. Make checks payable only to the insurance company or insurance agency. Insist on a receipt signed by the agent on the company’s letterhead. Before making a lump-sum payment, ask the agent or company about reimbursement of unearned premium. This is especially important during the open enrollment period when you have the right to change companies. Be sure you have the names and addresses of the agent and the insurance company. Know how to contact the agent and the company if you need help. Read your policy carefully when you receive it. You can return a policy for any reason and receive a full refund within 30 days of the date you received it.

The best time to buy a Medigap policy is during your Medicare open enrollment period because companies must sell you any plan they offer without regard to pre-existing conditions. Underwriting guidelines, rate guarantees, and premium changes matter, you want to work with someone who specializes in Texas Medicare supplements if you are not in the open enrollment period. Shop around. Prices can vary considerably. Use the rate guide section of this handbook to compare the prices of the plans that interest you. Consider other factors. Price should not be your only consideration. You can learn a company’s complaint record and A.M. Best financial rating by calling TDI’s Consumer Help Line. Both are important indicators of the service you can expect from a company. Your family and friends are other sources of information about a company’s customer service. Ask them if they have had any experiences with the companies you are considering. Consider your needs. Although it is illegal to sell you more than one Medigap policy, insurers may offer other policies with benefits that may overlap Medigap coverage. These include cancer, specified disease, hospital indemnity, and long-term care policies. Any duplication of benefits must be disclosed in writing. In general, duplicate coverage wastes money because you are paying twice for the same coverage. Look into Medicare prescription drug coverage. Medicare Part D can help you pay your prescription drug costs. There are exclusions for certain drugs, however, and Medicare Part D won’t pay for drugs covered by Medicare parts A or B. Medicare Part D plans are offered by private insurers approved by CMS. Coverage is not automatic. If you want it, you must select a Medicare-approved prescription drug plan and enroll in it. You are eligible if you have Medicare Part A or Part B.

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Texas Medicare Supplement Insurance Medicare supplement insurance fills the “gaps” between Medicare benefits and what you must pay out-of-pocket for deductibles, coinsurance, and copayments. Therefore, it is often called Medigap insurance. Medigap policies only pay for services that Medicare deems as medically necessary, and payments are generally based on the Medicare-approved charge. Some plans offer benefits that Medicare doesn’t, such as emergency care while in a foreign country. There are 12 standardized Medigap plans or Medicare supplement plans, labeled A through L. Each insurance company must use these same identifying letters. All companies that sell Medigap insurance must offer Plan A, but do not have to offer the other 11 plans. If you bought a Medigap policy before standardized plans were first introduced in 1992, you may keep your existing policy. You do not have to switch to one of the 12 standardized plans. Medigap policies are sold by private insurance companies that are licensed and regulated by the Texas Department of Insurance (TDI). Medigap benefits, however, are set by the federal government. The benefits provided by these plans are described in the appendix. Medigap policies are automatically renewed each year. Texas Medicare Select Medicare Select is a type of Medigap policy that generally requires you to use doctors and other providers in the plan’s network for your routine care. If you use out-of-network providers, you’ll have to pay more of the cost. Medicare Select coverage can be issued by an insurance company or a Medicare HMO. If you leave a Medicare Select plan, the company must make available any non-Medicare Select Medigap policy it has on the market with comparable or lesser benefits. Alternatives to Texas Medicare Supplement Insurance Before you buy a Medigap policy, consider these other options: Medicare Advantage Plans Depending on where you live, you may have the option to choose between Medicare or a Medicare Advantage plan. If you are in a Medicare Advantage plan, you don’t need a Medigap policy. Medicare Advantage plans provide at least the same benefits as Medicare. There are several types of Medicare Advantage plans: -Managed care plans, which include HMOs, PPOs, provider-sponsored organizations, and religious fraternal benefit society plans -private fee-for-service plans -special needs plans -Medicare medical savings accounts Medicare pays a monthly premium to the Medicare Advantage plan to provide your health care. The plan may require you to pay an additional premium and may charge you a copayment each time you go to the doctor or get a prescription. To join a Medicare Advantage plan, you must have both Medicare parts A and B and live in an area that has a plan. Some plans have other eligibility criteria. Not all plans are available in all areas of the state. Call Medicare or visit the Medicare web page and select the Compare Health Plans and Medigap Policies in Your Area interactive page. You may also call TDI’s Consumer Help Line to learn which plans are available in your area. Texas Medicare HMOs typically require you to use only physicians and hospitals in the HMO’s network. A Medicare HMO with a point-of-service option allows you to choose your own doctors, but you will have to pay extra. With a private fee-for-service plan, you can generally go to any doctor or provider and receive care anywhere in the United States. The doctor and provider, however, must agree to treat you and to accept the plan’s payment terms. If your Texas Medicare Advantage plan terminates its contract in your service area, you have the right to purchase Medigap plans A, B, C, F, K, or L offered in Texas without regard to your medical history or condition. If your Medicare Advantage plan ends services in your area, it must explain to you in writing your options and timeframes to buy a Medigap policy.

Medicare Premiums for 2009: Part A: (Hospital Insurance) Premium Most people do not pay a monthly Part A premium because they or a spouse has 40 or more quarters of Medicare-covered employment. The Part A premium is $244.00 per month for people having 30-39 quarters of Medicare-covered employment. The Part A premium is $443.00 per month for people who are not otherwise eligible for premium-free hospital insurance and have less than 30 quarters of Medicare-covered employment. Part B: (Medical Insurance) Premium $96.40 per month* Medicare Deductible and Coinsurance Amounts for 2009: Part A: (pays for inpatient hospital, skilled nursing facility, and some home health care) For each benefit period Medicare pays all covered costs except the Medicare Part A deductible (2009 = $1,068) during the first 60 days and coinsurance amounts for hospital stays that last beyond 60 days and no more than 150 days. For each benefit period you pay: A total of $1,068 for a hospital stay of 1-60 days. $267 per day for days 61-90 of a hospital stay. $534 per day for days 91-150 of a hospital stay (Lifetime Reserve Days). All costs for each day beyond 150 days Skilled Nursing Facility Coinsurance $133.50 per day for days 21 through 100 each benefit period. Part B: (covers Medicare eligible physician services, outpatient hospital services, certain home health services, durable medical equipment) $135.00 per year. (Note: You pay 20% of the Medicare-approved amount for services after you meet the $135.00 deductible.) Additional information about the Medicare premiums, deductibles, and coinsurance rates for 2009 is available in the September 19, 2008 Fact Sheet titled, "CMS Announces Medicare Premiums, Deductibles for 2009" on the www.cms.gov website.  *Note: If your income is above $85,000 (single) or $170,000 (married couple), then your Medicare Part B premium may be higher than $96.40 per month.  For additional details, see our FAQ titled: " Medicare Part B Monthly Premiums in 2009"