TEXAS MEDICARE FAQS
Medicare is a health insurance program that is available to eligible residents in the state of Texas. Qualifying residents who meet the Medicare eligibility requirements will receive assistance with paying for a variety of health care costs. To be eligible to receive Medicare benefits in the state of Texas, participants must be 65 years of age or older. However, certain exceptions may be made for applicants under the age of 65 who have disabilities. Additionally, Medicare Plans A and B may be purchased even if an applicant does not meet eligibility requirements.
To learn more about the Texas Medicare benefits, review the questions and answers below.
1. How do I calculate my Medicare premium amount and eligibility?
Applicants may use a premium calculator to determine Medicare eligibility and estimated premium amounts. Applicants will need to enter a date of birth, marital status, employment status and current health insurance information, if applicable. The applicant may also contact Social Security to determine eligibility or to get an estimated premium amount.
2. How do I know if I worked enough hours to qualify for Medicare?
If the applicant or the applicant’s spouse worked long enough to qualify for Social Security or Railroad Retirement benefits, then an applicant may qualify for Medicare benefits without premiums. Earning 40 credits through payroll taxes should guarantee that an applicant does not need to pay monthly Medicare premiums. However, Medicare can still be purchased even if an applicant does not qualify to receive premium-free Medicare.
3. Can I enroll in Medicare plans A, B, C and D?
Applicants may enroll in Medicare Part B without enrolling in Part A; however, applicants must be enrolled in Part B if enrolling in Part A. Applicants who are enrolled in Plan A or Plan B can also enroll in a Medicare Advantage plan for Plan C or a Medigap supplemental insurance policy. Applicants may also apply for Part D coverage if enrolled in Part A or Part B.
4. What does Original Medicare mean?
Original Medicare refers to Medicare Part A and Part B. Medicare Part C or Medicare Advantage plans are not considered Original Medicare plans. Part C is offered by private companies who contract with Medicare. Most Part C plans cover services that are not covered under Part A and Part B policies.
5. What other Medical health plans are available?
Medicare health plans are not part of the Original Medicare plans. Medicare health plans are offered by private companies to provide additional health benefits. Medical health plans include Medical Advantage plans, Medicare Medical Savings Account Plans and other Medicare health plans such as Medicare Cost Plans, Demonstration/Pilot Programs, PACE services and Medication Therapy Management.
6. Which options are available for low-income families?
Several health insurance assistance programs are available to low-income or limited income families who need help paying for medical costs. Available options include Medicaid, Medicare Savings Programs, PACE, prescription drug coverage, programs for low-income applicants in U.S. territories such as Puerto Rico and the U.S. Virgin Islands and Supplemental Security Income.
7. Does Medicare work with other insurance?
Medicare does work with additional health insurance coverage. One type of coverage will be the primary payer who pays each bill first. The primary payer then sends the rest of the bill to the secondary payer. A third payer may also be involved. Applicants should tell their doctors and medical providers if they have additional health insurance coverage.
8. Which services does Medicare Part A and Part B not cover?
Medicare Part A and B does not cover services such as acupuncture, cosmetic surgery, long-term or custodial care, most dental care, prescription eyeglasses, dentures, routine foot care and hearing aids. Applicants will need to pay for these services out-of-pocket unless applicants are members of another Medicare health plan that offers them.
9. Which Medicare preventative and screening services are covered?
Medicare Part B or medical insurance plans cover preventative and screening services such as abdominal aortic aneurysm screening, alcohol misuse screenings and counseling, bone density measurements, cardiovascular disease screenings, cervical cancer screenings, colorectal cancer screenings, mammograms, nutrition therapy services, lung cancer and prostate cancer screenings, obesity screenings, depression screenings, diabetes screenings and more.
10. Which vaccinations are covered?
Medicare Part B or medical insurance coverage includes several vaccinations. Covered vaccinations include flu shots, hepatitis B shots and pneumococcal shots. Part B only covers other shots if a patient has been exposed to a harmful disease or virus. Medicare Part D prescription drug plans cover other vaccinations but excludes flu, hepatitis and pneumococcal shots.
11. Are there late fees for paying Part A and Part B premiums?
Candidates who do not receive Social Security, Railroad Retirement benefits or Civil Service benefits will receive a Notice of Medicare Premium Payment Due to notify them of premium due dates. Applicants who do not pay after receiving the first notice will receive a second notice. If applicants do not pay after receiving the second notice, they will receive a Delinquent Notice. Applicants who do not pay for their premium by the 25th of the month will lose Medicare coverage.
12. What Medicare costs do I need to pay for?
For Medicare Plans A and B, candidates usually need to pay monthly premiums, deductibles, copayments and coinsurance costs. Many applicants do not need to pay Part A premiums but Part B premiums are always paid by the applicant. Premium amounts usually change at the beginning of each year.
13. What are the ten standard supplement insurance plans in Texas?
The ten standard supplement insurance plans in Texas include Plan A, Plan B, Plan C, Plan D, Plan F, Plan G, Plan K, Plan L, Plan M and Plan N. All companies must offer Plan A; however, companies who choose to offer additional plans must also offer Plan C or Plan F. Plan F includes a high-deductible option.
14. What do the ten standard supplement insurance plans cover?
Under the ten standard supplement insurance plans, services such as hospitalization, hospice, medical expenses and blood draws are covered. However, each supplement insurance plan includes a combination of benefits. Prices vary depending on each particular plan.
15. What do I do if I’m moving?
Candidates who have Original Medicare insurance are usually able to keep their Medicare supplement insurance after a move. However, some exceptions apply for Medicare Select Plans or plans with added benefits. Before moving, applicants with the Medical Advantage policy should contact their plan to see if the plan is available in their new zip code.
16. What is the 30-day “free look” policy?
Applicants have the option to return their Medicare supplement policy within 30 days of purchasing the plan. Applicants will receive their money back with no questions asked. However, candidates must keep a record of the date that the policy was received. The 30-day “free look” policy does not apply to Medicare Advantage plans.
17. What is Medicare Advantage?
Medicare Advantage refers to Medicare Plan C. Plan C includes a combination of Plan A and Plan B benefits, including hospital benefits and medical benefits. However, applicants must use doctors, providers and hospitals who are covered under Medicare Plan C. If not, applicants may end up paying more or all of the actual health care costs.
18. Can you apply for Medicare even if you don’t plan to retire?
Candidates who are interested in receiving Medicare insurance can apply for Medicare even if they do not plan to retire right away. Applicants can enroll in less than ten minutes by using the online enrollment application. Applicants will receive a card in the mail after the application has been processed and accepted.
19. Will I receive Medicare automatically if I live in Puerto Rico?
Applicants who live in Puerto Rico will not receive Medicare Part B automatically. Interested applicants need to sign up manually during their initial enrollment period to avoid paying a delay penalty. Candidates may sign up by contacting a local Social Security office.
20. What are the benefits to applying for Medicare online?
Applying for Medicare insurance online reduces time and money. Applicants will avoid trips to their local Social Security Office and can start and stop their online application at any time. Applicants can submit their application when the time is right and check back on the status of the online application.