Sherman, Texas Medicare Supplements Insurance

What is Medicare Part A? Medicare Part A is designed to help cover inpatient care in hospitals, including inpatient rehabilitation facilities and critical access hospitals. In addition, Medicare Part A covers inpatient stays in skilled nursing facilities (excluding custodial and long term care).

While original Medicare Part A provides great coverage, you may have to pay unlimited healthcare costs if you do not purchase a Medigap Plan. The out of pocket expense you will be responsible for is the "gap" between what Medicare pays and what the medical services actually cost.

How much will I have to pay? For hospital stays, you will be required to pay for the following for each benefit period:

• $1068 hospital deductible for days 1-60
• $267 per day for days 61-90
• $534 per day for days 91-150 (using your 60 lifetime reserve days as well)

For skilled nursing facility stays, you will be required to pay the following for each benefit period:

• $133.50 per day for days 21-100
• All costs for every day after day 100
• If you are an inpatient, you will pay for the first 3 pints of blood and 20% for additional pints (unless someone you know donates blood to replace what has been used)

For home health care, you will pay for 20% of durable medical equipment.

For hospice care, you will pay a $5 copayment for outpatient prescription drugs and 5% for inpatient respite care.

Should I purchase a Medigap Plan (Medicare Supplement Insurance)? While original Medicare Part A and Part B provide great coverage, you may be responsible for unlimited healthcare costs if you do not purchase a Medigap policy. A Medigap plan will help you lower your out of pocket costs and get more health insurance coverage We recommend that everyone enroll in a health insurance plan to protect their financial future. Some plans start at $0, which means there is a plan available for everyone!

Medicare Part B

What is Medicare Part B? Medicare part B covers medical services that Part A does not cover. This includes, but is not limited to medically necessary services such as doctors' services, outpatient care, and some preventive services.

While original Medicare Part B provides great coverage, you may have to pay for expensive healthcare costs if you do not purchase a Medigap Plan. The out of pocket expense you will be responsible for is the "gap" between what Medicare pays and what the medical services actually cost.

How much will I have to pay? For medical services, you will be required to pay for the following:

• Medicare Part B deductible ($135 per year)
• Medicare Part B monthly premium
• 20% coinsurance for almost all covered services
• 50% coinsurance for all outpatient mental health
• Co-payments for hospital outpatient services

Should I purchase a Medigap Plan (Medicare Supplement Insurance)? While original Medicare Part A and Part B provide great coverage, you may be responsible for unlimited healthcare costs if you do not purchase a Medigap policy. A Medigap plan will help you lower your out of pocket costs and get more health insurance coverage We recommend that everyone enroll in a health insurance plan to protect their financial future. Some plans start at $0, which means there is a plan available for everyone!

Medicare Advantage Plans (Part C)

What are Medicare Advantage Plans? Medicare Advantage Plans are health plan options offered by private companies and are approved by Medicare. They provide coverage for all of your Medicare Part A and Part B benefits. In addition, most provide prescription drug coverage and some offer additional benefits such as vision, hearing, and dental.

Should I purchase a Medicare Advantage Plan? You may be persuaded to purchase a Medicare Advantage plan because of the low cost and promise of extra benefits. However, folks who participate in these plans are not always better off financially. The out of pocket costs you will be required to pay when enrolled in a Medicare Advantage plan will depend on your individual medical needs and the type of plan you choose. Even with the additional benefits you could end up paying more. Many Medicare Advantage plans have daily hospital co-payments, daily co-payments for in-home care, and daily co-payments or multiple days in a skilled nursing facility. These costs can be significant and would be covered if you purchase the appropriate Medicare Supplement plan.

How much will I have to pay? While the monthly premium for a Medicare Advantage Plan can be $0, many folks will have greater out of pocket costs if they purchase a Medicare Advantage plan than if they purchase a Medicare Supplement Plan, especially those who have inpatient and post-acute medical needs. We understand out of pocket costs consume a large portion of income for many seniors, which is why we work hard to make sure you purchase a Medicare Plan that meets your specific needs.

Prescription Drug Plans (Part D)

What are Medicare Prescription Drug Plans? Medicare Prescription Drug Plans (also called "PDPs") are run by private insurance companies and are designed to protect you from high drug costs while giving you access to drugs that are necessary to stay mentally healthy and physically active. Each plan charges a different premium, has different co-payments, and covers different prescription drugs. We recommend that everyone enroll in a Medicare Prescription Drug Plan (even if you do not currently take a lot of prescription drugs) in order to avoid paying a late enrollment penalty and to protect against high future prescription drug costs.

How do I enroll in a Prescription Drug Plan? There are two ways you can get prescription drug coverage, which are:

• You can enroll in a Medicare Prescription Drug Plan (PDP). This plan will add prescription drug coverage to your original Medicare Plan, a Medicare Private Fee-for-Services Plan (PFFS), or a Medicare Medical Savings Plan.
• You can join a Medicare Advantage Plan (most likely HMO or PPO) that includes prescription drug coverage. These plans are often referred to as "MA-PDs."