Leander, Texas Medicare Options

Texas barn at sunset

Are you looking for Medicare options in Leander, Texas? You’ve come to the right place! Our licensed agents at Texas Medicare Advisors are knowledgeable, licensed experts in Medicare and can help you sort through all the options you have in Texas. 

We can help you understand all the working parts of Medicare and which options are best for you. Let’s go through the basics now!

Learn the Medicare Lingo

First, let’s go over each part of Medicare and which parts of Medicare are offered in Leander, TX.

Part A: Benefits and Cost

Medicare Part A is also called hospital insurance. It’s going to cover your room and board expenses when you are admitted as an inpatient to a hospital. It will also cover stays in a skilled nursing facility (SNF), hospice care, and some home health care.

Part A does not cover 100% of your expenses. You will be responsible for a deductible and a coinsurance amount based on how many days you’ve been in the hospital. First, you’ll need to meet the deductible of $1556. (This is the deductible for 2022 and is subject to yearly increases.) The Part A deductible works a little differently than others you may be accustomed to. This deductible applies to each benefit period. A “benefit period” starts on the first day you become an inpatient and ends after you have been out of the hospital for 60 consecutive days. At that point, the deductible is reset, and you’ll need to pay it again if you are admitted a second (or third or fourth) time.

After the deductible has been met, your coinsurance is based on the number of days you’ve been in the hospital. Up to day 60, Part A will pick up 100% of the expenses. From day 61 to day 90, you’ll be responsible for $389 each day. Beginning on day 91, if you have not used your 60 lifetime reserve days, you’ll be responsible for $778 per day. Your 60 lifetime reserve days can only be used once in your life. Once these have been exhausted, you’ll be responsible for 100% of the costs during that benefit period.

Skilled nursing facility coinsurance expenses are a little different

Coverage and Cost

Expenses with Medicare Part A can get costly if you have a long inpatient stay. However, most people enjoy the benefits of Medicare Part A premium-free. To be eligible for premium-free Part A, you (or your spouse) must have paid Medicare taxes for ten years or 40 quarters. If you have not met that requirement, your premium will be based on the number of quarters that you did pay Medicare taxes. That premium will be either $274 or $499 in 2022.

Part B: Benefits and Cost

Medicare Part B covers certain outpatient expenses. Part B will pay for visits to your doctor, diagnostic tests and images, surgeries, durable medical equipment (DME), and many preventive services. Like Part A, it does not pay for these services at 100%. Generally speaking, Part B will pay for about 80% of these services, leaving the Medicare beneficiary with 20% out-of-pocket.

Part B also has a deductible, but it is more straightforward than the Part A deductible. The Part B deductible is paid annually and is set at $233 for 2022.

You will pay a monthly premium for Medicare Part B. In 2022, the standard premium that most beneficiaries will pay is $170.10. Depending on your income, you could pay more. The Social Security Administration adjusts this premium for individuals with high incomes. Your premium will be based on your Modified Adjusted Gross Income (MAGI) from two years prior. (If you’re looking at your rates for 2022, they will be based on your tax return from 2020.) For instance, if you are married and filed a joint tax return and had a MAGI between $182,001 and $228,000, you’ll pay an Income Related Monthly Adjustment Amount (IRMAA) of $68, which will make your total monthly premium $238.10. This IRMAA amount goes up incrementally and caps at a monthly premium of $578.30.

Man in cowboy hat and cowboy boots leaning against a wooden wagon.

Part C: Benefits and Cost

Part C of Medicare is often referred to as Medicare Advantage. Enrolling in a Medicare Advantage plan bundles your coverage from Parts A and B into one policy. Instead of receiving benefits directly from the federal government, your coverage will be provided by the private insurance company that offers the Part C plan. All Part C plans must offer at least the same coverage found in Parts A and B, but most offer additional benefits.

Your cost for a Part C plan will vary based on where you live and which type of plan you choose. You may have very limited options in your location, or you may have many to choose from. Your options will depend on the providers in your area. If you enroll in one of these plans, you’ll need to see a provider who participates in the plan’s network. The fewer providers who participate, the fewer plan options you’ll have.

Most Medicare Advantage plans have low premiums, some even as low as $0 per month. However, you are still responsible for paying your Part B premium, and you will have other expenses associated with these plans. Again, those expenses will depend on the specific plan you choose.

Part D: Benefits and Cost

Part D of Medicare contains your prescription drug coverage. Like Part C plans, these are sold by private insurance companies that have met standards set by the Medicare program. Sometimes, Part D coverage is included in your Medicare Advantage plan. If it’s not, you’ll need to enroll in a stand-alone plan.

Each Part D plan has a drug formulary. A drug formulary is a list of the prescriptions that are covered under the plan and which tier those prescriptions are categorized into. Tiers range from 1-5 (maybe less depending on the plan), and your prescription cost is based on the tier. Common, generic medications usually fall into lower tiers than specialized, brand-name drugs. Lower tiers are also associated with lower costs.

Your premium will be dependent on the plan you choose. You’ll pay a higher premium if you take many medications or if those medications are highly specialized. Most plans also utilize the standard deductible of $480. (This is the deductible for 2022 and can change each year.) There are also different coverages phases of Part D plans that you’ll need to understand if you take more than just a couple of medications.

Medicare Supplements: Benefits and Cost

We’ve covered all the “parts” of Medicare, but there is an additional option you’ll need to know. Medicare supplements are an option to supplement your coverage in Parts A and B. Most beneficiaries will choose to enroll in either a Medicare Advantage or a Medicare supplement to help pay for the expenses that are leftover from Parts A and B.

Supplements work differently than Medicare Advantage plans. While they are sold by private insurance companies, the plans themselves are standardized. For instance, Plan G is a popular Medicare supplement in Leander, TX. Plan G will provide the same coverage no matter which insurance company you purchase the policy from. The only difference may be the monthly premium.

How Our Agents Help You

You’ve got a basic understanding of all the moving parts now. But now, you’ll need to choose the specific plans you want and which insurance companies you want to purchase them through. How do you know which one to choose? That’s where we come in!

Our agency in Leander, TX is contracted with multiple insurance companies. This means that we can compare plans across many carriers, finding you a plan that fits both your healthcare needs and your budget. We’ll make sure you aren’t paying more than you need, and we only work with trusted insurance companies. We’ll also look at their history of rate increases to help prevent any huge jumps in premiums from one year to the next.

After we’ve got you enrolled in everything you need, we’ll still be here when you have questions about your policies. We’ll even stay in touch to review your plans each year during the Annual Enrollment Period or when we notice that you could save money by switching to a different plan.

Whatever your Medicare needs are in Leander, TX, we’ve got you covered! Give us a call today, and we’ll get you scheduled with one of our licensed agents. We look forward to meeting you!

Request an advisor contact you TODAY!!