If you are looking for Medicare in Austin, Texas, you’ve come to the right place! Whether you are brand new to Medicare or you are a seasoned member, we can help. Every now and then, all of us could benefit from a quick review of what Medicare is and how all the components of Medicare work together to provide beneficiaries with healthcare coverage.
What is Medicare?
Medicare is a federal government program that was started by President Lyndon Johnson in 1965. Prior presidents should also be credited with the program’s creation. In fact, President Harry Truman was the first to suggest a program that provided health insurance to retirees. Fifty years later, the Medicare program was launched.
Medicare provides health insurance to individuals who are 65 and older, as well as other groups of individuals who qualify. It is an ever-evolving program that offers significant insurance benefits for those who qualify.
Who qualifies for Medicare?
Every United States citizen is eligible for Medicare upon their 65th birthday. Legal U.S. residents who have lived in the country for five consecutive years are also eligible. Younger individuals may also be eligible if they meet certain requirements. Once an individual has been on disability for 24 months, they are automatically enrolled in Medicare on the first day of the 25th month. Also, individuals who have been diagnosed with End-Stage Renal Disease (ESRD) are also eligible for Medicare.
What is Original Medicare?
Original Medicare consists of two parts: Medicare Part A and Medicare Part B. They each cover different aspects of healthcare and come with their own premiums, deductibles, and copay or coinsurance costs.
Part A is hospital insurance. It will cover your room and board for any inpatient hospital stays. Most Medicare beneficiaries do not pay a premium for Part A. As long as you paid Medicare taxes for ten years, you are eligible for premium-free Part A. If you have not met that requirement or are not married to someone who has, your premium will be based on how many quarters you did pay Medicare taxes.
The Part A deductible is $1556 in 2022. This is not an annual deductible but is based on “benefit periods.” A benefit period begins the first day you are admitted as an inpatient to a hospital and ends after you have been out of the hospital for 60 consecutive days. Any coinsurance costs are based on how many days you have been an inpatient.
Part B is outpatient insurance. It helps pay for things like doctor’s visits, surgeries, durable medical equipment (DME), diagnostic tests and images, and many preventive services. Everyone pays a premium for Part B unless you are also enrolled in other programs that provide financial assistance. The standard premium for Part B is $170.10 in 2022. Individuals who have higher incomes could have a higher premium called an Income-Related Monthly Adjustment Amount or IRMAA.
The Part B deductible is an annual deductible. In 2022, the deductible is $233. Once you have paid that deductible, your Part B expenses will be covered at approximately 80%.
What is Medicare Part C?
Medicare Part C consists of Medicare Advantage plans. Private insurance carriers sell Medicare Advantage plans, which take the place of Original Medicare. If you enroll in an MA plan, you’ll get all of your healthcare coverage from that insurance company rather than the federal government.
A Part C plan will offer the same benefits as Original Medicare but may also include extra benefits like prescription drug coverage and routine dental, vision, and hearing coverage. The premiums, deductibles, copays, and coinsurance costs will depend on the specific Medicare Advantage plan.
What Part C plans are available in Austin, Texas?
Medicare Advantage plans are not offered in every county. A Part C plan available in one county or state may not be available in a neighboring county or state. It largely depends on the providers in the area as Part C plans require participants to seek care within the plan’s network.
A few of the popular plans and carriers of Medicare Advantage in Austin, TX are:
- Humana Gold Plus (HMO)
- AARP Medicare Advantage (HMO)
- UnitedHealthcare Dual Complete (HMO D-SNP)
- Wellcare Complement Assist (HMO)
- Aetna Medicare Premier Plan (HMO)
Remember, your choices will be limited to where you live, and you will not be eligible to enroll in every type of MA plan.
What is Medicare Part D?
Part D consists of prescription drug plans (PDPs). A Part D plan can be purchased separately or as part of a Medicare Advantage plan. Part D plans are sold by private insurance carriers and they all employ the use of a drug formulary.
A drug formulary is a list of prescriptions that is covered by the plan and which tier those prescriptions each fall into. There can be anywhere from 3-5 tiers. The higher the tier, the more you will pay out-of-pocket for the medication.
Premiums for a Part D plan will vary, but most plans utilize the standard deductible, with is $480 in 2022. Most of the time, prescriptions in the lower tiers do not apply to the deductible. There are also several phases of coverage in each Part D plan, but that’s a topic for another post.
What Part D plans are available in Austin, Texas?
Like the Part C plans, Part D plans are different in each state or county. Some are offered across the country, while others are only available in limited areas. There are plenty of Part D options available to you in Austin, TX.
A few of the popular Part D carriers in Austin, TX are:
- Blue Cross
- Mutual of Omaha
What other products are available for Medicare in Austin, Texas?
There are other products you may consider purchasing once you are enrolled in Medicare.
First, a Medicare supplement. To supplement the coverage provided by Original Medicare, you will either choose to enroll in a Medicare Advantage plan or a Medicare supplement. While both types of plans help to pay for the expenses not covered by Original Medicare, they work quite differently.
Medicare supplements are sold by private insurance carriers, but unlike Medicare Advantage plans, they are standardized, meaning they remain the same, no matter which company you purchase one from. There are currently ten Medicare supplements on the market: Plans A, B, C, D, F, G, K, L, M, and N. If you purchase Plan G with Company A, you’ll have the same coverage as someone who purchased Plan G through Company B. The only difference may be the premium.
Also, unlike Medicare Advantage plans, there are no networks with Medicare supplements. If your provider accepts Medicare, they will also accept a Medicare supplement. The other big difference is that Medicare supplements only offer coverage for the services that are also covered by Original Medicare. They do not offer any additional benefits.
Depending on if you choose a Medicare supplement or a Medicare Advantage plan, you may also consider other products geared towards retirees. This could include a Dental, Vision, Hearing (DVH) plan, life insurance, hospital indemnity plans, and cancer policies.
Medicare Advisors in Austin, Texas
If you weren’t already aware, now you know why so many people find Medicare confusing. There are many working parts and lots of products to consider. The easiest way to navigate all the choices is to work with an independent Medicare advisor. An advisor can help educate you on every component of Medicare and then make recommendations based on your healthcare needs. Our Medicare advisors in Austin, TX, offer complimentary consultations. Call today to schedule yours!