In Texas, the average monthly health insurance premium is $480. Many residents consider this too high to fit their budget. Fortunately, US citizens over the age of 65, as well as younger workers with certain disabilities can obtain Medicare coverage at a much lower cost. Texas Medicare insurance is a program that is funded by the federal government, and the Texas state government offers additional assistance to Medicare beneficiaries living here.
Medicare coverage begins with Original Medicare, which is made up of Part A and Part B. Beneficiaries usually don’t have to pay for Part A, and Part B premiums cost only $134 a month for those whose annual income is less than $85,000. Both Part A and Part B do entail out of pocket costs such as deductibles, coinsurance, and copayments.
With Part A, a beneficiary receives hospital insurance which covers services such as inpatient care. Part B is for medical insurance, which includes coverage for medical treatments, durable medical supplies, and preventive services.
Some may wish to add more benefits to the Original Medicare plan by obtaining Medicare supplemental plans from Medicare-approved private carriers in Texas. These plans are also called Medigap plans, as they can compensate for various gaps in health insurance plans. Any such plan will also require a premium separate from the premium required by Original Medicare.
The supplemental plan can offer a variety of extra benefits not included in Original Medicare, including coverage for Medicare prescription drugs; a plan referred to as Medicare Part D. The plan can cover additional healthcare services that are not covered by Part A and Part B, or it can help with the deductibles and other out of pocket expenses involved with Original Medicare.
The benefits of Original Medicare and specific supplemental plans can be combined in a single Medicare Advantage Plan, which is also known as Medicare Part C. These plans have at least the same coverage as Part A and Part B, plus Part D and other healthcare services not found in Original Medicare.
These Advantage Plans can be purchased from Medicare-approved private carriers in Texas. Each plan can come with different extra benefits, and they will have different costs as well.
As Texas does have a high poverty rate at 17.2%, a significant number of Medicare beneficiaries in the state do not find it easy to afford the associated costs of Medicare coverage. The Texas state government does offer several Medicare Savings Programs that offer varying levels of assistance, depending on the income and assets of the Medicare beneficiaries.
The most generous of these MSPs is for the Qualified Medicare Beneficiary. The QMB program pays for Part A and Part B premiums, plus the deductibles, coinsurance, and copayments. To qualify, an individual’s monthly income has to be less than $1,032 while the combined income of a married couple cannot exceed $1,392 per month.
The Specified Low Income Medicare Beneficiary program pays for just the Part B premium. To qualify for the SLMB program, an individual must earn less than $1,234 a month while a married couple cannot make more than $1,666 a month.
The Qualifying Individual (QI) program also pays for just the Part B premium. The limited funding, however, means that granting applications is on a first come, first served basis. An individual needs to earn no more than $1,386 a month, while the income limit for a married couple is $1,872 a month.
The QMB, SLMB, and QI programs all have asset limits as well. An individual’s assets cannot be worth more than $7,560 while the limit for married couples is $11,340. The values of the house and one car are not counted towards the asset limits.
Those who qualify for these 3 MSPs also are eligible for the Low-Income Subsidy, which helps pay for Medicare Part D. Whether the LIS covers all or part of the Medicare Part D expenses depends on the income and assets of the beneficiary.
Finally, there is also the Qualified Disabled and Working Individual (QDWI) program. This pays for the premium for Part A. An individual cannot earn more than $4,132 per month and have assets worth more than $4,000. A married couple’s limits are $5,572 for income and $6,000 for assets.
Medicare beneficiaries in Texas can contact the Health Information Counseling & Advocacy Program of Texas (HICAP) at 800-252-9240. HICAP provides free and unbiased counseling regarding Medicare matters.
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