Individual/Family Plans

With the passage of the Affordable Care Act (Obamacare) the purchase of individual health plans is very regulated. You can only purchase an individual health insurance plan each year during Open Enrollment between November 1st and December 15th. There are a few exceptions to this, such as loss of coverage, marriage, birth of a child, etc. Also, depending on your income, you may qualify for a government subsidy to assist you in paying your premiums.

Most of the individual plans available are HMO plans. With an HMO plan, you have to choose a Primary care Physician at the time of enrollment, or the insuring company will choose one for you. The network of doctors that will except an HMO plan is much smaller than a PPO plan. There are no medical questions on the application and all pre–existing conditions are covered. If you are interested in an Individual health plan, please click on the link below.

Group Medical Plans

A business owner has a lot more options and flexibility than an individual. First of all, you can apply for a group medical plan anytime. Also, both HMO and PPO plans are available. In the state of Texas, you have to have at least two employees to make a group. There are participation requirements for eligible employees which vary by company. Eligible employees are those employees that work at least 30 hours per week and do not have health insurance coverage somewhere else. If you are interested in a group medical plan, click on the link below and complete the attached census and return to me. I usually receive the quotes back within two days.

Medicare Insurance Plans

When you turn age 65, you become eligible for Medicare Parts A and B. 

Part A helps cover: 

• Inpatient care in hospitals Skilled nursing facility care
• Hospice care
• Home health care 

Part B helps cover: 

• Services from doctors and other health care providers
• Outpatient care . Home health care
• Durable medical equipment (like wheelchairs, walkers, hospital beds, and other equipment)
• Many preventive services (like screenings, shots or vaccines, and yearly “Wellness” visits) 

There is no cost for Part A. There is a premium for Part B. 

When you turn age 65, there is a 7–month period when you can sign up for Medicare A & B: 3 months before your birth month, your birth month, and 3 months after your birth month. 

Medicare A & B will cover some, but not all of your medical expenses (about 80 %). To cover the rest of these expenses, you have a choice of optional coverages. They are as follows:

Medicare Supplement

Original Medicare pays for much, but not all, of the cost for covered health care services and supplies. Medicare Supplement Insurance policies, sold by private companies, can help pay some of the remaining health care costs for covered services and supplies, like copayments, coinsurance, and deductibles. Medicare Supplement Insurance policies are also called Medigap policies. 

Every Medigap policy must follow federal and state laws designed to protect you, and they must be clearly identified as “Medicare Supplement Insurance.” Insurance companies can sell you only a “standardized” policy identified in most states by letters A through D, F, G, and K through N. All policies offer the same basic benefits, but some offer additional benefits so you can choose which one meets your needs. 

Starting January 1, 2020, Medigap plans sold to people who are new to Medicare won‘t be allowed to cover the Part B deductible. Because of this, Plans C and F won‘t be available to people who are newly eligible for Medicare on or after January 1, 2020. If you already have either of these 2 plans (or the high deductible version of Plan F) or are covered by one of these plans before January 1, 2020, you‘ll be able to keep your plan. If you were eligible for Medicare before January 1, 2020, but not yet enrolled, you may be able to buy one of these plans. 

If you apply for a Medigap plan during your initial 7–month eligibility period, your Medigap coverage is guaranteed. After that you will have to provide evidence of insurability.

Prescription Drug Plans

Medicare prescription drug coverage is an optional benefit. Medicare drug coverage is offered to everyone with Medicare. Even if you don‘t use prescription drugs now, you should consider joining a Medicare drug plan. If you decide not to join a Medicare drug plan when you‘re first eligible, and you don‘t have other creditable prescription drug coverage or get Extra Help, you‘ll pay a late enrollment penalty if you join a plan later. Generally, you‘ll pay this penalty for as long as you have Medicare prescription drug coverage. 

Medicare Prescription Drug Plans. These plans (sometimes called “PDPS“) add drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private Fee for-Service (PFFS) plans, and Medicare Medical Savings Account (MSA) plans. You must have Part A and/or Part B to join a Medicare Prescription Drug Plan. 2. Medicare Advantage Plans or other Medicare health plans that offer Medicare prescription drug coverage. You get all of your Part A, Part B, and prescription drug coverage (Part D), through these plans. Medicare Advantage Plans with prescription drug coverage are sometimes called “MAPDs.” Remember, you must have Part A and Part B to join a Medicare Advantage Plan, and not all of these plans offer drug coverage. In either case, you must live in the service area of the Medicare drug plan you want to join.

Medicare Advantage Plans

A Medicare Advantage Plan is another way to get your Medicare coverage. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by Medicare approved private companies that must follow rules set by Medicare. If you join a Medicare Advantage Plan, you‘ll still have Medicare but you‘ll get most of your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from the Medicare Advantage Plan, not Original Medicare. Most plans include Medicare prescription drug coverage (Part D). In most cases, you‘ll need to use health care providers who participate in the plan‘s network. However, many plans offer out of network coverage, but sometimes at a higher cost. Remember, you must use the card from your Medicare Advantage Plan to get your Medicare–covered services. Keep your red, white, and blue Medicare card in a safe place because you‘ll need it if you ever switch back to Original Medicare.