Two longhorns on a ranch in Seguin, Texas

Seguin, Texas: Medicare and Options

Our Medicare advisors in Seguin, TX, are here to help you understand your Medicare options and find the plans that best suit your needs. Whether you’re just beginning your journey into the Medicare program or you’re a long-time beneficiary, we can help! 

No matter where you are in the process, we first like to make sure you know how the Medicare program works and why working with a Medicare Advisor is advantageous.

The Parts of Medicare: A-D

There are four components that make up the Medicare program. (Plus, an extra option that should also be considered.) Each plays an important role in your comprehensive healthcare coverage. Let’s review the basics of each part.

Part A: Hospital Insurance

Part A helps pay for your room and board when you are admitted as an inpatient to a hospital or skilled nursing facility. Before your coverage begins, you’ll need to pay the deductible of $1556. This deductible applies to every benefit period. A benefit period begins on the first day of your stay and ends after you have been out of the hospital for 60 days. Once you’ve met the deductible, you will also have coinsurance costs. The first 60 days are completely covered by Part A. On days 61-90, your coinsurance cost is $389. After day 90, if you have not used your 60 lifetime reserve days, your coinsurance cost is $778. Once all those days have been depleted, you are responsible for the full amount of the stay. 

The good news is that most Medicare beneficiaries receive premium-free Part A. The only requirement is that you (or your spouse) had to have paid Medicare taxes for ten years.

Part B: Outpatient Insurance

Outpatient services include visits to your doctor, diagnostic tests, medical equipment, surgeries, and some preventive services. Before your Part B coverage begins, you’ll need to pay the annual deductible, which is $233 in 2022. After that, your outpatient services will be covered at about 80%, leaving you with 20% to pay out-of-pocket.

The standard deductible for Part B in 2022 is $170.10. While this is what most beneficiaries pay, you may pay more if you earned over a certain threshold. The Social Security Administration (SSA) calculates your premium by looking at your Modified Adjusted Gross Income (MAGI) from two years prior to your coverage. If you fall above a certain threshold, you will pay IRMAA, the Income-Related Monthly Adjustment Amount.

Part C: Medicare Advantage

Medicare Advantage plans can be purchased through many private insurance companies. There are five kinds of Medicare Advantage plans, but all of them work in a similar manner. These plans combine your benefits from Parts A and B, add in extra benefits, and roll all of them into one plan. The extra benefits could include gym memberships, meal delivery, dental care, prescription drug coverage, and much more. Your premium, deductible, and copay/coinsurance will depend on which specific plan you enroll in. 

One important thing to note about these plans is that they usually limit their members to certain providers. Benefits are only offered if the member receives care within the plan’s network of providers and facilities. Going outside of the network could result in higher out-of-pocket fees – possibly even the entire cost of treatment.

Picture of downtown Seguin, Texas
While the premium will vary based on the plan you choose, almost all Part D plans use the standard deductible of $480 (for 2022).

Medicare Advantage Options in Seguin, TX

Medicare Advantage plans are not offered everywhere – they vary from one county to the next. A Medicare advisor can help determine which MA plans are available in your area, but a few of the popular Part C plans in Seguin, TX include:

  • AARP Medicare Advantage (HMO)
  • UnitedHealthcare Dual Complete (HMO D-SNP)
  • Cigna Preferred Medicare (HMO)
  • Humana Gold Plus (HMO)
  • Wellcare Complement Assist (HMO)

Part D: Prescription Drug Plans

Prescriptions are covered by Part D plans. You can purchase an individual Part D plan, or one may be included in your Medicare Advantage plan. The most important thing to check when choosing a Part D plan is whether or not the plan covers your current prescriptions.

While the premium will vary based on the plan you choose, almost all Part D plans use the standard deductible of $480 (for 2022). Your Part D deductible cannot exceed $480 in 2022. Most plans do not apply the deductible to common, generic medications, like those taken for high blood pressure or high cholesterol.

Part D Options in Seguin, TX

 Remember, you’ll need to make sure your current medications are covered under the specific Part D plan. A few of the popular carries of Part D plans in Seguin, TX, include:

  • AARP
  • Amerivantage
  • Blue Cross MedicareRx
  • Humana
  • Cigna
  • Mutual of Omaha
  • SilverScript
  • Elixir
  • Clear Spring
  • Wellcare

Medigap Plans

 A Medigap plan is a great way to supplement your coverage under Parts A and B. These plans are designed to pay for the costs leftover by Original Medicare. There are currently ten Medigap plans available, and the most popular are Plans F, G, and N.

 Medigap plans are standardized, which means the coverage found in each one will be the same, no matter which insurance company offers the plan. Plan F offers the same coverage whether it’s purchased from Company Y or Company Z. The only difference between the companies is their premiums.

Why should I use a Medicare advisor in Seguin, TX?

 It is highly recommended that you find a Medicare advisor in Seguin, TX, to help you choose which Medicare options are right for you. As you’ve learned, there is a lot to know about the program and about how the individual parts of Medicare work together. An independent Medicare advisor will help you narrow down your options to the ones that provide you with the coverage you need. We will compare rates across many carriers to ensure you are getting a competitive rate.

 Plus, there is absolutely no additional charge to work with us! Our Medicare advising services are completely complimentary. What are you waiting for? Give us a call today and schedule your consultation. We look forward to meeting you.

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