July 12, 2004

AMARILLO – Looking for ways to supplement Medicare coverage? Start with the alphabet, said Andrew B. Crocker, Texas Cooperative Extension gerontology health program specialist based in Amarillo. Not only does Medicare come in Plans A and B, but supplemental coverage – often called MediGap – comes in plans A through J.

"The federally-funded insurance program that we know as Medicare helps Americans over 65 and certain people under 65 pay for much of their health care," he said.

But Medicare doesn't cover everything. That's why some beneficiaries look to other insurance companies for MediGap coverage, Crocker said.

"In Texas," he said, "private insurance companies are licensed by the Texas Department of Insurance to sell up to 10 different MediGap policies – plans A through J. Each insurance company that offers a MediGap policy must offer plan A, but offering the other nine plans is optional."

Plan A may include:

- Coverage of daily hospital expenses beyond what Medicare covers;

- Coverage of Medicare Part A co-payments (if any);

- Coverage of Medicare-eligible hospital expenses;

- Coverage of the cost of blood products not included under Medicare Parts A and B; and

- Coverage of Medicare Part B co-payments, up to 20 percent.

Plans B through J should include all of the above, plus some or all of the following:

- Coverage of skilled nursing facility care;

- Coverage of Medicare Part B non-covered expenses;

- Coverage of expenses that occur while traveling to foreign countries;

- Coverage of costs of recovery at home;

- Coverage of preventive health care;

- Coverage of prescription medications; and

- Coverage of higher deductibles which are the cost of lower premiums.

MediGap insurance coverage may not be necessary for individuals who are covered under an employer's or former employer's group insurance, those who are covered by Medicaid or those who are qualified Medicare beneficiaries, Crocker said.

For anyone considering purchasing MediGap insurance, Crocker offered some advice:

- Buy within six months of enrolling in Medicare Part B. "During this ‘open-enrollment' period, a company must sell you a policy regardless of pre-existing medical conditions," he said. - Shop around to get the best policy at the best price. Contact the Texas Department of Insurance for a rate guide.

- Consider the company as well as the price. "Look at a company's reputation, strength and reliability," he said. "This information is also available through the Texas Department of Insurance."

Some policies have endorsements that affect rates, Crocker said. "Some policies charge higher rates for smokers than non-smokers. Some policies charge more depending on the area of the state in which you reside. Other policies may charge men more than women. Check with your insurance agent to determine what endorsements your policy may carry."

Before signing on that dotted line, protect yourself by:

- Reading the policy and forms before signing;

- Buying from trustworthy agents and companies;

- Making sure the agent and company are legally licensed to sell the policy being purchased;

- NOT paying cash; and

- Making sure to get the name and address of the insurance agent AND the insurance company.

"MediGap policies have a 30-day trial period," Crocker said. "If within 30 days of receiving your MediGap policy you are dissatisfied with it, you may return it and receive your money back.

"Be sure you keep thorough records of names and dates. These will be important if you choose to return your policy."

For more information contact the Texas Department of Insurance at (800) 252-3439 or http://www.tdi.state.tx.us. Local Area Agencies on Aging of Texas also have useful information. Call (800) 252-9240.