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Austin & San Antonio Medicare Guide

Welcome to the Austin & San Antonio New To Medicare Guide for residents of all Austin & San Antonio areas. The information will help you no matter where you’re located. On this page you will discover information and guidance for your journey to Medicare. Everything you need to know is in this single source and after reading you’ll be armed with knowledge & resources you need to make your best decisions.

Guide Contents

These sections appear in order on this page.

The Parts & “Gaps” Of Medicare
The Two Ways To Have Medicare
Medicare Advantage
Medicare Supplements
Part D Prescription
Conclusion & Contact Us
Frequently Asked Questions

After reading the guide, Click Here to download the bonus tools; Medicare Checklist and Quiz.

The Parts Of Medicare

Medicare has 5 parts, with the primary ones being Parts A & B. Medicare Part A covers hospitalization, skilled nursing facility, and home health care. Medicare Part B covers doctors and outpatient treatment. Medicare A & B have “Gaps,” which are potentially high out of pocket costs as well as other health related items that aren’t covered. The other 3 parts of Medicare are provided by private insurers and help fill the gaps by providing additional coverage & benefits.

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The Other 3 Parts Of Medicare

Medicare Advantage – Medicare Advantage, also known as “Part C,” is Private Medicare Insurance. With Medicare, you have the choice of being covered directly through the government or a private insurer. Medicare Advantage includes additional coverage not provided with Original Medicare.
Medicare Supplements – Medicare Supplements, also known as Medigap, are insurance plans that supplement Medicare A & B. They are offered by private insurers and help cover your out of pocket medical costs.
Part D – Medicare Part D is prescription coverage provided by private insurers.

Need To Know

The #1 reason to supplement Medicare is that, by itself, Original Medicare does not limit your out of pocket Medical bills.

The Two Ways To Have Medicare

Although there are 5 parts to Medicare, there are two ways to arrange them. You can either have Original Medicare directly through the government or a Private Medicare Advantage plan. If you have Original Medicare directly through the government you can supplement it with a Medicare Supplement and a Part D (prescription) plan. You cannot supplement Medicare Advantage, it is all inclusive. Here are what these two plan packages look like.

Package 1 – Original Medicare With Supplemental Insurance

Includes;

Medicare A & B coverage for hospitalization, doctors, & outpatient care.
Medicare Supplement (Medigap) insurance to cover your deductibles & copays with Medicare A & B.
Part D Prescription insurance for medication coverage at the pharmacy.
You can also add dental, vision, & hearing coverage to your package.

Package 2 – Medicare Advantage Part C

Includes;

You receive coverage through a private insurer and a plan available in your zip code.
Medicare Advantage replaces Original Medicare and becomes your coverage, it doesn’t supplement it.
Medicare Advantage includes hospital and doctor coverage under parts A & B and may also include; Part D prescription, dental, vision, hearing aid, and other benefits in one plan.

Need To Know

You can either have Original Medicare or Medicare Advantage for your coverage, not both.

Medicare Advantage Part C

Medicare Advantage, also known as “Part C,” are health plans provided by private insurers. With Medicare you have the choice of getting your benefits directly through the government (Original Medicare) or through a private insurer. Both Original Medicare and Medicare Advantage include Part A coverage for hospitalization and Part B for doctors & outpatient care.

Original Medicare stops with Medical benefits only. Medicare “Advantage” gives you the opportunity to get additional benefits and coverage with your plan. These benefits can include;

Medical Cost Protection – Medicare Advantage plans include financial protection with a cap on your out of pocket medical bills.

Prescription – Medicare Advantage plans often include Part D prescription coverage with the plan.

Dental, Vision, and Hearing Aid coverage

Silver Sneakers – Gives you free access to exercise facilities and online exercise videos.

In many cases, you can get these additional benefits for no extra cost. You only need to pay your monthly Medicare premium.

Medicare Advantage Pros & Cons

Pros

Plans include more benefits & coverage than Original Medicare, such as dental, vision, hearing aid, and gym membership.
You pay little or no extra monthly cost for the additional benefits. You will typically only pay your monthly Medicare premium ($170.10 in 2022), maybe little more. So, Medicare Advantage plans can be a great value.
All benefits are included in one plan.

Cons

You may have out of pocket copays for medical care. These costs vary, depending on the type of service. Many find Advantage plan copays to be reasonable but they may be higher than what you would have with a Medicare Supplement.
Medicare Advantage have networks of doctors that accept the plan. The quality of the network can vary among plans & some plans allow you to go out of network.

Find Your Best Plan

There is a large variety of Medicare Plan options in the Austin & San Antonio area and no “one size” for everyone. We can help you compare and find the best option for you. Click the button to request a quote and get specific information on your best options.

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Medicare Supplements (Medigap)

Medicare Supplements are insurance plans that help you cover deductibles & copays with Medicare A & B. They are provided by private insurance companies that coordinate coverage with Medicare. Medicare Supplements are designed to give you more peace of mind by keeping your out of pocket medical costs very low.

Here are some other important things to know about Medicare Supplements;

Medicare Supplements are represented by a letter, which means the amount of coverage that you get. Plans G, N, and F, for example, are the most popular plans.
The coverage that you get based on the letter of your policy is exactly the same at each insurance provider. The monthly cost, however, varies among the different insurance companies.
Medicare Supplement companies must pay their part for services approved by Medicare, they do not approve or deny coverage.

How Medicare Supplements Work

Medicare A & B is your primary medical insurance.
Medicare processes and approves claims.
Medicare forwards claims automatically through an electronic system to your Medicare Supplement provider.

Your Medicare Supplement insurer receives claims from Medicare.
They process claims based on Medicare’s instructions. Medicare Supplement insurers do not authorize claims.
Claims are paid directly to your doctors and medical providers without paperwork on your part.

Medicare Supplement Pros & Cons

Pros

For the most popular plans you have very low (sometimes none) out of pocket medical costs for medical care. The most popular plans include F, G, and N.
There are no networks of doctors & hospitals or referrals required. You can choose to see any medical provider without the concern of in or out of network.

Cons

You pay a monthly cost that is in addition to what you pay for Medicare A & B, which some people do not want to pay. The monthly cost is most often more than Medicare Advantage but many still find it to be very reasonable.
Medicare Supplements generally only provide medical coverage. So, for pharmacy, dental, vision, and others; You will need separate plans.

Medicare Part D

Medicare Part D is prescription coverage with Medicare. Part D is provided by private insurance companies and not directly through the government. You can have Part D coverage through an individual plan that only covers prescriptions or included as part of a Medicare Advantage plan. Individual Part D plans are usually paired with Original Medicare and a Medicare Supplement policy, as referenced in the Two Ways section within this guide. There are various plans and insurance providers that offer coverage in the the Austin & San Antonio areas, here are general features that you can expect.

Part D provides coverage for generic, brand, and specialty medications. Specific medications covered vary among the different plans.

Generic medications covered for no deductible and zero or a low copay.

Options with and without a deductible for brand & specialty drugs.

Copays for brand name medications average around $42 for a one month supply.

Pick up your medications at your retail pharmacy or use 90 day home delivery.

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About Us

We are Lone Star Medicare, LLC, an independent agency that specializes in supplemental Medicare insurance. Our products include; Medicare Supplements, Medicare Advantage, Medigap, Part D, and Dental & Vision. Located in Austin, we offer plans in every corner of the state. Our service is totally free and provided conveniently by phone, online, and by mail. We have developed an excellent reputation by helping thousands of individuals maximize their Medicare benefits and get their best results. We operate by old fashioned values like; Honesty, dependability, relationships, quality, & excellence. It’s our mission to help improve the lives of Texans on Medicare and make a difference in communities. We do this by educating, volunteering, making donations, and offering quality insurance plans.

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Frequently Asked Questions

Click the + icon on the left of each topic below to open its frequently asked questions.

General Medicare Questions

When will I start Medicare? If you are turning 65, you are eligible to start Medicare the first day of the month that you turn 65. If you are over 65 and have or are leaving employer insurance; you are eligible to start Medicare anytime. If you are disabled you will typically start Medicare 24 months after being awarded disability. If you have End Stage Renal Disease or ALS, you are usually awarded Medicare immediately.

When should I apply for Medicare? First, if you are already receiving Social Security payments when you become eligible for Medicare, you don’t need to apply. You will be automatically enrolled in Medicare. If you are turning 65 and need to apply, you can do so 3 months before the first day of the month that you turn 65. If you are over age 65 and have insurance through your employer; you can apply anytime and your coverage can begin as soon as the first day of the next month. If you are receiving disability

How do I enroll in Medicare? 1. Apply Online through the Social Security website. 2. Call the Social Security Administration at 1-800-772-1213 and schedule an appointment to enroll by phone. Instead of calling the main Social Security 800 number, you can call your local office to schedule a phone enrollment. To find your local office click here.

What Penalties Can I Incur With Medicare? If you don’t enroll in Medicare Part B when you’re first eligible, and decide to enroll later, your monthly premium will include a penalty. Your penalty gets worse based on the length of time that you didn’t sign up. Penalties can be avoided if you maintain other insurance such as employer group medical. Veterans Administration benefits do not count as other coverage toward penalties.

What is the benefit of working with Lone Star Medicare? Medicare can be confusing and the government doesn’t directly provide you with all benefits. So, you have choices to make and things to do. As a top independent agency, we are a one stop guide and resource to help make your life easier. We can help you get the coverage you need and save money. There are also no fees or costs for you, it’s a win win.

Medicare Advantage Questions

Will Medicare Advantage and it’s extra benefits cost me more monthly? In most cases no. The nice thing about Medicare Advantage is that you can get extra benefits included, for little or no extra monthly cost.

How does Medicare Advantage provide extra benefits for no extra monthly cost? When you sign up for a Medicare Advantage plan it is provided by a private insurance company and it becomes your Medicare benefits. Medicare then pays your insurance provider a monthly amount to provide you with your benefits. Insurance providers are already efficient at providing extra benefits (dental, vision, hearing, etc), so they’re able to include them for no extra cost.

Will having Medicare Advantage lower the quality of my coverage or care? No. Medicare Advantage is regulated by the federal government. Medicare Advantage plans provide coverage for medically needed care and treatment. However, the quality of service and doctor / hospital networks can vary with different plans and insurers. Some plans & providers are better than others.

If I sign up for Medicare Advantage, can I keep my doctors or will I need to change them? In most cases, yes. Medicare Advantage plans have networks, meaning a list of doctors and hospitals that are accept the plan. Some Medicare Advantage plans allow you to go out of network, to any doctor. When evaluating a Medicare Advantage plan, you should check if your doctors and medical providers accept the plan. If you’re working with us, this is something that we will do for you.

When can I enroll in a Medicare Advantage plan to get additional benefits? There are two primary periods when you can enroll in a Medicare Advantage plan. 1. When you first start Medicare A & B. 2. During the Annual Open Enrollment period which begins October 15th and lasts through December 7th.

If I decide to take Medicare Advantage instead of Original / Standard Medicare, can I ever change back? Yes. Each year from January 1st through March 31st you can dis-enroll from a Medicare Advantage plan and go back to Original Medicare.

Medicare Supplement Questions

When can I sign up for a Medicare Supplement? Your Medicare Supplement open enrollment period starts 6 months before the month you turn 65 and ends 5 months after that month. During this time period you can enroll in any Medicare Supplement policy without health questions. Your coverage will begin the month you start Medicare A & B or turn 65. If you are outside of your open Medicare Supplement open enrollment period, you can apply anytime, you may just need to answer health questions.

Will Medicare Supplements cover me at my doctors & medical providers Standard Medicare Supplement plans cover you at any doctor that accepts Medicare A & B. If your doctor accepts Traditional Medicare A & B, they should also accept a Standard Medicare Supplement with any insurance provider.

Do Medicare Supplements cover pre-existing conditions? Coverage for pre-existing conditions varies with different insurance companies. Many Medicare Supplement insurers cover pre-existing conditions from the start of your coverage. Some Medicare Supplement insurers have a waiting period for pre-existing conditions that can be offset if you have maintained coverage.

Will my Medicare Supplement cost me more if I have pre-existing conditions? No. Premium costs for Medicare Supplements are not based on your health or claims history.

Can Medicare Supplement insurance providers deny coverage for a service or procedure? No. Medicare Supplements cover their part of the costs for all services provided under Medicare A & B. They do not determine if a service or procedure is covered, Medicare does.

Can I be dropped from a Medicare Supplement policy? As long as you pay your premium and keep it up to date, no. Once you are covered by a Medicare Supplement policy it is guaranteed renewable each year and you can never be dropped because of your age, health, or claims history.

Do Medicare Supplements cover prescription drugs? Medicare Supplements cover their part of costs for services provided under Medicare A & B. Medicare A & B only covers certain medications administered to you at a doctors office or in the hospital. To have coverage for medications you take regularly and fill at the pharmacy, you will need a stand alone Part D plan.

If I don’t take any medications or only a couple, do I still need a Part D prescription plan? It is highly recommended that you enroll in a Part D prescription plan unless you have creditable prescription coverage through another source. If you don’t sign up for a Part D plan when you’re first eligible, and decide to enroll later, you may incur lifetime penalties.

Can my Medicare Supplement rate be increased? The most common way Medicare Supplements are priced is called “attained age” pricing. This means that once you have a Medicare Supplement, your rates can increase each year based on your age when your policy automatically renews. Your Medicare Supplement rate can also increase based on changes to Medicare and rate increases for all insureds in a particular state. You cannot be singled out for rate increases because of your personal health and claims history.

If I choose a Medicare Supplement plan, can I change it later? You can change your Medicare Supplement plan. Keep in mind, if you do, you more than likely will need to qualify and answer health questions.

Does it matter which insurance company provides my Medicare Supplement Each Medicare Supplement insurance provider is regulated by Medicare and required to provide the benefits and coverage based on your letter policy. Rates, service, and long term stability varies. It is these reasons why you should compare insurance providers and choose a quality option for your coverage.

What happens to my Medicare Supplement if I move? In most cases, If you move, you can take your Medicare Supplement with you. The coverage and benefits are locked in. The monthly rate you pay, however, may adjust to rates in your new service area.

Will My Medicare Supplement cover me if I’m traveling? Yes. Medicare Supplements work with Medicare A & B to cover you at any Medicare Approved doctor in the country. This includes when you’re traveling and have an emergency or if you schedule an appointment.

What is the difference between Medicare Supplements and Medicare Advantage? Medicare Supplements are secondary insurance policies to Medicare A & B. In this case you keep Traditional Medicare as your primary insurance. Medicare Advantage plans, also known as Part C, are when your Medicare is replaced by a private insurance provider. In this case you have one plan package that includes all of your benefits. Inquire with your agent for more details.

If I choose a Medicare Supplement, can I change to an Advantage Plan later and vice versa? If you start with a Medicare Supplement you can change to an Advantage Plan during your next valid open enrollment period. These occurr annually or in special situations. If you start with an Andvantage Plan and want to change to a Medicare Supplement later; you may have to answer health questions and qualify.

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