Medigap Plans in Texas: What You Need to Know

Table of Contents

You’ve worked hard for your retirement. The last thing you need is a surprise medical bill derailing your plans. While Original Medicare is a great start, it doesn’t cover everything, and those out-of-pocket costs can add up fast. That’s where a Medigap plan comes in. Think of it as a financial safety net, catching unexpected expenses like deductibles and coinsurance before they hit your budget. By paying a steady monthly premium, you get peace of mind. This guide will help you understand the different Medigap plans in Texas, so you can protect your savings and enjoy the retirement you deserve.

Key Takeaways

Enroll on Time to Avoid Health Questions: Your six-month Medigap Open Enrollment Period is a one-time opportunity to buy any plan without being denied or charged more for pre-existing conditions. Missing this window means you’ll likely face medical underwriting.
Focus on Price, as Plan Benefits are Standardized: A Plan G from one company has the same core benefits as a Plan G from another. This lets you shop around and compare companies based on their monthly premium and customer service to find the best value.
Remember Medigap is a Partner to Original Medicare: Medigap policies supplement your Original Medicare by helping pay for costs like deductibles and coinsurance. They don’t cover prescription drugs (you’ll need a separate Part D plan for that) and cannot be paired with a Medicare Advantage plan.

How Do Medigap Plans in Texas Work?

If you’ve ever looked at a medical bill and wondered about all the extra costs beyond the main service, you already understand why Medigap exists. Original Medicare (Part A and Part B) is a fantastic foundation for your health coverage, but it doesn’t cover everything. You’re still responsible for costs like deductibles, copayments, and coinsurance, which can add up quickly. This is where a Medicare Supplement Insurance plan, often called Medigap, comes into play.

Think of it as a helper policy that works alongside your Original Medicare. You buy it from a private insurance company, and its job is to help pay for those out-of-pocket costs that Medicare leaves behind. It literally helps fill in the financial “gaps” in your coverage, giving you more predictable healthcare expenses and peace of mind. It’s important to know that Medigap only works with Original Medicare. You cannot have a Medigap policy and a Medicare Advantage plan at the same time, as they serve different purposes. With Medigap, you keep Original Medicare as your primary insurance and can see any doctor or visit any hospital in the country that accepts Medicare, without needing referrals. The Medigap plan simply helps with the bills, making it a straightforward way to manage your medical costs and protect your savings from unexpected health issues.

What Exactly Is Medicare Supplement Insurance?

Medicare Supplement Insurance, or Medigap, is extra insurance you can purchase from private companies to help cover your share of healthcare costs. When you have Original Medicare, it pays its approved amount for a service, and then your Medigap plan steps in to help pay for some of the remaining costs, like your Part A hospital deductible or the 20% coinsurance for doctor visits.

It’s important to know that Medigap policies are standardized. This means that a Plan G from one company has the exact same basic benefits as a Plan G from another. While the coverage is the same, the monthly premium you pay can vary between insurance companies, which is why it’s always a good idea to compare your options.

Understanding Original Medicare’s Gaps

While Original Medicare is a great starting point, it was never designed to cover 100% of your healthcare costs. It leaves behind certain expenses, often called “gaps,” that you are responsible for paying. Understanding these gaps is the first step in deciding if a Medigap plan is the right choice for you. These out-of-pocket costs fall into two main categories: services that Medicare doesn’t cover at all and the portion of the bills you’re expected to pay for covered services. This cost-sharing structure can make it difficult to predict your medical expenses from one year to the next, which is why many people look for additional coverage.

What Original Medicare Doesn’t Cover

Original Medicare Parts A and B are your foundation for hospital and medical coverage, but there are several common healthcare needs they don’t address. For instance, most long-term care, such as extended stays in a nursing home or assistance with daily activities, is not covered. The same goes for most dental work, routine eye exams, and eyeglasses. According to the Texas Department of Insurance, other services typically excluded are hearing aids, cosmetic surgery, and routine foot care. If you plan to travel, it’s also important to know that most healthcare you receive outside of the United States won’t be covered by Original Medicare.

Key Medicare Costs in 2025

Beyond the services that aren’t covered, you also share the cost of Medicare-approved services through deductibles, copayments, and coinsurance. You’re responsible for the Medicare Part B deductible before your medical coverage begins paying. After that, you typically pay 20% of the cost for most doctor services and outpatient care, with no annual limit on what you might owe. For hospital stays, you have a significant Part A deductible to meet for each benefit period. Some Medigap plans, like the High-Deductible Plan G, require you to pay a certain amount out-of-pocket before the plan pays anything. For instance, the deductible for these high-deductible plans is set to be $2,870 in 2025.

The Medigap Market in Texas at a Glance

You’re not alone in looking for ways to manage these costs. In Texas, nearly 950,000 people have chosen a Medigap plan to add predictability to their healthcare budget. The market can seem crowded with options from various insurance companies, but there’s a key feature that simplifies the process: standardization. Federal and state laws require Medigap plans to be standardized, which means that the benefits for each plan letter (like Plan G or Plan N) are the same regardless of which company sells it. A Plan G from one insurer offers the exact same basic medical coverage as a Plan G from another. This is great news for you because it allows you to focus your comparison on what truly differs: the price and the company’s reputation for service.

Because the benefits are identical, you can shop for the most competitive premium without worrying that you’re sacrificing coverage. Insurance companies set their own monthly premiums, and these can vary significantly for the same exact plan. One company might charge much more than another for the same Plan G policy. This is why it’s so important to compare quotes from multiple carriers. Your goal is to find a company that offers a stable, affordable rate and has a strong track record of customer satisfaction. This approach ensures you get the best value for your money while securing the financial protection you need.

How Medigap Helps Pay Your Medicare Costs

A Medigap plan works as a secondary payer to Original Medicare, which is your primary insurance. This means you must be enrolled in both Medicare Part A and Part B to buy a Medigap policy. When you visit a doctor or hospital that accepts Medicare, you’ll show both your Medicare card and your Medigap card. Medicare pays its share first, and then your Medigap plan pays its portion of the remaining bill.

These plans only cover services that Medicare deems medically necessary. They don’t cover things like long-term care, dental, vision, or prescription drugs. For drug coverage, you’ll need a separate Medicare Part D plan. Medigap simply smooths out the unpredictable costs associated with your core Medicare coverage.

Which Medigap Plans Are Available in Texas?

When you start looking at your Medigap options in Texas, you’ll find you have quite a few choices. At first, it might seem like a lot to sort through, but there’s a key piece of information that makes it much simpler: all Medigap plans are standardized. This is a federal rule designed to help you. It means that the basic benefits for each plan letter are the same, no matter which insurance company is offering it. So, a Plan G from one company will provide the exact same foundational coverage as a Plan G from another.

This is incredibly helpful because it lets you compare apples to apples. Instead of getting bogged down in confusing coverage differences, you can focus on what really matters for your decision: the monthly premium and the insurance company’s reputation for customer service. It simplifies the shopping process and gives you the confidence that you’re choosing based on price and quality, not fine print. In Texas, you have access to a full range of these standardized options, giving you the flexibility to find the one that truly fits your healthcare needs and your budget.

A Breakdown of Plans A Through N

In Texas, you can choose from Medigap Plans A, B, C, D, F, G, K, L, M, and N. Each plan offers a different level of coverage for the “gaps” in Original Medicare, like deductibles, coinsurance, and copayments. As the Texas Department of Insurance explains, this standardization is designed to protect you. It ensures that you know exactly what you’re getting with each plan letter. The only differences between same-letter plans from various companies will be the monthly premium and the quality of their customer service. This makes it much simpler to shop around and find the best value for your specific situation.

What Are Medicare SELECT Plans?

While comparing Medigap options, you might see something called a Medicare SELECT plan. This is a specific type of Medigap policy that offers the same standardized benefits as its regular counterpart—for instance, a SELECT Plan G covers the same things as a standard Plan G. The key difference is that SELECT plans require you to use a specific network of hospitals and doctors to receive full benefits. In exchange for using this network, these plans often come with lower monthly premiums, making them a budget-friendly choice if the network fits your needs.

The network is the most important detail to check before choosing a SELECT plan. You’ll want to confirm that your preferred doctors and local hospitals are included. If you get non-emergency care from a provider outside the network, the plan may not pay its share, leaving you with higher out-of-pocket costs. However, you are always covered for emergency care, even when you’re outside the network. For those who don’t travel frequently and are happy with their local providers, a SELECT plan can be a great way to get excellent Medigap coverage for a lower price.

Why Are Plans G, N, and F So Popular?

While you have many options, most people find their best fit among three popular plans: G, N, and F.

Plan G is often the top choice for new Medicare beneficiaries because of its comprehensive coverage. It pays for nearly all of your out-of-pocket costs after you’ve met the annual Medicare Part B deductible, giving you great peace of mind.

Plan N is another excellent option, especially if you’re looking for a lower monthly premium. In exchange, you’ll have small copayments for some doctor and emergency room visits, creating a nice balance of strong coverage and monthly savings.

Lastly, Plan F provides the most extensive coverage available, but it’s important to know that new Medicare members are no longer able to enroll in this plan if they became eligible on or after January 1, 2020.

Texas Enrollment by Plan Type

While Texas provides a wide array of Medigap plans, most people find their best fit with just a couple of them. Plan G has become the go-to for new beneficiaries, offering robust coverage that’s nearly identical to the old Plan F. For those who want a lower monthly premium, Plan N is an increasingly popular choice, providing strong protection with just a few predictable copayments. While it’s useful to know what’s popular, the right decision always comes down to your individual health needs and budget.

Covering Part B Excess Charges

One detail that can cause confusion is something called a Part B excess charge. This happens when a doctor who accepts Medicare is legally allowed to charge up to 15% more than Medicare’s approved amount for a service. While these charges aren’t common, they can be an unexpected expense. For total protection against this, Medigap Plans F and G are the only two options that cover these costs. Choosing one of these plans gives you an extra layer of financial security, so you never have to worry if your doctor charges more than the standard Medicare rate.

What’s Covered by Different Medigap Plans?

One of the best things about Medigap is that the plans are standardized. This means that a Plan G from one insurance company has the exact same medical benefits as a Plan G from another. The only differences are the price and the company’s customer service. This standardization makes it much easier to compare your options without getting lost in the fine print.

While there are 10 different plans available in Texas, labeled A through N, most people find their needs are met by one of three popular choices: Plan G, Plan N, or Plan F (if you were eligible for Medicare before 2020). Each plan is designed to cover the “gaps” in Original Medicare, like deductibles, coinsurance, and copayments. The key is to figure out which set of benefits gives you the right amount of coverage for your health needs and budget. Let’s break down what each plan includes so you can see how they stack up.

Standard Benefits Included in Every Plan

Before you start comparing the differences, it helps to know what all Medigap plans have in common. Every single plan, from A to N, covers a core set of benefits. Think of these as the foundational building blocks of your coverage. No matter which plan you choose, you can count on it to help pay for your Medicare Part A coinsurance for hospital and hospice care, your Part B coinsurance or copayments for medical services, and the first three pints of blood you might need for a transfusion. This basic coverage is outlined in the official Medicare supplement insurance guide and ensures you have a safety net for some of the most common and significant medical costs.

How Do Plan-Specific Benefits Differ?

Once you move past the core benefits, you’ll see how the plans differ. The most popular options offer more extensive coverage. For years, Plan F was the top choice because it covered everything Original Medicare didn’t, including the Part B deductible. However, it’s now only available to those who were eligible for Medicare before January 1, 2020.

For new enrollees, Plan G is the most comprehensive option. It covers nearly everything Plan F does, with one exception: you have to pay the annual Medicare Part B deductible yourself. After that, the plan picks up the rest. Plan N is another great choice if you want a lower premium. It provides solid coverage but requires you to pay small copayments for some doctor and emergency room visits.

Plan N Copayments Explained

Plan N is a popular choice for people who want a lower monthly premium and are comfortable with some predictable cost-sharing. In exchange for that lower premium, you agree to pay a small copayment for certain medical visits. Specifically, you may have a copayment of up to $20 for some office visits and a $50 copayment for an emergency room visit if you aren’t admitted to the hospital. These costs are often much more manageable than the 20% coinsurance you would otherwise face with Original Medicare alone. This structure offers a great middle ground, providing strong protection against major medical bills while keeping your monthly expenses down. It’s a design that creates a nice balance of strong coverage and monthly savings for many beneficiaries.

Foreign Travel Emergency Care

If you have plans to travel outside the country, it’s important to know that Original Medicare offers very limited coverage abroad. This is where certain Medigap plans can be a huge help. Plans C, D, F, G, M, and N all include a benefit for foreign travel emergencies. This coverage typically pays for 80% of your emergency care costs after you meet a small deductible. It’s designed for unexpected medical issues that arise during the first 60 days of your trip and has a lifetime limit. For many retirees, having this foreign travel coverage is a key factor in choosing a Medigap plan, as it provides peace of mind while exploring the world.

Is the High-Deductible Plan G Right for You?

If you like the comprehensive coverage of Plan G but want a much lower monthly premium, the high-deductible version might be a perfect fit. With this plan, you agree to pay all of your Medicare-covered costs out-of-pocket until you meet a set annual deductible. For 2025, that deductible is $2,870. Once you’ve met it, the plan pays 100% of covered services for the rest of the year. This option is often a good match for people who are generally healthy and don’t expect many medical bills but want robust protection against a major health event. It gives you peace of mind without the high monthly cost of a standard Texas Medigap plan.

Who Sells Medigap Plans in Texas?

In Texas, you’ll find a competitive market for Medigap plans, with many well-known private insurance companies offering policies. Because all Medigap plans are standardized by the federal government, the core benefits of a specific plan letter, like Plan G, are identical no matter which company you buy it from. This is great news for you, as it simplifies the comparison process. You don’t have to worry about one company’s Plan G having better hospital coverage than another’s. They are the same.

This standardization allows you to focus your decision on the two factors that do vary between companies: the monthly premium and the company’s reputation for customer service and financial stability. Some insurers have a larger presence in the state, while others might be smaller but offer more competitive rates or better service. Understanding which companies are the major players and how they are rated for quality can help you narrow down your choices and find a policy that provides both excellent coverage and long-term value.

Top Providers by Market Share

When you look at the Medigap market in Texas, a few large companies stand out. Market share simply tells you which insurers cover the most people. In Texas, UnitedHealthcare is the largest provider of Medicare Supplement plans, with its parent company, United Health Group, insuring nearly a third of all Medigap policyholders in the state. Another major player is Mutual of Omaha, which holds a significant portion of the market as well. While a large market share can indicate a company’s stability and experience, it doesn’t automatically mean it’s the best choice for you. It’s one of several factors to consider alongside price and customer satisfaction when making your decision.

How Companies Are Rated for Service and Value

Since plan benefits are identical, the best way to find real value is to compare companies on their pricing and service quality. Independent rating agencies evaluate insurers on several key metrics to help you do just that. They look at factors like pricing structures, available discounts (such as household discounts), the number of consumer complaints filed with state regulators, and overall customer experience. A company’s financial strength rating is also crucial, as it shows their long-term ability to pay claims. Sorting through this information for multiple companies can be time-consuming, which is why many people choose to work with an independent agency. At The Big 65, we help you compare top-rated carriers to find a plan that fits your budget and gives you confidence in your coverage.

When Is the Best Time to Enroll in a Texas Medigap Plan?

Timing is everything when it comes to buying a Medigap plan. While you can technically apply for a policy at any time, there’s a specific window of opportunity where you have the most options and protections. Missing this window can make it more difficult and expensive to get the coverage you want. Let’s walk through the key enrollment periods so you can make a confident and timely decision.

What Is Your Medigap Open Enrollment Period?

The absolute best time to buy a Medigap policy is during your Medigap Open Enrollment Period. This is a one-time, six-month window that starts on the first day of the month you are both 65 or older and enrolled in Medicare Part B. During these six months, you have a golden ticket. Insurance companies are required to sell you any Medigap plan they offer, regardless of your health history. They can’t deny you coverage or charge you a higher premium for pre-existing conditions. This is your chance to get the plan you want with no health questions asked, making it a critical period to mark on your calendar.

What Are Guaranteed Issue Rights?

What if your Open Enrollment Period has already passed? Don’t worry, you might still have an opportunity. In certain situations, you are given what’s called a “guaranteed issue right” to buy a Medigap policy. These rights are triggered by specific life events, such as losing your employer health coverage after turning 65 or if your Medicare Advantage plan stops serving your area. When you have these rights, an insurance company must offer you certain Medigap plans without using medical underwriting. You typically have 63 days from when your other coverage ends to use this right, so it’s important to act quickly. The Texas Department of Insurance provides a helpful guide on these special circumstances.

Special Rights for Texans Under 65

In Texas, if you’re under 65 and on Medicare due to a disability, you have special protections that are really important to know about. The state gives you a special six-month open enrollment period, which works just like the one for people turning 65. During this time, you can buy any Medigap plan sold in your area, and insurance companies can’t ask you health questions, deny you coverage, or charge you more because of a pre-existing condition. This is a huge advantage. You also have guaranteed issue rights in certain situations, like if you lose your employer health plan. This gives you another protected window to buy a policy. For a full breakdown of these rights, the Texas Department of Insurance provides a comprehensive guide to help you understand your options.

What Happens If You Miss Your Enrollment Window?

Taking advantage of your Medigap Open Enrollment Period is so important because it may be your only chance to enroll without any health-related hurdles. If you wait and apply later without a guaranteed issue right, insurance companies in Texas can use medical underwriting. This means they will review your entire medical history and can ask detailed health questions. Based on your health, they could charge you a much higher premium than someone who enrolled during their open enrollment window. In some cases, they can even deny your application for coverage altogether. Acting during your initial six-month window ensures you get the policy you need at the best possible price.

How Much Does a Texas Medigap Plan Cost?

One of the first questions on everyone’s mind is, “What will this cost me?” When it comes to Medigap plans in Texas, there isn’t a single price tag. The monthly premiums are set by private insurance companies and can vary quite a bit. However, understanding how these prices are determined can help you find a plan that fits your budget and provides the coverage you need. Let’s break down the key elements that go into the cost of a Medigap plan.

How Are Premiums Calculated?

Insurance companies in Texas use one of three pricing methods to set your monthly premium. It’s helpful to know which method a plan uses, as it affects how your rate may change over time.

Community-rated: With this method, everyone who has the same plan pays the same premium, regardless of their age. Your rate won’t go up just because you get older, though it can still increase due to inflation or other factors.
Issue-age rated: Your premium is based on your age when you first buy the policy. The younger you are when you enroll, the lower your premium will be. Rates won’t increase due to your age, but they can for other reasons.
Attained-age rated: These plans start with a lower premium based on your current age. However, the premium will increase as you get older. These plans can become quite expensive over time.

What Can You Expect to Pay for Each Plan?

While the exact price you’ll pay depends on several factors, looking at averages can give you a general idea. In Texas, monthly premiums can be as low as $48 for a basic plan or climb much higher for more comprehensive coverage.

For example, Medigap Plan G, a popular choice for new Medicare beneficiaries, often has monthly premiums ranging from about $96 to over $900. Plan F, which is only available to those eligible for Medicare before 2020, sees similar ranges. Plan K, which requires more cost-sharing, is often one of the least expensive options, with premiums sometimes starting under $50. These wide ranges show why it’s so important to compare quotes from different insurance companies for the same plan.

Sample 2025 Premiums in Dallas

To give you a real-world idea of how premiums can differ, let’s look at some sample monthly rates in Dallas for a 65-year-old female who doesn’t smoke. Remember, these are just examples, but they clearly show the range you might find for the most popular plans:

AARP/UnitedHealthcare: Plan G at $136, Plan N at $98
Wellabe: Plan G at $141, Plan N at $104
Mutual of Omaha: Plan G at $152, Plan N at $115
State Farm: Plan G at $160, Plan N at $112

As you can see, the price for the exact same plan can change quite a bit from one company to the next. In this comparison, the lowest monthly premium found for Plan G was $105, while the lowest for Plan N was just $75. This data, highlighted in a recent NerdWallet analysis, really drives home the importance of comparing your options. Since the benefits of each plan letter are standardized, you can focus on finding a trusted company that offers a price that fits your budget.

What Factors Influence Your Premium?

Beyond the pricing method and the specific plan you choose, several personal factors will influence your final monthly premium. Insurance companies look at your location, as premiums can be higher in areas with a greater cost of living. Your age and gender also play a role in what you’ll pay.

In some situations, your health status can affect your premium, especially if you apply outside of your Medigap Open Enrollment window. During this protected period, companies can’t use your health history to charge you more. Additionally, whether you use tobacco can impact your rate. All these elements combine to create a premium that is personalized to you.

Common Premium Discounts and Perks

The monthly premium you see isn’t always the final price you’ll pay. Many insurance companies offer discounts that can make their plans much more affordable, and the most common one is a household discount. For example, some Texas insurers provide a discount of up to 12% if you live with a spouse or partner, even if they aren’t enrolling with you. Since the benefits for each plan letter are standardized, these discounts are a major reason to compare prices from different companies. A plan that looks more expensive at first glance might actually be the better deal once you factor in the savings.

Beyond the household discount, it’s always worth asking about other ways to save. Some insurers offer loyalty discounts if you’ve had another type of health plan with them in the past. Others provide perks that add value to your coverage. While these extras don’t lower your monthly premium, things like free gym memberships or access to a 24/7 nurse hotline can certainly contribute to your overall health and well-being. When you’re getting quotes, always ask about any available discounts or value-added benefits. You might be surprised by how much you can save just by asking the right questions.

How to Choose the Right Medigap Plan for You

Picking the right Medigap plan feels like a big decision, but it doesn’t have to be overwhelming. The best plan for you comes down to your personal health needs, your budget, and your comfort level with out-of-pocket costs. By thinking through these key areas, you can find a plan that gives you peace of mind and financial security. Let’s walk through how to compare your options and make a choice that fits your life.

Do You Need a Medigap Plan?

First, it’s worth asking if a Medigap plan is the right move for you at all. While these plans are an excellent way to manage out-of-pocket costs, they aren’t a universal solution for every person on Medicare. Your current health coverage and financial situation play a big role in this decision. For example, if you already have other insurance that helps pay for Medicare’s deductibles and coinsurance, adding a Medigap policy would be redundant. Before you start comparing plan letters and premiums, take a moment to review your existing benefits. You might find that you already have the protection you need, or that there are other programs available that could be a better fit.

When Other Coverage Might Be Enough

You likely don’t need to add a Medigap plan to your coverage if you already have certain types of health insurance. According to the Texas Department of Insurance, this includes having group health insurance from a current or former employer, whether it’s your own or a spouse’s plan. It’s also important to remember that you cannot have a Medigap policy and a Medicare Advantage plan at the same time; they are two different ways to get your Medicare benefits. If you are enrolled in a Medicare Advantage plan, it provides your hospital and medical coverage, so a Medigap plan wouldn’t work with it. Similarly, if you have coverage through Medicaid, it already helps with your Medicare costs, making a separate Medigap plan unnecessary.

Cost-Saving Programs to Consider

If you’re concerned about healthcare costs and have a limited income, there are programs designed to help before you even consider a Medigap plan. Medicare Savings Programs (MSPs) can help pay for your Medicare premiums and, in some cases, your deductibles and coinsurance. The Qualified Medicare Beneficiary (QMB) program is one type of MSP that covers these costs, and if you qualify for it, you don’t need a Medigap policy. Other programs like Medicaid or the Program of All-Inclusive Care for the Elderly (PACE) can also provide significant financial assistance. Exploring these cost-saving options first is a smart step. An experienced agent can help you understand if you might be eligible for these state and federal programs.

Plan G vs. Plan N: Which One Is Better?

For many people new to Medicare, the choice often comes down to Plan G and Plan N. Plan G is a popular option because it offers very comprehensive coverage. Once you’ve paid your annual Medicare Part B deductible, Plan G covers almost all of your remaining out-of-pocket costs, which makes your healthcare expenses highly predictable.

Plan N is another great choice, often with a lower monthly premium. In exchange for that lower premium, you’ll have small copayments for some doctor and emergency room visits. It’s important to know that Plan N doesn’t cover Part B excess charges, which are extra amounts some doctors can charge above what Medicare approves. Your decision between the two often depends on whether you prefer paying a little more each month for more complete coverage or saving on premiums and paying small costs as you go.

What Kind of Coverage Do You Really Need?

Take a moment to think about your health, both now and in the future. Do you have chronic conditions that require frequent doctor visits? Do you anticipate needing more medical care down the road? A Medigap plan can be a financial safety net, protecting your savings from high, unexpected medical bills.

At the same time, you don’t want to pay for more coverage than you actually need. The Texas Department of Insurance advises against buying policies that duplicate benefits you might already have. Being honest about your health situation and how often you see a doctor will help you find that sweet spot between having robust coverage and maintaining a comfortable budget.

How to Plan for Your Medigap Budget

Medigap premiums can vary quite a bit, so it’s smart to understand what goes into the price. Insurance companies in Texas set their rates based on factors like your age, gender, and whether you use tobacco. The plan you choose and the company you buy it from also play a big role in the final cost.

One of the most important things to remember is that different companies can charge different prices for the exact same plan. This is why it’s so crucial to compare Medigap plans from several different insurers. Taking the time to shop around ensures you’re not overpaying for your coverage and helps you find the best value for your budget.

Let’s Clear Up Common Medigap Myths

Medicare can feel like a puzzle, and with so much information out there, it’s easy to get a few pieces mixed up. Medigap, in particular, is often misunderstood. Let’s walk through some of the most common myths I hear and set the record straight so you can feel confident about your coverage choices. Think of this as your personal myth-busting guide to Medigap in Texas. We’ll tackle everything from prescription drugs to policy cancellations, giving you the clear, simple facts you need.

Do Medigap Plans Cover Prescriptions?

One of the biggest points of confusion is whether Medigap covers prescription medications. It’s a fair question, but the answer is simple: Medigap plans sold today do not. If you rely on prescriptions, you’ll need a separate plan for that. The reality is that “Medigap plans do not cover prescription drugs. If you have a Medigap plan and want drug coverage, you need to buy a separate Medicare Part D plan.” This is a critical detail to remember as you budget for your healthcare costs. Keeping your medical and prescription drug coverage separate allows you to pick the best Part D plan for your specific medication needs.

Is Medigap the Same as Medicare Advantage?

This is another common mix-up. While both are offered by private insurance companies, they function in completely different ways. Medigap is not a replacement for your Medicare benefits; it’s an addition. The key thing to understand is that Medigap plans work with Original Medicare, not instead of it. They help pay for the costs that Original Medicare doesn’t cover, like deductibles and coinsurance. You absolutely cannot have both a Medigap policy and a Medicare Advantage plan at the same time. They are two distinct paths for your healthcare coverage, so you’ll need to choose one or the other.

Benefit Stability Year After Year

One of the best parts about Medigap is the predictability it offers. When you choose a plan, like a Plan G, its core benefits are set and don’t change from one year to the next. This consistency is a huge relief because you won’t have to worry about your coverage suddenly shrinking or your costs unexpectedly changing. This is a key difference from Medicare Advantage plans, which can alter their benefits, doctor networks, and costs every single year. As CBS News points out, this stability is a major reason people choose Medigap. It allows you to budget for your healthcare with confidence, knowing your financial safety net will remain the same for the long haul.

Prior Authorization and Network Freedom

With a Medigap plan, you have the freedom to see any doctor or visit any hospital in the United States that accepts Medicare. You aren’t restricted to a local network of providers, which is a huge advantage if you travel or spend part of the year in another state. Because Medigap works with Original Medicare, you also don’t need a referral from a primary care physician to see a specialist. This gives you direct access to the care you need, when you need it. Furthermore, you can largely avoid the hassle of prior authorizations, which is when an insurance company must approve a service before you can receive it. This freedom and flexibility put you in control of your healthcare decisions.

Can You Be Dropped? Do You Need to Stay in Network?

It’s natural to worry about losing your health coverage, especially if your health changes down the road. Here’s some good news: your Medigap policy is guaranteed renewable. This means that “once you have a Medigap policy, the insurance company cannot cancel it as long as you pay your premiums on time, even if your health changes.” This provides incredible peace of mind. Another major benefit is freedom of choice. Since Medigap supplements Original Medicare, you can see any doctor or visit any hospital in the U.S. that accepts Medicare. There are no restrictive networks to worry about, giving you flexibility and control over your healthcare decisions.

Understanding Your Consumer Rights in Texas

When you’re choosing a Medigap plan, it’s good to know that Texas has specific rules in place to protect you. These regulations are designed to ensure you are treated fairly and have the information you need to make a sound decision. Knowing your rights gives you confidence as you compare your options and helps you identify trustworthy partners who will put your best interests first. From having time to review your policy to protections against aggressive sales tactics, these rules create a safer environment for you to secure your healthcare coverage.

The 30-Day “Free Look” Period

One of the most important consumer protections in Texas is the 30-day “free look” period. After you purchase a Medigap policy, you have a full 30 days to review it. If you decide for any reason that it’s not the right fit for you, you can return it for a full refund, no questions asked. This gives you valuable time to read through the details without pressure. Additionally, all Medigap policies are “guaranteed renewable.” This means the insurance company cannot cancel your policy as long as you pay your premiums. They can’t drop your coverage because your health changes, which provides incredible long-term security and peace of mind.

Protections Against Unfair Sales Practices

The Texas Department of Insurance has established clear guidelines to shield you from unfair or misleading sales tactics. You have the right to take your time and not be rushed into a decision. Before you sign anything, make sure you read the application and policy documents carefully. It’s also wise to verify that any agent you speak with is licensed in Texas. When you make a payment, it should always be to the insurance company directly, not the individual agent. If you ever feel pressured or encounter tactics that seem misleading, you have the right to report these unfair practices and seek a different advisor.

Rules on Owning Multiple Policies

To prevent you from paying for redundant coverage, Texas law makes it illegal for anyone to sell you more than one Medigap policy. Since these plans are standardized, owning two of the same kind would be a waste of your money. It’s also important to be cautious about buying other types of insurance, like a cancer or hospital indemnity policy, that might duplicate the benefits you already have with Medigap. A good agent will help you understand what your Medigap plan covers so you don’t accidentally purchase overlapping policies. This rule ensures your money goes toward meaningful coverage that truly fills the gaps in your Original Medicare.

How to Apply for a Medigap Plan in Texas

Once you’ve compared your options and have a plan in mind, the next step is to apply. This part of the process can feel a little intimidating, but it’s really just a matter of following a few key steps and paying close attention to timing. Think of it as filling out any other important application—the key is to be prepared.

The application process itself is fairly standard across different insurance companies. You’ll provide your personal information, select the plan you want, and answer some questions. The most important factor in this process isn’t the paperwork itself, but when you choose to submit it. Applying at the right time can make all the difference in your eligibility and premium costs. Let’s walk through exactly what you need to do to get your Medigap policy in place.

What Are the Steps to Apply?

Timing is everything when it comes to Medigap. The absolute best time to apply is during your Medigap Open Enrollment Period. This is a six-month window that starts on the first day of the month you turn 65 and are enrolled in Medicare Part B. For example, if your 65th birthday is in May and your Part B coverage also starts in May, your open enrollment window runs from May 1st to October 31st.

During this specific period, insurance companies cannot turn you down or charge you more because of your health history. You have what are called “guaranteed issue rights,” which means any Medigap plan available in your area is yours for the taking. This is your golden ticket to getting the coverage you want without any hassle.

Will You Need to Go Through Medical Underwriting?

If you miss your Medigap Open Enrollment Period, applying for a plan becomes a bit more complicated. Outside of that six-month window, insurance companies in Texas can use medical underwriting to review your application. This means they will take a close look at your health history, including pre-existing conditions, current health status, and prescription drug usage.

Based on this review, an insurer can legally deny you coverage or charge you a higher premium for the same plan. This is why enrolling on time is so critical. While there are some special circumstances that might grant you another opportunity to enroll without underwriting, your initial Open Enrollment Period is the one time you can be certain you’ll be accepted. It’s a one-time opportunity you don’t want to miss.

What Paperwork Do You Need to Apply?

When you’re ready to fill out your application, having your information organized will make the process smooth and simple. You won’t need a mountain of paperwork, but you will need a few key pieces of information. Before you sit down to apply, make sure you have these items handy.

You’ll definitely need your red, white, and blue Medicare card, as it contains your Medicare number and the start dates for your Part A and Part B coverage. You will also need to provide basic personal details like your full name, address, and date of birth. If you are applying outside of your Open Enrollment Period, be prepared to answer detailed questions about your health history.

Can You Switch Medigap Plans Later On?

This is a question I hear all the time: “Am I stuck with my Medigap plan forever?” The short answer is no, but changing plans isn’t always a simple swap. You can apply for a new Medigap policy at any point during the year, regardless of what plan you currently have. The key thing to understand, however, is that timing matters.

If you apply outside of a protected enrollment period, an insurance company can—and likely will—ask you detailed questions about your health history. This process is called medical underwriting. Based on your answers and medical records, the company can legally charge you a higher premium than someone with a clean bill of health or even deny your application altogether. This is why it’s so important to choose your initial plan carefully, as it might be the only chance you get to enroll without your health being a factor.

On a reassuring note, once you are enrolled in a Medigap plan, your coverage is very secure. As long as you pay your premiums on time, the insurance company cannot cancel your policy, even if your health changes down the road. This protection gives you valuable peace of mind, knowing your coverage will be there when you need it most. So while switching is possible, it’s a process that requires careful planning to avoid potential roadblocks.

When Can You Change Your Medigap Plan?

The absolute best time to enroll in a Medigap plan is during your Medigap Open Enrollment Period. Think of this as your one-time golden ticket to get any plan you want. This six-month window starts on the first day of the month that you’re both 65 or older and enrolled in Medicare Part B.

During this period, insurance companies are not allowed to use medical underwriting. That means they must sell you any Medigap plan they offer, and they can’t charge you more because of past or present health problems. This is a critical federal protection that ensures you have access to coverage. Once this one-time window closes, you generally lose these guaranteed issue rights.

What Are Medigap “Trial Rights”?

What if your Open Enrollment Period is long gone? You might still have an opportunity to switch plans without going through medical underwriting. Certain situations grant you “guaranteed issue rights,” which act like a special pass to buy a new policy.

For example, if you lose other health coverage, such as a retiree plan from a former employer, you typically have a 63-day window to buy a Medigap plan with these rights. There are also special cases for those who qualify for Medicare due to a disability before age 65. You get an initial open enrollment period when you first enroll in Part B, and then you get a second one when you turn 65. The Texas Department of Insurance provides a helpful guide on these specific circumstances.

Where to Find Help with Texas Medigap Plans

Trying to sort through all the Medigap options can feel like a full-time job. The good news is, you don’t have to do it by yourself. Texas offers a wealth of resources, from state programs to independent professionals, all designed to help you find the right coverage without the headache. Let’s look at where you can turn for clear, reliable guidance.

Should You Talk to an Insurance Agent?

One of the most effective ways to find the right plan is to talk with a licensed, independent insurance agent. Because these professionals are independent, they aren’t tied to a single insurance company. This means they can offer you unbiased advice based on what’s truly best for you, not what a particular company is selling. They’ll take the time to understand your health needs and your budget, then help you compare plans from multiple carriers. It’s their job to sort through the fine print and technical details so you can feel confident in your decision.

Where to Find Free Help and Online Tools

Texas also provides several fantastic, free resources to help you make an informed choice. The Texas Department of Insurance is a great starting point for understanding your rights and the plans available in the state. For more personalized support, you can connect with counselors who offer free, one-on-one assistance. The Texas Health Information, Counseling and Advocacy Program (HICAP) is one such program dedicated to helping Medicare beneficiaries. Similarly, the national State Health Insurance Assistance Program (SHIP) has local counselors who provide free, in-depth advice on everything Medicare-related, including Medigap. These programs are staffed by trained specialists who can answer your specific questions.

Frequently Asked Questions

If all Plan Gs have the same benefits, why do the prices vary so much? This is a fantastic question because it gets to the heart of how Medigap works. While the federal government standardizes the benefits of each plan letter to protect you, it doesn’t regulate the price. Private insurance companies are free to set their own monthly premiums. They base their prices on factors like their business costs, the overall health of their customer pool, and the pricing model they use. This is why you can see two identical Plan G policies with completely different price tags, and it’s exactly why shopping around is so important.

What happens if I miss my six-month Medigap Open Enrollment Period? Missing your initial enrollment window doesn’t mean you can never get a plan, but it does change the rules. After that protected period ends, insurance companies can use medical underwriting to evaluate your application. This means they will review your health history and can ask you detailed questions about your medical conditions. Based on that review, they can charge you a higher premium than a standard applicant or even deny your application for coverage altogether. Your Open Enrollment Period is your one guaranteed chance to get any plan you want without your health being a factor.

Do I really need a Medigap plan if I’m healthy right now? It’s smart to think about this, especially when you’re feeling great. Think of a Medigap plan less as something for your health today and more as a protection for your savings tomorrow. Original Medicare is a strong foundation, but it leaves you responsible for deductibles and a 20% coinsurance with no annual cap. A serious illness or unexpected accident could lead to significant out-of-pocket costs. A Medigap plan helps cover those costs, giving you predictable expenses and peace of mind, no matter what the future holds.

Can I use my Medigap plan if I travel outside of Texas? Yes, absolutely. This is one of the biggest advantages of having a Medigap plan. Because your policy supplements Original Medicare, you have the freedom to see any doctor or visit any hospital in the United States that accepts Medicare. You are not restricted to a local network of providers. This gives you incredible flexibility whether you’re visiting family in another state, taking a vacation, or spending your winters somewhere warmer.

Is Medigap the same thing as a Medicare Advantage plan? This is a common point of confusion, but they are fundamentally different. A Medigap plan works with your Original Medicare, acting as a secondary insurance to help pay for costs that Medicare doesn’t cover. A Medicare Advantage plan (Part C) is an alternative way to get your Medicare benefits, essentially replacing Original Medicare with a private, all-in-one plan. You cannot have both at the same time, so you must choose which path is the right fit for you.