Hill Country Associates represents a number of leading providers of Medicare Supplements for individuals 65 years of age or older and/or Social Security disabled. Sometimes referred to as “Medi-Gap”, this coverage assists in covering the deductibles and co-pays required by Medicare Parts A and B.
Click here to request a quote for this product. You an also print it out and fax it to 512.863.5620 or mailed to our business address. Please contact us directly at 512.763.1097 to discuss a quote over the phone.
2007 MEDICARE PART A
Part A is Hospital Insurance and covers costs associated with confinement in a hospital or skilled nursing facility.
|
When you are Hospitalized for: |
Medicare Covers |
YOU PAY |
| 1-60 days | Most confinement costs after the required Medicare Deductible | $992 DEDUCTIBLE |
| 61-90 days | All eligible expenses, after the patient pays a per-day co-payment | $248 A DAY CO-PAYMENT As much as $7,440 |
| 91-150 days | All eligible expenses, after Patient pays a per-day co-payment. (These are Lifetime Reserve Days which may never be used again.) | $496 A DAY CO-PAYMENT As much as $29,760 |
| 151 days or more | NOTHING | YOU PAY ALL COSTS |
|
Skilled Nursing Confinement: |
All eligible expenses for the first 20 days then all eligible expenses for days 21-100, after patient pays a per-day co-payment |
After 20 days $124 A DAY CO-PAYMENT As much as $9,796 |
2006 Medicare Part B
|
On Expenses Incurred for |
Medicare Covers |
YOU PAY $131 Annual Deductible PLUS |
|
Medical Expenses: Physician's services for inpatient and outpatient medical/surgical services; physical/speech therapy, diagnostic tests |
80% of Approved Amount | 20% of Approved Amount |
|
Clinical Laboratory Services: Blood tests, urinalysis |
Generally 100% of approved amount | Nothing for services |
|
Home Health Care: Part-time or intermittent skilled care, home health aide services, durable medical supplies and other services |
100% of approved amount; 80% of approved amount for durable medical equipment | Nothing for services; 20% of approved amount for durable medical equipment |
|
Outpatient Hospital Treatment: Hospital services for the diagnosis or treatment of an illness or injury |
Medicare payment to hospital, based on outpatient procedure payment rates | Coinsurance based on outpatient payment rates |
|
Blood |
After first three pints of blood, 80% of approved amount | First three pints plus 20% of approved amount for additional pints |
Note: On all Medicare-covered expenses, a doctor or other health care provider may agree to accept Medicare “assignment.” This means the patient will not be required to pay any expense in excess of Medicare’s “approved” charge. The patient pays only 20% of the “approved” charge not paid by Medicare.
Physicians who do not accept assignment of a Medicare claim are limited as to the amount they can charge for covered services. In 2007, the most a physician can charge for services covered by Medicare is 115% of the approved amount for non-participating physicians. For routine office visits covered by Medicare a non-participating physician can charge up to 115% of the fee schedule amount.
Examples of providers you may choose from through Hill Country Associates:
- Mutual of Omaha offers Plans A, C, D, F, and G.
- Blue Cross/Blue Shield offers Plans A, D, and F.
- United American offers Plans A, B, C, D, F, & G and a high deductible “F” Plan primarily aimed at young and healthy seniors.
- Conseco Insurance offers Plans D and F
- Sterling Investors offers Plans F and G
- Pacificare offers Plans F and G
- Continental General offers Plans A, B, C, D, E, F, and G.
Basic Benefits: Included in Plans A through G
Hospitalization: Part A coinsurance plus coverage for 365 additional days after Medicare benefits end.
Blood: First 3 pints of blood each year.
| Plan A | Plan B | Plan C | Plan D | Plan E | Plan F | Plan G |
| Basic Benefits | Basic Benefits | Basic Benefits | Basic Benefits | Basic Benefits | Basic Benefits | Basic Benefits |
| Skilled Nursing Facility Coinsurance | Skilled Nursing Facility Coinsurance | Skilled Nursing Facility Coinsurance | Skilled Nursing Facility Coinsurance | Skilled Nursing Facility Coinsurance | ||
| Part A Deductible | Part A Deductible | Part A Deductible | Part A Deductible | Part A Deductible | Part A Deductible | |
| Part B Deductible | Part B Deductible | |||||
| Part B Excess100% | Part B Excess of 80% | |||||
| Foreign Travel Emergency | Foreign Travel Emergency | Foreign Travel Emergency | Foreign Travel Emergency | Foreign Travel Emergency | ||
| At Home Recovery | At Home Recovery | |||||
| Preventive Care NOT covered by Medicare |
*Plan F also has an option called a "High Deductible Plan F." This high deductible plan pays the same benefits as Plan F after one has paid an approximate $2,000 calendar year deductible. Benefits from high deductible Plan F will not begin until out-of-pocket expenses of $2,000 (for full year) are paid. Out-of-pocket expenses for this deductible are expenses that would ordinarily be paid by the policy. These expenses include the Medicare deductibles for Part A and Part B, but do not include the plans'' separate foreign travel emergency deductible.
Medicare Advantage Plans are relatively new to Texans and are to be considered alternatives to traditional Medicare and Medicare Supplements. At the current time, we represent two plans. Others are available and will be evaluated to determine those that are best for our clients.
Following is a brief comparison of Medicare Supplements and Medicare Advantage Plans:
Pro's of Medicare Supplements:
- Almost total coverage for all medical needs of Seniors, depending on which plan is selected.
- Universal acceptance -- any doctor, any hospital, anywhere. (Even overseas, depending on the plan.)
- Availability from many providers at various rates.
Pro's of Medicare Advantage Plans:
- Cost is substantially less than Medicare Supplements
- Part "D" (prescription coverage) is included, with no need to purchase separately.
- Only one medical condition (end-stage renal disease) is used as a criteria for non-coverage.
- Especially helpful for Social Security disabled persons, with better coverage than Medicare Supplements for those under 65 and social security disabled.
- Some coverages are available in excess of original Medicare and Medicare Supplements.
- Some plans rebate the $93.50 the individual has deducted from his/her Social Security check each month.
Medicare Advantage Plans availalbe through Hill Country Associates:
Texas Community Care
Universal Health Care
