Supplemental Health Insurance in Texas

Supplemental health insurance is a health insurance plan that covers medical expenses that are not covered by the traditional health insurance plans. Such expenses include, but not limited to, preventive care, emergency services, hearing therapy, dental care, and eye treatments. Supplemental health insurance policies are also available for some medical conditions like cancer, stroke, and renal failure.
In Texas, supplemental insurance is designed to shield you from paying out-of-pocket for illnesses not covered by major health insurance. Supplemental health insurance is meant to “supplement”, not replace your main medical policy, even though most supplement insurance types may be purchased individually, on as-needed basis:

What is Considered Supplemental Health Insurance?

A health plan designed to complement your regular health insurance plan and limit your out-of-pocket expenses is considered supplemental health insurance. On average, an adult Texan spends about $1,000 in out-of-pocket medical-related expenses per year. Supplemental health insurance covers illnesses as well as other expenses for which you would otherwise pay out-of-pocket.

What is the Purpose of Supplemental Health Insurance?

The major purpose of supplemental health insurance covers targeted and specific medical needs. For instance, if you are at risk of a specific illness, you can purchase a single insurance supplement as an add-on to your primary medical insurance instead of getting a blanket medical insurance policy covering different critical illnesses.

Also, as with most health insurance plans, supplemental health insurance protects you from paying out-of-pocket for covered medical needs.

What is Supplemental Health Insurance for?

Supplemental health insurance is for paying medical care costs that are above and beyond what traditional health insurance policies can cover.

What are the Types of Supplemental Health Insurance?

The different types of supplemental health insurance in Texas, include:

• Vision Insurance
• Dental Insurance
• Accident Insurance
• Long-term care (LTC)
• Medicare supplemental plans
• Critical Illness & Cancer Insurance
• Hospital Indemnity Insurance
• Fixed Indemnity Insurance
• Disability Insurance

The above list is by no means exhaustive. Supplemental health insurance is available via Medicare, Medicaid, and private insurance companies. The most common supplemental insurance plans in Texas are Medicare supplement plans. Otherwise known as Medigap, these plans are sold by private companies to beneficiaries of Original Medicare. Medigap can cover illnesses not covered by Medicare.

The second most-common type of supplemental plans in Texas are the hospital and the critical illness indemnity plans, frequently purchased by those insured with Short-term health plans. These supplemental indemnity plans help lower the insured’s out-of-pocket cost in case of an emergency hospitalization.

Do You Need Supplemental Health Insurance in Texas?

You need supplemental health insurance if your existing health insurance has gaps in:

• Deductible (too high), and/or
• Coverage (not enough, or not existent)

In the absence of a major health insurance plan, you may need to get a stand-alone supplemental health plan, to get at least some emergency protection.

If you are over 65 and you are an enrollee of Original Medicare, you may need a Medicare supplemental plan (Medigap) to get similar coverage to the privately offered Medicare Advantage.

Always discuss your insurance options with a state-licensed insurance professional. A Texas health insurance agent can help you based on your individual set of circumstances.

Why Do You Need Supplemental Health Insurance Insurance?

You need supplemental health insurance to get health insurance coverage that is more precisely tuned to your individual needs, than you are able to get through an average off-the shelf health plan. This remains true regardless of your age, income level, and the type of insurance used (ACA, Short-Term, Medicare).

Besides helping to cover deductibles, copays and other out-of-pocket medical insurance expenses in excess of regular health insurance coverage - supplemental insurance also helps with hospital stays and ER visits.

Contact an insurance agent in Texas to discuss your supplemental health insurance options.

How Much Supplemental Health Insurance Insurance Do You Need?

Your supplemental health insurance generally depends on what your major health plan covers and how much of a gap in this coverage you need to bridge.

The more coverage you seek, the higher the premium will be. In order not to get too much coverage for your needs (and overpay for it in the process), it is very important to understand the clauses, and exclusions of the coverages you are trying to supplement.

Speak with a licensed Texas health insurance agent. Explain your supplemental health insurance needs and ask for professional advice.

What Supplemental Health Insurance Coverage Do You Need?

The type of supplemental coverage you need depends on what you are trying to achieve with this coverage:

• Specific type of medical service (ex: Vision insurance, Dental insurance, Hearing insurance)
• Specific illness (ex: Critical Illness insurance, Cancer insurance)
• Covering gaps in coverage (ex: Medigap for Original Medicare)
• Covering the high deductible in case of an emergency hospitalization (ex: Hospital indemnity insurance)
• Covering the costs of ER treatment, without underlying health insurance (Hospital indemnity - up to the limits of the plan)

The needed supplemental insurance may work in 3 different ways:

1. By supplementing gaps of coverage of major health plan (ACA, Short-Term, Medicare, etc.),
2. As stand-alone coverage (ex: Dental, Vision, Hospital Indemnity, Critical Illness Indemnity, etc.), or
3. As multiple stand-alone supplement plans working alongside each other. (see list above)

Always discuss your insurance needs with a qualified and state-licensed insurance professional with a wide range of insurance products to offer.

Is Supplemental Health Insurance Insurance Required by Law in Texas?

Supplemental health insurance is not required by law. There is no law in Texas that mandates you to purchase any of the supplemental health insurance types.

How Does Supplemental Health Insurance Insurance Work?

Supplemental health insurance works like most health insurance. You receive medical services and you or your health provider makes a claim for reimbursement from your plan provider. To receive coverage, you have to periodically pay premiums - either monthly or annually. You may also have to pay deductibles, coinsurance, and copays for some services, depending on your plan. Your basic insurance plan may only cover a portion of a healthcare expense, leaving the remaining to your supplemental plan.

However, you should not consider supplemental health insurance as a replacement for major health care. Supplemental health plans give limited benefits, usually up to a specified sum, for particular preventative therapies or health issues. Supplemental plans may pay you a fixed lump payment straight in specific instances.

Supplemental health insurance covers out-of-pocket payments you incur, based on the plan's terms, which can vary greatly. It can compensate you for the days you are unable to go to work because of an accident or illness keeping you in the hospital while paying your medical expenses.

What Does Supplemental Health Insurance Cover?

Supplemental health insurance cover the following:

• Serious illnesses such as cancer, stroke, or kidney failure.
• Accidents
• Hospital stays like emergency room services, ICU treatments, ambulance services, X-rays, and lab tests.
• To learn more about what supplemental health insurance covers, please speak with an insurance agent in Texas.

What is Supplemental Health Insurance Good for?

In Texas, supplemental health insurance is beneficial for both health and financial security. It can also be used to cover medical costs associated with illnesses like kidney failure or cancer. To know more about how supplemental health insurance can be beneficial to you, consult an insurance agent in Texas.

What Does Supplemental Health Insurance Typically Include?

Supplemental insurance typically includes coverage for the type of supplement it is meant to cover. For example:

• Accident insurance provides coverage in case of an accident,
• Hospital indemnity insurance provides monetary help to assist paying for a hospitalization,
• Critical illness insurance covers the specified one or a group of critical illnesses,
• Medigap - covers the extra costs (such as copays and deductibles) of Original Medicare
• Dental insurance provides coverage for dental work
• Vision insurance helps pay for exams, prescriptions, and lenses. vision coverage. To find out what supplemental health insurance in Texas normally covers, you may need the assistance of a Texas insurance agent. This is because the coverage options contained in each plan vary depending on the insurance provider.

Who is Covered by Supplemental Health Insurance?

Supplemental health insurance covers the person(s) named in the policy. It could be one person in an individual plan, the person and their dependents, or people covered by a group plan.

What Types of Items Does Supplemental Health Insurance Cover?

In Texas, Supplemental health insurance typically covers conditions such as:

• Heart attack
• Cancer
• Organ transplant
• Coma
• Renal failure
• Stroke
• Car or travel accidents
• Trips and falls
• Loss of a limb, paralysis, or loss of eyesight
• Emergency room services
• ICU treatments and so on.

Does Supplemental Health Insurance Cover Heart Surgery?

Yes, if you already have a major health plan (ACA, Short-term, or Medicare), your supplemental health insurance can help cover the out-of-pocket costs (such as deductibles, coinsurance, and copay) of your heart surgery.

Without the major health plan, you are limited only to the coverage provided by your supplemental plan. For example, if you have a hospital indemnity with a fixed benefit at the time of admission to the hospital and for each day spent - the plan will pay just that, directly to you. However you decide to use this money is up to you and once it’s used up, there is no more, to pay the majority of the hospital bills.

Does Supplemental Health Insurance Cover Therapy?

Supplemental health insurance in Texas normally does not cover therapy. Mental health services are covered (at least partially), using the major medical plans, such as the:

• Employer-sponsored (ACA-compliant) group health plans,
• ACA plans purchased on the individual health marketplace
• Medicaid, and
• Children’s Health Insurance Program (CHIP).

Does Supplemental Health Insurance Cover Pregnancy?

Childbirth and newborn care are the services normally provided under the major medical health plan. All Affordable Care Act (ACA)-compliant health insurance provide this coverage as part of the Essential health benefits (EHBs).

While none of the supplemental health plans specifically cover pregnancy, hospital indemnity insurance may be of help, to cover the extra costs of being admitted to the hospital. Hospital indemnity insurance helps pay for the deductible and coinsurance costs, until the main health coverage picks up the rest of billing.

Does Supplemental Health Insurance Cover Dental?

Yes, dental insurance is one of the types of supplemental coverage in Texas. Health insurance on its own normally does not cover dental work. You may purchase dental coverage as a supplement to the major health policy, or as a stand-alone feature - if just dental coverage is desire.

What is Not Covered by Supplemental Health Insurance?

What is not covered - depends on the type of supplemental health insurance plan. Frequently, such plans provide coverage that is mutually exclusive of each other.

For example, a typical Medigap plan does not cover long-term, vision, hearing, or dental care, while the supplemental plans intended for those particular issues will cover just those

Always seek help from state-approved and licensed insurance professionals. An insurance agent in Texas can provide extensive information on what supplemental health insurance does not cover, depending on the type of supplemental health insurance you want.

What Does Supplemental Health Insurance Typically Exclude?

To some extent, supplemental health insurance in Texas may exclude things like:

• Cosmetic surgery
• Acupuncture
• Hearing aids and exams for fitting them
• Routine foot care
• Homemaker services
• Private-duty nursing care
• Voluntary Abortion
• Congenital Diseases/Genetic Disordered
• IVF and Infertility Treatments

Always discuss your insurance plans with a licensed health insurance agent, who can guide you through the supplemental health insurance solutions that are currently available at your location.

What is an Example of Supplemental Health Insurance?

Here are a few examples of the most common supplemental health insurance plans:

• Hospital indemnity insurance
• Critical illness insurance
• Accident insurance
• Dental
• Vision
• Medigap.

What is the Most Common Use of Supplemental Health Insurance?

​​Supplemental health insurance in Texas is mostly used by enrollees of Original Medicare. These Medicare supplement insurance plans (also called Medigap) help to cover cost “gaps” in a person’s Original Medicare plan. While Original Medicare has an extensive cost coverage for medical services, there are still certain services and supplies that are not covered. A Medigap plan helps an enrollee to pay the remaining medical cost like coinsurance, copayments, and deductible.

Generally, supplemental health insurance is commonly used to offset the health bills not covered by your regular health insurance plan. It may assist you in paying for hospital and doctor expenditures, including deductibles and copayments.

What is the Difference Between Supplemental Health Insurance and Short-term Health Insurance?

Short-term health insurance in Texas is temporary health coverage and is typically held for a short period (up to 3 years). Most people purchase short-term insurance when they are in a transition phase and unable to purchase ACA-compliant health insurance (usually through an employer) .

Supplemental health insurance on the other hand covers health conditions that are usually not covered by the regular health plans. These health conditions may include cancer, stroke, and kidney failure.

Another function of supplemental insurance plans (like Hospital indemnity), is to help fill the coverage gaps left by short-term health coverage. If you get hospitalized with a short-term health plan, you could face a $15,000 or higher deductible, which an indemnity type policy helps you cover.

If you are considering short-term health coverage - ask your insurance agent to explain how it works and how you can benefit from this coverage in your particular circumstances.

Do I Need Supplemental Health Insurance if I Have Original Medicare Insurance?

Yes, you need supplemental health insurance if you have Original Medicare. Supplemental health insurance for Original Medicare is called Medigap. Original Medicare is known for providing a wide range of health-related services and medical supplies. However, enrollees still have out-of-pocket payments like coinsurance, copayments, and deductibles. A Medigap plan can help you cover these costs.

A Texas-licensed insurance agent can help you decide if you need supplemental health insurance if you already have existing original medicare insurance.

Who Can Get Supplemental Health Insurance?

Anyone can get a supplement health plan according to their needs. (read on for more)

Who Qualifies for Supplemental Health Insurance?

Every Texas resident qualifies for supplemental health insurance.

Some supplement plans must be purchased as an extra coverage (ex: Medigap does not work unless used with Original Medicare).

The majority of supplemental health plans can be purchased as a supplement or stand-alone coverage (ex: Vision, Dental, Hospital Indemnity, Critical Illness, Long-Term Care, etc.)

To get additional information about supplemental health insurance in Texas, consult a licensed insurance agent.

Who Needs Supplemental Health Insurance?

Anyone who wants to add an additional level of financial protection in case they need to use medical care and want to minimize out-of-pocket expenses.

Even though supplemental health insurance is available as a stand-alone plan, it should be primarily considered as extra coverage, to add to the major medical plan.

Who Should Get Supplemental Health Insurance?

You should get supplemental health insurance if:

• You are covered by or consider buying Short-term health insurance. Short-term health plans usually carry high deductibles and supplemental indemnity plans (such as: Hospital Indemnity and Critical Illness Indemnity) can help with paying such high out-of-pocket costs.
• You are covered by Original Medicare. Medigap supplemental plans can help cover the out-of-pocket costs not covered by Medicare.
• You want a particular coverage that is not well-represented by the existing health insurer. Multiple supplemental insurance plans can be purchased as stand-alone coverage (a-la-carte).

Always discuss your insurance decisions with a Texas-licensed insurance agent, who can provide professional and current advice, based on your particular set of circumstances.

What are the Benefits of Supplemental Health Insurance?

The benefit of supplemental health insurance is that it assists with medical expenses not covered by your standard health insurance plan, or the lack thereof. It helps you maintain financial stability in the event of a serious sickness, injury, or another disaster.

The most significant downside of supplemental insurance however is that it’s cost adds to your monthly expense budget.

Why is Supplemental Health Insurance Good?

Supplemental health insurance is good because it provides more choices of coverage, which can be purchased to fit your particular medical and financial needs. It is a useful tool for a balanced health insurance plan.

You may find yourself in a situation where your primary health plan does not cover particular expenses when a serious illness or accident occurs. It is your supplemental health insurance that will help pay for those costs.

Also, in the process of handling the costs of a major illness or accident, household and other general expenses do not stop. If you have a supplemental health plan, it will directly benefit you because you will still be financially stable to handle your regular bills when you experience a medical emergency.

Furthermore, a supplemental health plan can be cost-effective. For a very low monthly premium, they can give you peace of mind when the unexpected happens.

Why is Supplemental Health Insurance Bad?

The only drawback of supplemental health insurance can be the high cost of some additional health coverage.

Speak with a knowledgeable state-licensed insurance agent about the best supplemental plan options that can fit your needs.

Is Supplemental Health Insurance Worth it?

Yes, Supplemental insurance is worth it. Supplemental health insurance makes it easier to manage serious health challenges, and most importantly, it makes sure that you are protected financially, from spending too much out of pocket needlessly.

Speak to a licensed Texas health insurance agent, to discuss a custom-built health plan, incorporating supplemental coverage for extra protection.

What Happens if You Don’t Have Supplemental Health Insurance?

If you do not have supplemental insurance in Texas, you:

• Do not get the extra financial assistance, to help cover the out-of-pocket costs (copay, coinsurance, and deducible) of the major medical plan (ex: ACA, Short-Term, or Original Medicare)
• Do not get the coverage for certain events or specific illnesses (ex: Accident insurance, Critical Illness insurance, etc.)

Why is Supplemental Health Insurance Important?

Supplemental health insurance is important because it assists you with:

• Paying for specifically named benefits and medical services
• Paying for expenses that may arise as a result of an injury or serious illness.
• Covering your major health insurance plan’s out-of-pocket costs.

What Happens When Your Supplemental Health Insurance Lapses?

If your supplemental health insurance plan lapses because you stopped paying the plan's premium, your coverage under the plan will be terminated.

Any questions you have about supplemental health insurance should be addressed to a Texas-licensed health insurance agent of your choice.