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2024 Texas Medicare Advantage Plans

Ashford Insurance

Medicare Insurance Made Easy

2024 Texas Medicare Advantage Plans

A Medicare Advantage (MA) plan is a type of health plan offered by a private company that contracts with Medicare to provide you with all your Medicare Parts A and B benefits. MA plans include health maintenance organizations, preferred provider organizations, private fee-for-service plans, and Special Needs Plans.

You can get your Texas Medicare benefits through Original Medicare, or you can choose a Medicare Advantage Plan. With Original Medicare, the government pays for your Medicare benefits when you get them. Medicare Advantage Plans, Part C of Medicare are offered by private companies that have been approved by Medicare. Medicare pays these companies to administer your Medicare benefits.

If you join a Texas Medicare Advantage Plan, the plan will provide all your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage. They are completely different than a Medicare Supplement Insurance (Medigap) policy.

There are several types of Texas Medicare Advantage Plans:

Health Maintenance Organization (HMO) plans: In most HMOs, you may only go to doctors, other health care providers, or hospitals that are in the plan’s network, except in an emergency or urgent situation. You also need to get a referral from your primary care doctor for diagnostic tests or to see other doctors or specialists.

Preferred Provider Organization (PPO) plans: With a PPO, you pay less if you use doctors, hospitals, and other healthcare providers that belong to the plan’s network. You pay more if you use doctors, hospitals, and providers outside of the network.

Private Fee-for-Service (PFFS) plans: PFFS plans are similar to Original Medicare in that you can generally go to any doctor, other health care provider, or hospital as long as they agree to accept the plan’s payment terms. The plan will determine how much it will pay doctors, other health care providers, and hospitals, and how much you must pay when you get care.

Special Needs Plans (SNPs): SNPs provide specialized and focused health care for specific groups of people, like those who have both Medicare and Medicaid, live in a nursing home, or have certain chronic medical conditions.

HMO Point-of-Service (HMO-POS) plans: These are HMO plans that may allow you to get some services out-of-network for a higher copayment or coinsurance.

Medical Savings Account (MSA) plans: These plans combine a high-deductible health plan with a bank savings account. Medicare will deposit money into the account (usually less than the deductible). You can use the money to pay for your health care services throughout the year. MSA plans do not offer any Medicare drug coverage. If you want drug coverage, you have to join a Medicare Prescription Drug Plan, Part C of Medicare.

To be eligible to enroll in a Texas Medicare Advantage plan you must have both Medicare Parts A and B and live in the plan’s service area.

You must continue to pay your Part B premium and pay one monthly premium for the services included in a Medicare Advantage Plan. Each Medicare Advantage Plan has different premiums and costs for services, so it’s important to compare plans in your area and understand plan costs and benefits before you join. Some may have a $0 premium.

Texas Medicare Advantage Plans must cover all the services that Original Medicare covers except for hospice care. Original Medicare will cover hospice care even if you are in a Medicare Advantage Plan. In all types of Medicare Advantage Plans, you will always be covered for emergency and urgent care. Medicare Advantage Plans must offer emergency coverage outside of the plan’s service area (but not outside the U.S.). Many Medicare Advantage Plans also offer extra benefits such as dental care, eyeglasses, or wellness programs.

Most Medicare Advantage Plans include Medicare prescription drug coverage (Part D). In addition to your Part B premium, you usually pay one monthly premium for both the plan’s medical and prescription drug coverage.

Medicare Advantage Requirements

In exchange for a low monthly premium, Medicare Advantage Plans have certain requirements and rules that must be followed to ensure compliance and tend to be the biggest frustrations:

  • Network restrictions, including hospital and doctor limitations.
  • Prior authorization from the insurance company first for different services (MRI, hospital stay, etc.).
  • Referrals from your Primary Care Physician to see specialists.

A Medicare Advantage Plan may make sense for you if you think that a Medicare supplement and stand-alone Prescription Drug Plan may be too expensive for your budget.

Things to consider before you buy a plan

Ask your medical providers If they’ll take the MA plan.

Ask the plan if It requires a referral for you to see a specialist.

If you live in another state for part of the year, find out if the plan will still cover you. Many plans require you to use regular services within the service area (except for emergency care), which is usually the county in the state where you live.

Find out if the plan includes:

  • Monthly premiums
  • Any copayments for various services
  • Any out-of-pocket limits
  • Costs of using non-network providers

If you have Medicaid or receive long-term care, or live in a nursing home, Special Needs Plans may be available in your area. If you choose other types of MA plans, find out if:

  • The plan’s in-network providers you use are certified to accept Medicaid.
  • In-network providers bill the plan correctly and/or refer to Medicaid providers as needed.
  • The providers’ office knows what Medicaid covers and what the plan covers.
  • You’ll have monthly premiums to pay.

Medicaid will not cover MA plan premiums.

Remember, plan benefits can change from year to year. Make sure you understand how a plan works before you join.