2025 Medicare Advantage Plans in Denton County Texas

Now, more than ever, it is vitally important that you understand your healthcare options. Choosing the right plan is the single most important decision you’ll make for your future health.  As a licensed Medicare supplement insurance agent in the state of Texas, we work with many TX health insurance carriers and will be your advocate in dealing with them. Our broker and consultant services are offered at no cost to you.

WHAT IS MEDICARE ADVANTAGE?

Medicare Advantage is part of the Medicare program known as Medicare Part C. Medicare Advantage (MA) plans are an alternative to Original Medicare, also known as fee-for-service Medicare. MA plans are a form of coordinated or managed care health coverage. Joining an MA plan is optional, and their availability varies by state and county.

To enroll in an MA plan, you must have both Medicare Part A and Part B. If you join an MA plan, you will receive all Medicare-covered benefits through your plan. You are still on Medicare and still retain the full rights and protections as other Medicare beneficiaries.

There are many different types of Medicare Advantage plans, but the two most popular are:

• Health Maintenance Organizations (HMOs). HMOs have closed provider networks, and you generally must get all but emergency care within your plan’s network. You choose a primary care doctor who oversees all your medical care. Your plan may require a referral for specialist care and prior authorization for specific tests and procedures. HMO plans almost always include Part D prescription drug coverage.
• Preferred Provider Organizations (PPOs). These plans also have provider networks, but you can still use any provider that accepts Medicare. However, you’ll pay less out-of-pocket if you stay in your network. You don’t have to choose a primary care doctor or need a specialist referral. Most PPO plans also include Part D coverage.

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.

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. People with End-Stage Renal Disease (permanent kidney failure) generally cannot enroll in a Medicare Advantage Plan.

You must continue to pay your Part B premium and generally 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.

HOW DO ADVANTAGE PLANS WORK?

Medicare Advantage plans contract with Medicare on an annual basis. Medicare pays the plan a fixed monthly amount for each Medicare beneficiary who enrolls. The amount is readjusted each year and varies from county to county. The plan must provide all Medicare Parts A and B benefits. Based on the monthly amount it receives from Medicare, the plan takes the financial risk of providing all medically necessary services regardless of how many people use their services, how often they are provided, or how costly they are.

Texas Medicare Advantage Plans have to cover all of 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.

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

There are many people who are enrolled in some of the best Medicare Advantage plans in Texas. If you have recently enrolled in Medicare Part A and Part B or if you will be eligible soon, you might want to join them and investigate Medicare Advantage plans in Texas yourself. It’s possible to just stick with Original Medicare (Medicare Part A and Medicare Part B) but opting for a Medicare Advantage plan can help you significantly reduce your out-of-pocket expenses and can provide you with some extra perks.