2025 Medicare Advantage Plans Available to Texas Residents

Ashford Insurance offers Medicare Advantage Plans to all Medicare-eligible residents in Texas.

How Medicare Advantage plans work

Medicare Advantage (Medicare Part C) offers an alternative way of receiving your Original Medicare benefits. When you enroll in a Medicare Advantage plan in Texas, your Medicare Part A and Part B coverage comes from a private, Medicare-approved health insurance company instead of directly from the government. The same is true in other states.

Medicare Advantage plans are required to include the same benefits you get from Original Medicare, Part A and Part B (with the exception of hospice care, which is still covered by Medicare Part A). Many Medicare Advantage plans in Texas (as in other states) include additional benefits that you won’t get from Original Medicare, like routine vision, dental, and prescription drug coverage. (Original Medicare includes limited prescription drug coverage in certain situations.)

There may be several types of Medicare Advantage plans in your part of Texas. Some Medicare Advantage plans are specifically designed around certain illnesses. These plans, known as Medicare Special Needs Plans (SNPs), set up their coverage, provider networks, and drug formularies to focus on beneficiaries with specific health conditions.

If you join a Texas Medicare Advantage Plan, the plan will provide all of 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 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.

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.

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.

COVERAGE OPTIONS

In Original Medicare, a beneficiary can go to any doctor, hospital, or other health care provider that takes Medicare. To get Medicare coverage, people who join a Medicare Advantage plan must follow the plan’s rules. For example, some Medicare Advantage plans require members to stay within a network of providers (with which the plan has a contract). Specific plans won’t cover members who go to a doctor’s office or a hospital outside this network. Other plans might cover people who go outside the network of providers, but they may require the member to pay more out-of-pocket for getting this care out-of-network. Some Medicare Advantage plans also offer Part D prescription drug coverage. Others are “stand-alone” plans that only provide health coverage, and people can buy a Part D drug plan to cover their prescriptions.

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.

Here are a few other things you need to know about Medicare Advantage plans.

• You must be enrolled in Medicare Part A and Part B to qualify.
• You can only sign up during certain time periods. You can generally enroll when you’re first eligible for Medicare. Another opportunity comes around every year, during the Annual Election Period (October 15 – December 7). In some situations, such as when you lose coverage, you may qualify for a Special Election Period during which you can enroll.
• You’re still in the Medicare program if you’re enrolled in a Medicare Advantage plan, and you still need to continue paying your Medicare Part B monthly premium.
• You must live in the service area of the Medicare Advantage plan you sign up for.
• If you have end-stage renal disease (ESRD), you might not qualify for most Medicare Advantage plans (except Special Needs Plans). You can call a Medicare Advantage plan directly or call Medicare at the number at the bottom of this page, to discuss your specific situation.

WHY CHOOSE MEDICARE ADVANTAGE?

Medicare Advantage plans must cover the same services offered under Original Medicare. Still, they may also provide additional services that Original Medicare doesn’t cover, such as eyeglasses, hearing aids, health club membership, and other wellness benefits. Many Medicare Advantage plans also include coverage of prescription drugs.

Anyone considering enrollment into Medicare Advantage must weigh the pros and cons to make an informed decision based on the four C’s: coverage, cost, convenience, and choice. It’s also crucial to remember that a person with Medicare Advantage cannot have a Medigap policy.

HOW TO ENROLL

There are limited times of the year during which people with Medicare can enroll (and disenroll) from a private Medicare Advantage health plan. People joining Medicare for the first time have an Initial Enrollment Period, during which they can also select a Medicare Advantage plan. People can also join, switch, or disenroll from a Medicare Advantage plan during the Annual Election Period from October 15 through December 7.

The Medicare Advantage Open Enrollment Period (January 1 – March 31) will allow anyone enrolled in an MA plan at the beginning of the year to switch plans or disenroll from Medicare Advantage and return to Original Medicare. There are also Special Enrollment Periods for certain circumstances, such as when a senior moves from one plan’s service area to a new location.

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

In Summary, Medicare Advantage plans are an alternative way to get your Medicare benefits. Joining an MA plan is optional. If you do not join an MA plan or you disenroll from an MA plan, you have Original fee-for-service Medicare (Parts A and B). Note: It is essential to carefully consider enrollment/disenrollment from a Medicare Advantage plan, especially regarding the ability to pick up a Medigap policy.