Many people new to Medicare in Tarrant County can be overwhelmed by Medicare and confused about their options. The parts and plans quickly turn to alphabet soup—Part A, Part D, PPO, AEP. After years of dealing with one set of health insurance choices, you now have to learn a whole new world. Being confused is a very natural reaction.

To make it worse, not understanding Medicare can have real-life consequences. Missing a deadline or choosing the wrong plan can cost you money because of fees or poorly suited coverage.

2025 Tarrant County Medicare Advantage Plans

Medicare Advantage plans, often called Medicare Part C, combine Medicare Parts A & B (Original Medicare) into one plan. However, instead of receiving the benefits of Parts A & B through Original Medicare, Medicare Advantage plans are offered through private insurers that are approved by Medicare.

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, the 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 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 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 probably also need to get a referral from your primary care doctor for diagnostic tests or to see other doctors or specialists.

With Medicare Part C HMO plans, there are important restrictions on how you get your care:

• To get coverage from a Medicare Part C HMO plan, you can obtain care only from doctors, hospitals, and other healthcare providers who belong to the HMO’s official “network”—meaning providers who are under contract with the HMO.

• A Medicare Part C HMO plan won’t pay for care by a specialist unless referred by your HMO-network primary care physician.

• Under a Medicare Part C HMO plan, you might not be covered for certain kinds of care unless the plan approves that care in advance.

• You have limited rights to appeal a decision made by the Medicare Part C plan with regard to the care they won’t cover.

An HMO-POS plan has the features of an HMO plan. One is a defined list of providers, often referred to as a network, that members must use for care and services. The plan may require the member to have a primary physician who coordinates care and there may be prior authorization requirements.

However, there is one big difference. An HMO-POS plan allows members to use healthcare providers that are outside the plan’s network for some or all services. For example, one HMO-POS plan will cover out-of-network hospitalization but not mental health care. In most cases, a referral from the primary physician is required and authorization may be necessary. The plan has separate deductibles and out-of-pocket limits for in- and out-of-network services.

The members will pay more for out-of-network services and the plan may limit use. However, this option provides an element of flexibility not available with an HMO plan.

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 generally 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 (HMOPOS) 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.

Medicare Part C managed care plans are required to cover any medical service that would be covered under Medicare Part A and Part B. Also, many Medicare-managed care plans add some coverage (though usually not much) that isn’t covered by Part B. Each plan decides what extras it will offer.

Why choose a Medicare Advantage plan?

Medicare Advantage Plans offered by private insurance companies provide all of the Part A and Part B benefits of Original Medicare, but many offer additional coverage. HMOs and PPOs can typically offer benefits at a lower cost by creating a specific network of providers, allowing the insurance company to manage costs and reduce out-of-pocket expenses.

To be eligible to enroll in a 2023 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 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.

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Whether an “all-in-one” Medicare Advantage plan or a standalone Part D plan suits you, Ashford Insurance can help. Get a quote for prescription drug plans online now at no cost to you. Or, let one of our licensed agents review your options and find the best drug insurance plan for your unique needs. Just give us a call today at 817-952-3153.