2025 Texas Medicare Advantage

Medicare Part C plans have grown in popularity over the years. They are essentially insurance plans provided by private insurance companies that offer the same benefits as original Medicare with the added bonus of supplemental coverage.

While Medicare Advantage plans don’t have to cover every benefit offered by Original Medicare in exactly the same way, the coverage must be deemed to meet or exceed Original Medicare’s standards. Medicare Advantage is more customizable to Medicare recipients and has grown in popularity accordingly by offering a wider variety of services such as prescription drugs, dental coverage and other sought-after benefits.

Medicare Advantage plans offer Medicare benefits administered via health insurers that operate in the private sector. Most Part C plans are health maintenance organizations (HMOs) that operate with primary care physicians that manage a patient’s health care regimen. Other Part C plans are preferred provider organizations (PPOs) which are typically more flexible than HMOs.

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)
• Preferred Provider Organization (PPO) 
• Private Fee-for-Service (PFFS) plans
• Special Needs Plans (SNPs)
• HMO Point-of-Service (HMO-POS) plans
• Medical Savings Account (MSA) plans

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.

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

Conclusion

Seniors have a lot of options when it is time to sign up for Medicare Advantage Plans. There is no one-size-fits-all plan that works for everyone. Understanding the details of each plan is crucial for making an informed decision.