Medicare Advantage plans can be an alternative to Original Medicare, which can include gaps in coverage.  As you determine the best Medicare coverage for your situation, consider this guide as insight for comparing plans and understanding your benefits as a Texas resident.

Medicare was designed to help you, the Medicare Beneficiary, with your healthcare costs; however, it was not designed to cover all your healthcare costs. Therefore, there is a cost-share that is passed onto you which includes premiums, co-pays, coinsurances, and deductibles. In addition, there are two main choices in which you can get your Medicare coverage: Original Medicare or a Medicare Advantage Plan.

You can get your Medicare benefits through Original Medicare, or you can choose an affordable Texas 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.

affordable 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.

If you join an affordable 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.

Preferred Provider Organization (PPO) plans: With a PPO, you pay less if you use doctors, hospitals, and other health care 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 (HMO-POS) plans: These are HMO plans that may allow you to get some services out-of-network for a higher copayment or coinsurance.