Medicare Advantage plans

You might have the option to join a Medicare Advantage plan, also called Medicare Part C. To be eligible, you must have both Medicare parts A and B and live in an area that has a plan.

The federal government contracts with insurance companies and managed care plans to offer Medicare Advantage in certain areas. Medicare pays the plan a set amount each month for the plan to provide Medicare Parts A and B services to its members. You pay your monthly Medicare Part B premium and any premium the Medicare Advantage plan charges. You also must pay any copayments, deductibles, and coinsurance the plan requires.

If you are in a Medicare Advantage plan, you won’t get a Medicare Summary Notice. You’ll instead get monthly statements from your plan, and you might be able to view your claims on the plan’s website.

Medicare Advantage options vary by ZIP code and county. The options available in Texas include:

• managed care plans, such as health maintenance organizations (HMOs), preferred provider organizations (PPOs), and provider-sponsored organizations (PSOs).
• private fee-for-service plans.
• Medicare special needs plans.

Medicare Advantage plans usually have more benefits than original Medicare. For instance, some Medicare Advantage plans cover dental and vision services. However, Medicare Advantage might not be the best option for some people. Your choice of doctors and hospitals in a Medicare Advantage plan is limited. If you have other insurance, such as a group retirement plan, ask your group plan if it works with a Medicare Advantage plan or with original Medicare.

Because Medicare negotiates contracts with Medicare Advantage plans each year, the plans available and the benefits they provide can change each year. If your plan discontinues services, you will have to find a new plan in your area or return to the original Medicare. To learn what plans are available in your area, call Medicare or visit the Medicare Plan Finder.

If your Medicare Advantage plan leaves your area, or if you move out of the plan’s service area, you may have the right to join another Medicare Advantage plan. You may also have the right to buy Medicare supplement plans A, B, C, F (including Plan F with a high deductible), K, or L, regardless of your medical history or condition.

If your Medicare Advantage plan ends, it must give you written notice of your options and tell you how long you must buy a Medicare supplement policy. The written notice is your proof to the Medicare supplement company of your right to buy Medicare supplements. If you’re under age 65 and on Medicare, this right in Texas is limited to Medicare supplement Plan A.

Medicare’s open enrollment period for Medicare Advantage and prescription drug plans is from October 15 to December 7.

Medicare will mail you a Medicare & You handbook each year before open enrollment. The handbook has a list of Medicare Advantage and prescription drug plans. Use the handbook to review whether there are any changes and costs in your Medicare Advantage or prescription drug plan.

The Texas State Health Insurance Assistance Program (SHIP) can help you compare plans and costs in your area. Call SHIP at 800-252-9240.

The Medicare open enrollment period doesn’t apply to Medicare supplement plans.