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Ashford Insurance

Fort Worth Texas Medicare Advantage

Medicare Advantage Made Easy

Fort Worth Texas Medicare Advantage

Medicare Advantage plans (also known as Medicare Part C) combine doctor, hospital and often drug coverage into one plan. Some may cover routine dental, vision and hearing needs, and may offer other services. Most Advantage plans offer prescription drug coverage.

Medicare Advantage plans are offered by private health insurance companies. These insurance companies provide consumers with Advantage plan coverage. In turn, rather than Medicare paying a physician or hospital for services provided, Medicare pays an ongoing, predetermined amount to the insurance company for providing the Advantage plan coverage.

Medicare Advantage plans provide Part A and Part B benefits through private insurance companies that have a contract with the federal program. If you are enrolled in a Medicare Advantage plan, you will still get all of the same benefits that you would if enrolled in Original Medicare (except for hospice care, which is still covered by Medicare Part A). Some plans offer additional benefits not included in Original Medicare, such as health and wellness programs, and routine vision and dental benefits. Many Medicare Advantage plan include prescription drug coverage (Medicare Advantage Prescription Drug plans). 

Medicare Advantage Plans provide all your Medicare Part A and Part B benefits. CMS (Centers for Medicare & Medicaid Services) requires Medicare Advantage Plans to offer at least the same level of coverage as Medicare Part A and Part B of Original Medicare.

Many Medicare Advantage (Part C) plans include prescription drug, vision, hearing and dental coverage not offered by Original Medicare (Parts A & B). Additionally, each Medicare Advantage plan is required by law to feature an annual maximum cap on out-of-pocket costs, meaning once that limit is reached you will pay nothing for additional covered medical services.

You can get your Fort Worth 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.

Medicare Advantage plans usually have copays and deductibles, but many limit the total amount you will have to pay for medical expenses out of pocket each year. Medicare Advantage plans work like the managed care plans you may have had during your working years. You will have to receive your care from doctors, hospitals, and other providers within the plan’s network. 

Plans can be health maintenance organization (HMO), or preferred provider organization (PPO). If you have an HMO, you can only visit doctors and hospitals in those networks. PPO plans have out-of-network benefits as well. Visits to a specialist often require referrals, and some types of care may require advance approval. There are several distinct physician/hospital networks in the Dallas Texas region. If you have a doctor or facility preference, be sure to confirm their participation in the plan’s associated network – before you purchase the plan.

 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.

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.

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.

If you enroll in a Medicare Advantage Plan, you continue to pay your Medicare Part B premium, and you may pay an additional premium. The insurer determines the Medicare Advantage plan’s premium, which can vary from one Medicare Advantage Plan to another. However, many Medicare Advantage Plans may have premiums as low as $0.

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.

Ashford Insurance serves seniors and other Medicare-eligible people in The Metroplex who don’t want to take their chances with Original Medicare coverage, and our licensed, bonded professionals in Fort Worth will be happy to answer any questions you have about Medicare Advantage or any other aspect of senior health care. Even if you’re looking ahead and aren’t eligible for Medicare yet, Ashford Insurance will be happy to answer your questions.

While some seniors prefer the greater flexibility that Medicare supplement plans offer, Medicare Advantage may be exactly what you’re looking for if you intend to depend primarily on network doctors in your area.

If you’re unsure which Medicare Advantage plan is the best choice for you, contact Ashford Insurance now and we’ll help you find the very best Fort Worth Medicare Advantage coverage to suit your needs and budget.

Confused?  Many People Are. It can seem overwhelming when trying to plan your future coverage and sort through the many options, especially since the choices you make can have a significant effect on your health care and your financial well-being.

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.