Ashford Insurance

Fort Worth, TX Medicare Advantage

Medicare Advantage Made Easy

Fort Worth, TX Medicare Advantage

What is Medicare Advantage (Part C)?

While many people opt to get their Medicare coverage in separate components through the government with Original Medicare (Primarily Part A and Part B), Medicare Advantage is different. With a Medicare Advantage plan, you can receive the same Part A and B benefits (and oftentimes more) in one bundle through private insurance companies. In essence, Medicare Advantage is the alternative method for receiving Medicare coverage.

Also known as Medicare Part C, Medicare Advantage is not in addition to Part A and Part B; it’s just the private counterpart for both. Fort Worth, TX Medicare Advantage plans are offered by Medicare-approved private companies to seniors all around the Fort Worth area. If you’re already enrolled in both Medicare Part A and Medicare Part B, you have the option of replacing your Part A and Part B coverage with similar coverage provided by your Part C plan. But that’s not all. One great thing about Medicare Advantage is that it can cover a wide range of services—dental, vision, hearing, and prescription drugs to name just a few—that Original Medicare can’t.

Fort Worth, TX 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 plans include prescription drug coverage (Medicare Advantage Prescription Drug plans).

Many Fort Worth, TX 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.

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): SNPsprovide 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.

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.

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.

What does Medicare Advantage cover?

Medicare Advantage (or Part C, or MA plans) offers the same coverage as Original Medicare. By law, every Medicare Advantage plan must include all the benefits of Medicare Part A (hospital insurance) and Part B (medical insurance).

However, many MA plans go even further, offering additional coverage Original Medicare won’t provide. Some of these benefits may resemble what you were used to through employer coverage, and there may be even more:

  • Dental coverage
  • Vision coverage
  • Prescription drug coverage (like the add-on Part D for Original Medicare)
  • Hearing aid coverage
  • Health Programs 

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.).

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

A common point of confusion for people is Medigap vs. Medicare Advantage. These plans are not the same:

  • Medigap (or Medicare Supplement) is supplemental insurance a beneficiary can buy to supplement their coverage under Original Medicare. Medigap helps pay for things like coinsurance, deductibles, or other areas where Original Medicare coverage falls short.
  • Medicare Advantage is the counterpart to Original Medicare. While Original Medicare takes an á la carte approach to healthcare, where you can choose to add a Medigap plan and prescription drug coverage (Part D), Medicare Advantage is more like bundling all your health care into one package.

Once you know the distinctions between what Medicare Advantage provides and what Medigap provides, you’ll have an easier time deciding which Medicare plan is best for you.

While some Fort Worth 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.

Ashford Insurance serves Fort Worth seniors and other Medicare-eligible people in The Metroplex who don’t want to take their chances with Original Medicare coverage, and our licensed professionals in Fort Worth will be happy to answer any questions you may 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.