You have the option to receive your Medicare benefits in Keller, Texas through Original Medicare or opt for a Medicare Advantage Plan. Original Medicare involves the government covering your benefits directly when you receive them. On the other hand, Medicare Advantage Plans, also known as Medicare Part C, are provided by private companies approved by Medicare, which Medicare pays to administer your benefits.

Medicare Advantage plans consolidate Medicare Parts A & B (Original Medicare) into a unified plan. However, instead of obtaining the benefits directly from Original Medicare, these plans are delivered through private insurers approved by Medicare.

Upon joining a Texas Medicare Advantage Plan, you gain coverage for both Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance). These plans differ significantly from Medicare Supplement Insurance (Medigap) policies.

Several types of Texas Medicare Advantage Plans are available, including:

1. Health Maintenance Organization (HMO) plans: Typically restricting you to the plan’s network for doctors, healthcare providers, or hospitals, except in emergencies. Referrals from your primary care doctor may be necessary.

2. Preferred Provider Organization (PPO) plans: Offering cost savings when using in-network doctors and providers, with higher costs for out-of-network services.

3. Private Fee-for-Service (PFFS) plans: Allowing you to visit any doctor, provider, or hospital accepting the plan’s payment terms, with the plan determining payment and your associated costs.

4. Special Needs Plans (SNPs): Tailoring healthcare for specific groups, such as those with both Medicare and Medicaid, residing in nursing homes, or dealing with specific chronic medical conditions.

5. HMO Point-of-Service (HMO-POS) plans: Variations of HMOs, permitting some out-of-network services at a higher cost.

6. Medical Savings Account (MSA) plans: Combining a high-deductible health plan with a bank savings account funded by Medicare. Money in the account can cover healthcare services, but these plans do not include Medicare drug coverage.

Eligibility for enrollment in a Texas Medicare Advantage plan requires having both Medicare Parts A and B and residing in the plan’s service area. Continuing payment of your Part B premium is necessary, and you typically pay one monthly premium for the services included in the Medicare Advantage Plan.

Each plan has distinct premiums and service costs, underscoring the importance of comparing plans in your area to comprehend their costs and benefits before joining. Some plans may even have a $0 premium.

Texas Medicare Advantage Plans must encompass all services covered by Original Medicare except for hospice care. Emergency and urgent care are consistently covered in all types of Medicare Advantage Plans, with emergency coverage extending beyond the plan’s service area (excluding outside the U.S.). Many Medicare Advantage Plans may additionally offer supplementary benefits like dental care, eyeglasses, or wellness programs.

Most Medicare Advantage Plans also include Medicare prescription drug coverage (Part D). Beyond your Part B premium, a single monthly premium typically covers both medical and prescription drug coverage. It’s crucial to stay informed about potential changes in plan benefits from year to year and understand the workings of a plan before enrollment.