Medicare Advantage Agents San Antonio

Medicare can be complex. There are numerous plans, plan combinations, benefits, rules, and exceptions — all of which can be confusing. Buying health insurance is a huge investment, so you want to find a plan that meets your needs. An ethical and knowledgeable agent or broker can help you get the best value for your money. Agents or brokers who sell health insurance products related to Medicare have to pass a test on their knowledge of Medicare every year.

Medicare Advantage is the private health insurance alternative to the federally run original Medicare. Think of Advantage as a kind of one-stop shopping choice that combines various parts of Medicare into one plan.

If you decide on a Medicare plan, you’ll still need to enroll in parts A and B and pay the Part B premium. In addition, you will need to choose a Medicare Advantage plan and sign up with a private insurer.

The federal government requires these plans to cover everything that Original Medicare insurance covers. Some plans pay for services that the original Medicare does not, including dental and vision care. In addition, in recent years the Centers for Medicare and Medicaid Services, which sets the rules for Medicare, has allowed Medicare Advantage plans to cover such extras as wheelchair ramps and shower grips for your home, meal delivery, and transportation to and from doctors’ offices.

Most Medicare Advantage plans also fold in prescription drug coverage. Not all these plans cover the same extra benefits, so make sure to read the plan descriptions carefully.

Medicare Advantage plans generally are either health maintenance organizations (HMO) or preferred provider organizations (PPO).

Many people are enrolled in some of the best Medicare Advantage plans in San Antonio Texas. If you have recently enrolled in Medicare Part A and Part B or if you will be eligible soon, you might want to join them and investigate Medicare Advantage plans in Texas yourself. It’s possible to just stick with Original Medicare (Medicare Part A and Medicare Part B) but opting for a Medicare Advantage plan can help you significantly reduce your out-of-pocket expenses and can provide you with some extra rewards.

San Antonio Medicare Advantage plans provide Medicare coverage through private health insurance companies approved to participate in the Medicare program. These plans can be HMOs, PPOs, Regional PPOs, or Private Fee-for-Service Plans.

Medicare Advantage plans provide all Part A and B services while generally including some additional services, such as wellness programs, hearing aids, and vision services. These plans also tend to have lower cost-sharing overall and a maximum that you would have to pay for out-of-pocket costs each calendar year–a feature not available through Original Medicare.

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.

Texas Medicare Advantage Plans combine coverage for the hospital (Part A) and doctor (Part B) visits all in one plan and are required to offer all the benefits included in Original Medicare (except hospice care which continues to be covered by Part A). However, many Medicare Advantage (Part C) plans also include prescription drug coverage and routine eye and dental care coverage not offered by Original Medicare.

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 San Antonio 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.

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.

Preferred Provider Organization (PPO) plans: With a PPO, you pay less if you use doctors, hospitals, and other healthcare 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.

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 San Antonio 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.

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.

Medicare Advantage Limits

Medicare Advantage plans have defined geographic service areas and most have networks of physicians and hospitals where you can receive care. Ask your physicians if they participate in your health insurance plan’s Medicare Advantage network.