Medicare Advantage in Texas

Are you close to turning 65? If you or your family is hitting this milestone age soon, then it’s time to take a look at Medicare. Do you know what it covers? Where are the gaps in coverage? When are you eligible to sign up? Enrolling in Medicare can be an overwhelming and confusing experience. Benefits may be different from those you had while you were under a private policy.

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.

There are many people who are enrolled in some of the best Medicare Advantage plans in 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 perks.

Medicare Advantage Plans are also known as Medicare Part C. A Medicare Advantage Plan is a type of Medicare health insurance, offered by a private company that contracts with Medicare.

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 Advantage Plans offer added benefits, these often include coverage for routine vision care, hearing aids, routine dental care, prescription drug coverage, and fitness center membership

Ashford Insurance offers Medicare Advantage in Texas.

Medicare Advantage Plans in Texas are also sometimes referred to as Medicare Health Plans, Medicare Part C Plans, and MAs/MA-PDs (and originally, Medicare Advantage Plans were called Medicare Choice plans). A Medicare Advantage Plan combines your Medicare Hospitalization (or Medicare Part A) and medical insurance or Doctor’s Visit Coverage (or Medicare Part B) into one Health Plan that provides the same Medically Necessary Services as Original Medicare. Some, but not all Medicare Advantage Plans also offer Prescription Drug Coverage (or Medicare Part A and Medicare Part B, and Medicare Part D) at no additional cost and are called MA-PDs.

A Medicare Advantage Health Plan (Medicare Part C) may provide more help at a lower cost than traditional Medicare plus Medigap. Instead of paying for Parts A, B, and D, a person would enroll through a private insurance company that, in many cases, covers everything provided by Parts A, B, and D and may offer additional services. The beneficiary would pay the Medicare Advantage premium along with the Part B premium in most cases.

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.

You can get your 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 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 (HMOPOS) plans: These are HMO plans that may allow you to get some services out-of-network for a higher co-payment 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 must join a Medicare Prescription Drug Plan, Part C of Medicare.

Texas Medicare Eligibility & Enrollment

To sign up for a Medicare Advantage plan in Texas, you must enroll in Original Medicare (Part A and Part B).

To be eligible for Original Medicare at age 65, you must meet the following requirements:

• You must be a U.S. citizen or permanent legal resident who has lived in the U.S. for five continuous years.
• You or your spouse must be eligible to receive Social Security or Railroad Retirement benefits.
• You or your spouse must be government employees or retirees who have not paid into Social Security, but you’ve paid Medicare payroll taxes.

You could potentially be eligible for Medicare under 65 if:

• You receive Social Security disability benefits or certain Railroad Retirement Board disability benefits for at least 24 months.
• You have ALS (amyotrophic lateral sclerosis, also called Lou Gehrig’s disease).
• You have End-Stage Renal Disease (ESRD), and you or your spouse have paid Social Security taxes for the required period of time.

It’s important to note that if you have ESRD, you may not qualify for most Medicare Advantage plans. However, you may be able to sign up for a Texas Medicare Special Needs Plan (SNP) that is specifically designed to help meet your health care needs.

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 must cover all 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.

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.