Medicare Advantage Insurance Plans in Texas 2024

How Medicare Advantage plans work

Medicare Advantage (Medicare Part C) offers an alternative way of receiving your Original Medicare benefits. When you enroll in a Medicare Advantage plan in Texas, your Medicare Part A and Part B coverage come from a private, Medicare-approved health insurance company instead of directly from the government. The same is true in other states.

Ashford Insurance offers Medicare Advantage Plans to all Medicare-eligible residents in Texas.

Medicare Advantage plans are required to include the same benefits you get from Original Medicare, Part A, and Part B (with the exception of hospice care, which is still covered by Medicare Part A). Many Medicare Advantage plans in Texas (as in other states) include additional benefits that you won’t get from Original Medicare, like routine vision, dental, and prescription drug coverage. (Original Medicare includes limited prescription drug coverage in certain situations.)

There may be several types of Medicare Advantage plans in your part of Texas. Some Medicare Advantage plans are specifically designed around certain illnesses. These plans, known as Medicare Special Needs Plans (SNPs), set up their coverage, provider networks, and drug formularies to focus on beneficiaries with specific health conditions.

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): 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 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.

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.

Here are a few other things you need to know about Medicare Advantage plans.

• You have to be enrolled in Medicare Part A and Part B to qualify.
• You can only sign up during certain time periods. You can generally enroll when you’re first eligible for Medicare. Another opportunity comes around every year, during the Annual Election Period (October 15 – December 7). In some situations, such as when you lose coverage, you may qualify for a Special Election Period during which you can enroll.
• You’re still in the Medicare program if you’re enrolled in a Medicare Advantage plan, and you still need to continue paying your Medicare Part B monthly premium.
• You must live in the service area of the Medicare Advantage plan you sign up for.
• If you have end-stage renal disease (ESRD), you might not qualify for most Medicare Advantage plans (except Special Needs Plans). You can call a Medicare Advantage plan directly, or call Medicare at the number at the bottom of this page, to discuss your specific situation.

There are many reasons why you might choose Medicare Advantage Part C (Medicare Advantage). Here are a few of the most common reasons:

• More comprehensive coverage. Medicare Advantage plans often offer more comprehensive coverage than Original Medicare, including benefits for dental, vision, and hearing care.
• Lower out-of-pocket costs. Medicare Advantage plans typically have lower out-of-pocket costs than Original Medicare, including lower deductibles, copayments, and coinsurance.
• More flexibility. Medicare Advantage plans offer more flexibility than Original Medicare, such as the ability to see doctors outside of your network for a higher cost.
• Ease of use. Medicare Advantage plans are typically easier to use than Original Medicare, as they have a single point of contact for all of your healthcare needs.

If you are considering Medicare Part C, it is important to compare plans carefully to find one that meets your needs and budget. You can use the Medicare Plan Finder to compare plans in your area.

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