Medicare Advantage Plans in Tarrant County Texas: 

Medicare Advantage Plans in Tarrant County, Texas: A Comprehensive Overview

Medicare Advantage plans, also referred to as Medicare Part C, are provided by private insurance companies with contracts under the Centers for Medicare & Medicaid Services (CMS).

To be eligible for a Medicare Advantage (MA) plan, individuals must qualify for Part A, be enrolled in Medicare Part B, and reside within the service area of the desired plan. MA plans operate at the local level, specifically tailored to county boundaries, offering numerous choices.

Benefits of Medicare Advantage Plans:

If you’re seeking ways to reduce Medicare costs, a Medicare Advantage plan presents a viable solution. These plans deliver all the benefits of Original Medicare coverage in Texas but often at a more affordable rate. Additionally, 100% of individuals with Medicare Part A and B have access to Medicare Advantage plans.

1. Lower Monthly Premiums:

Many Medicare Advantage plans come with a $0 monthly premium. In cases where a premium is applicable, it is paid in addition to the monthly Part B premium. An added advantage of Medicare Advantage plans is the inclusion of prescription drug coverage in most plans.

2. Lower Out-of-Pocket Costs:

Medicare Advantage plans restrict out-of-pocket costs for services covered by Medicare Part A and Part B. While MA plans set their deductibles, coinsurance, and copays within federal limits, once the out-of-pocket maximum is reached, the plan covers 100% of covered healthcare expenses for the remainder of the year. Unlike Original Medicare, there is no spending limit, and annual out-of-pocket costs are not capped.

For those preferring to retain Original Medicare but desire more predictable, albeit higher, monthly premiums, Medicare Supplement plans (Medigap Plans) serve as an alternative to Medicare Advantage.

Undecided on the best choice? Seek guidance from a local Medicare Insurance agent who can assist in selecting the optimal health insurance plan based on individual health needs and budget. Call 817-952-3153 for assistance.

Types of Medicare Advantage Plans in Texas: HMOs vs PPOs

The prevalent Medicare Advantage plans are Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs), both operating through private insurance companies with Medicare contracts. Key similarities include the use of provider networks, prescription drug coverage, and the requirement of having Medicare Part A and Part B, residing within the plan’s service area.

Medicare Advantage HMOs generally offer lower costs, requiring the selection of a primary care physician for care coordination and referrals. Specialist visits may necessitate referrals, and out-of-network services are typically not covered unless pre-approved.

Medicare Advantage PPOs provide more flexibility at slightly higher costs. While allowing visits to out-of-network providers, this flexibility may entail higher coinsurance or copayments. Active participation in care coordination, including documentation of medical care and prescription drug usage, is required.

To maintain existing relationships with healthcare providers, verify if preferred providers participate in a Medicare Advantage plan’s network.

For assistance in choosing a plan that includes preferred doctors and required prescriptions, contact Ashford Insurance at 817-652-3153.

Obtaining Prescription Drug Coverage with Medicare Advantage in Tarrant County, Texas

Medicare Advantage plans with prescription drug coverage are termed Medicare Advantage Prescription Drug (MAPD) plans. These plans consolidate Medicare medical and prescription drug benefits into a single plan for added convenience.

Costs of Medicare Advantage Plans in Texas:

$0 represents the lowest monthly premium for a Medicare Advantage plan, with most individuals with Medicare Part A and B having access to a $0 premium Medicare Advantage plan. Premiums for Medicare Advantage Prescription Drug (MAPD) plans vary by plan type, and payments are made directly to the plan provider, separate from the Part B premium.

For personalized assistance in determining eligibility for a $0 premium Medicare Advantage plan, contact a local Ashford Insurance agent at 817-952-3153 or schedule a call.

When to Enroll in a Medicare Advantage Plan in Tarrant County, Texas

Understanding the appropriate time to enroll, switch, or unenroll in a Medicare Advantage plan can yield cost savings. The ideal period to join a Medicare health or drug plan is during the Initial Enrollment Period, lasting three months before turning 65, the month of turning 65, and three months after turning 65. This seven-month window aligns with the enrollment of Medicare Part A & B.

Note: Failure to enroll in Medicare Part B during the Initial Enrollment Period may result in a lifetime penalty, increasing monthly Part B premiums. Timely sign-up for Medicare online or contacting Social Security is essential, especially if Social Security benefits are not yet collected.

If the Initial Enrollment Period is missed, eligibility for enrollment during the Annual Election Period (AEP) or the Medicare Advantage Special Election Period (MA SEP) is possible. Changes can be made during the Medicare Advantage Open Enrollment Period as well.

Annual Election Period (AEP):

Occurs annually from October 15 to December 7, allowing changes such as switching from Original Medicare to a Medicare Advantage plan, transitioning from one MA plan to another, or joining a Medicare prescription drug plan.

Medicare Advantage Open Enrollment Period:

Occurs annually from January 1 through March 31, providing options to change Medicare Advantage plans, switch from an MA plan to Original Medicare, or join a Medicare prescription drug plan.

Medicare Advantage Special Election Period (MA SEP):

Qualifying for special circumstances such as relocation, loss of current coverage, or changes in plan contracts with Medicare allows enrollment in a Medicare Advantage Special Election Period, enabling changes to Medicare Advantage or Medicare Advantage Prescription Drug plans.

For further assistance, contact an Ashford Insurance agent at 817-952-3153.