Medicare Advantage Plans

Medicare Advantage Plans in Texas

If you’re a Medicare beneficiary in Texas trying to figure out your coverage options, you’ve come to the right place. Medicare Advantage plans are an alternative to Original Medicare (Part A and Part B). Instead of getting your Medicare benefits through the federal health-care program, you’ll get them through your Medicare Advantage plan, which is offered through private insurance companies that are approved by Medicare.

One benefit of Medicare Advantage plans (also known as Medicare Part C) is that some plans may offer coverage beyond what Original Medicare provides. These plans must cover at least the same level of coverage as Original Medicare, Part A and Part B. However, depending on the specific Medicare Advantage plan, you may also be able to get coverage for routine vision or dental, wellness programs, or prescription drugs. Original Medicare coverage of prescription drugs is limited, and it doesn’t cover routine vision or dental, or wellness programs.

There are several types of Medicare Advantage plans available; the specific plan options in your location may vary. Some of your Medicare Advantage plan options may include Health Maintenance Organization (HMO) plans and Preferred Provider Organization (PPO) plans. HMOs and PPOs are two of the most popular types of managed-care Medicare Advantage plans. Your costs are generally lower with an HMO, but you’ll have less provider choice and need to see your primary care doctor if you want to see a specialist. If you’d prefer greater provider flexibility, PPOs give you the option to use non-network providers, but your cost-sharing may be higher.

For the greatest provider flexibility, Private Fee-for-Service (PFFS) plans don’t have provider networks. Instead, you can get health-care services from any provider that will contract with the plan on a case-by-case basis and agree to treat you. The doctor or hospital must accept the Private Fee-for-Service plan’s terms and conditions each time that you are treated.

Special Needs Plans are available for beneficiaries with unique health needs, including those who live in an institution (such as a nursing home), have certain chronic conditions, or have Medicare and Medicaid (also known as dual eligibles). Special Needs Plans limit enrollment to beneficiaries in these three groups, and each plan targets a certain group. You’ll need to meet the eligibility criteria of the Special Needs Plan to join. Not every kind of Special Needs Plan is available in every location. One benefit of these plans is that they tailor their benefits to meet the specific needs of their members. For example, a Special Needs Plan for beneficiaries with cancer may include provider networks and formularies that are specifically tailored for cancer patients.

For those who don’t mind having high out-of-pocket costs, a Medicare Savings Account (MSA) plan is another option. These health plans typically come with a high deductible that you must meet before the plan begins to pay for health care. The plan deposits money into a medical savings account every year; you can use this money to pay for covered healthcare costs before you reach your deductible.

Medicare Advantage plans in Texas with prescription drug coverage

Some Medicare Advantage plans in Texas offer prescription medication coverage. These plans are called Medicare Advantage Prescription Drug plans and provide both health and prescription drug coverage under one comprehensive plan.

If you’re currently enrolled in Original Medicare and want prescription drug benefits, you may prefer the convenience of having all of your benefits covered under a Medicare Advantage Prescription Drug plan; normally, under Original Medicare, Medicare Part D coverage is available through a separate, stand-alone Medicare Prescription Drug Plan.

Even if you don’t currently take prescription drugs, it’s a clever idea to sign up for Medicare Part D as soon as you’re first eligible if you don’t have other creditable prescription drug coverage (insurance that is as good as the Part D benefit). If you don’t have Medicare Part D and go without creditable prescription drug coverage for 63 days in a row or more, you could have to pay a late-enrollment penalty for Part D if you enroll later.

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