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Ashford Insurance

Medicare Plans for Fort Worth

Medicare Advantage Made Easy

Medicare Plans for Fort Worth

Medicare Advantage plans are Part C of Medicare.

These plans offer the same coverage that Medicare Parts A and B do under one plan instead of two.

The biggest difference between Original Medicare and Medicare Advantage plans is that Medicare Advantage plans are fully managed by private insurers.

Many Medicare Advantage plans also offer qualifying prescription drug plans, so you don’t have to manage a third plan.

But not all plans do. Pay attention to whether the Medicare Advantage plans you consider include qualifying prescription drug coverage.

Medicare Advantage plans work similarly to typical health insurance plans
These plans have set provider networks and annual out-of-pocket maximums. These annual out-of-pocket limits help control your spending.

Since provider networks are set with Medicare Advantage plans, check the provider networks before enrolling to make sure your doctors are in-network.

Medicare Advantage plans offer additional benefits

Beyond the standard Medicare coverages, Medicare Advantage plans offer additional benefits like hearing aid discounts and fitness memberships.

Some even include limited dental and vision coverage.

You can get your Fort Worth 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 your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage. They are completely different than a Medicare Supplement Insurance (Medigap) policy.

Medicare Advantage plans usually have copays and deductibles, but many limit the total amount you will have to pay for medical expenses out of pocket each year. Medicare Advantage plans work like the managed care plans you may have had during your working years. You will have to receive your care from doctors, hospitals, and other providers within the plan’s network. 

Plans can be health maintenance organizations (HMO), or preferred provider organizations (PPO). If you have an HMO, you can only visit doctors and hospitals in those networks. PPO plans have out-of-network benefits as well. Visits to a specialist often require referrals, and some types of care may require advance approval. There are several distinct physician/hospital networks in the Dallas Texas region. If you have a doctor or facility preference, be sure to confirm their participation in the plan’s associated network – before you purchase the plan.

 There are several types of Fort Worth 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 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 if 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 (HMO-POS) 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 must join a Medicare Prescription Drug Plan, Part C of Medicare.

Medicare Advantage Eligibility

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 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.

Ashford Insurance serves seniors and other Medicare-eligible people in The Metroplex who don’t want to take their chances with Original Medicare coverage, and our licensed, bonded professionals in Fort Worth will be happy to answer any questions you may have about Medicare Advantage or any other aspect of senior health care. Even if you’re looking ahead and aren’t eligible for Medicare yet, Ashford Insurance will be happy to answer your questions.

While some seniors prefer the greater flexibility that Medicare supplement plans offer, Medicare Advantage may be exactly what you’re looking for if you intend to depend primarily on network doctors in your area.

If you’re unsure which Medicare Advantage plan is the best choice for you, contact Ashford Insurance now and we’ll help you find the very best Fort Worth Medicare Advantage coverage to suit your needs and budget.

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.

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.