Medicare Advantage Plans in Texas

Texas Medicare Part C (Advantage Plans)

Texas Medicare Advantage Plans are private health plan options approved by Medicare. These plans are also referred to as Medicare Part C Texas plans. Private insurance companies develop and administer them, but these plans are still regulated by Medicare.

These Part C plans pay instead of Medicare, and you will pay co-pays for medical services. Medicare Advantage plans are an option for Medicare beneficiaries who have Medicare Parts A & B and who live in the plan’s service area.

You must realize that a Medicare Advantage plan does not replace Part B. You must stay enrolled in and pay for Part B to be enrolled in a Medicare Advantage plan.

Medicare Advantage plans work very differently than Medigap plans. 

Here are some facts to consider about Medicare Advantage:

• Texas Medicare Advantage plans often have lower premiums than Medigap plans
• Though Medicare Advantage premiums may be lower, you will have cost-sharing (copays or coinsurance) for most medical services, such as doctor visits, hospital stays, lab work, MRI scans, and even chemotherapy and radiation. Limitations, copays, and restrictions may apply.
• Most plans have networks, so it is important to make sure your doctor participates before enrolling.
• Medicare Advantage plans sometimes offer extra benefits such as routine vision care or gym membership
• As of 2021, there are no health questions on a Medicare Advantage application.

Medicare Advantage plans have become popular in recent years as the cost of health care has gone. Because many plans include a built-in Part D drug benefit, you can carry one member ID card that can be used both for medical and pharmacy needs.

When you enroll in a Medicare Part C plan, you are locked into that plan for the rest of the calendar year. You cannot leave the plan except during valid election periods. For example, every year in the fall there is an Annual Election Period from October 15th – December 7th. During this time, you can change from one Medicare Advantage Plan to another. You can also switch from your Medicare Advantage plan back to 

Common Medicare Advantage Plan Types

Part C Medicare Advantage plans come in several types. Among these are:

• Texas Medicare HMO
• Texas Medicare PPO
• Medicare PFFS Plans

Not sure which type of Medicare plan is most suitable for you? Contact Ashford Insurance to discuss your Texas Medicare Part C options with an experienced agent. We will walk you through some of the more important questions about Medicare Advantage plans in our state.  We’ll explain how to find out if the doctor is in the plan’s network, and what kinds of copays you might be expected.

Note: Medicare Advantage plans work very differently from Medicare Supplements. Many of these private Medicare health insurance plans require you to use certain networks of doctors. Your policy may not cover providers outside of the network. Working with an insurance agent to carefully review the coverage will help you ensure it matches your individual needs.

Your Medicare Advantage plan’s benefits, formulary, pharmacy network, provider network, premium and/or co-payments, and co-insurance may change on January 1 of each year.

This means you need to do your annual homework. You’ll need to review your coverage every September to make sure that your plan is still right for you the next year. Choosing a Medicare Advantage plan means you will need to do a bit of review each year. 

Medicare Advantage plans also have certain enrollment periods, so check with an Ashford Insurance agent to find out when you can apply.