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Ashford Insurance

Watauga Medicare Advantage

Medicare Advantage Made Easy

Medicare Advantage Plans can charge different out-of-pocket costs than Original Medicare and can have different rules about how you get your services. The private insurance companies offering these plans are paid by Medicare a fixed monthly amount. These plans must follow Medicare’s rules and must cover all services that Original Medicare covers; except for hospice which is covered by Original Medicare even if you are in a Medicare Advantage Plan. They may also offer extra coverage such as dental, vision, hearing, and/or wellness benefits and may include Part D. These plans may include cost sharing such as a monthly premium (in addition to your Part B premium), co-pays, coinsurances, deductibles and are required to have an annual out-of-pocket maximum. Medicare Advantage Plans can change annually, therefore if you have a Medicare Advantage Plan you should review the Evidence of Coverage and Annual Notice of Change sent to you in the fall by your plan. You do not need, and can not have, a Medicare Supplement plan if you have a Medicare Advantage Plan. To be eligible for a Medicare Advantage Plan you must be enrolled in Part A and Part B, live in the service area of the plan, and not have End Stage Renal Disease (except under specific circumstances). Ashford Insurance offers Watauga Texas Medicare Advantage Plans (Part C of Medicare) from UnitedHealthcare® Medicare Solutions.

You can get your Watauga 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.

Many Medicare Advantage (Part C) plans include prescription drug, vision, hearing and dental coverage not offered by Original Medicare (Parts A & B). Additionally, each Medicare Advantage plan is required by law to feature an annual maximum cap on out-of-pocket costs, meaning once that limit is reached you will pay nothing for additional covered medical services.

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 the 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.

You can make a decision about how to receive your Medicare coverage during certain periods. When you first become eligible for Medicare you may choose between Original Medicare and a Medicare Advantage Plan and may choose a Medicare Advantage Plan three months prior, the month of, and three months after you turn 65. During the Annual Election Period (October 15th – December 7th), you may move from Original Medicare to a Medicare Advantage Plan or a Medicare Advantage Plan to Original Medicare or you can switch from one Medicare Advantage Plan to another. During the Medicare Advantage Open Enrollment Period (January 1st – March 31st), you can make one move from a Medicare Advantage Plan back to Original Medicare or from one Medicare Advantage Plan to another Medicare Advantage Plan. In most cases, you are locked into your choice for the calendar year; however, some people qualify for a Special Election Period and can make a change during the lock-in period; this may include a move in or out of a service area, qualification for Low Income Subsidy, or losing group coverage.

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

Watauga Medicare Advantage Plans

Sarah began working in the healthcare industry in 2001, where she worked for many years with elderly Alzheimer and Dementia patients. From there she worked as a Group Benefits Administrator with a local healthcare company in the Human Resource Department for a period of 10 years. Since then, she has decided to work in the Medicare insurance industry full time and has joined the family business, Ashford Insurance, as a Medicare Insurance Agent.

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(817) 952-3153

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Weekends & Evenings by Appointment

Address 1245 Southridge Court Suite 101, Hurst, TX, 76053

* A licensed sales agent may call or e-mail as a result of completing the information to discuss Medicare Advantage, Prescription Drug Plans or Medicare Supplement Insurance.

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