Medicare Advantage Plans in Texas

As a senior citizen approaching age 65, one important decision you need to make is the type of Medicare Program in the state of Texas that will be most beneficial to you. The right one for you will be a very personal, individual matter. Reviewing your unique medical needs with a Medicare insurance agent is a good starting place.

Medicare Part A and Part B is the choice of many new Medicare enrollees. Medicare Supplement Plans and Medicare Advantage Plans are two ways to get coverage for some out-of-pocket costs with Original Medicare.

When Can You Enroll in a Medicare Advantage Plan in Texas

The first opportunity you will have to enroll in a Medicare Advantage Plan is at your Initial Enrollment Period. This seven-month period includes the month of your 65th birthday and the three months before and after your birthday month. This gives you time to learn more and decide on the best available coverage.

In these situations, you may become eligible for a Special Enrollment Period (SEP):

• Losing employer-provided insurance upon retiring
• Relocating to a place with different plan options
• Entering or leaving a long-term care hospital or skilled nursing facility
• Being diagnosed with a condition like chronic heart failure or diabetes

Annually between October 15 and December 7, the Medicare Advantage and Prescription Drug Plan Annual Enrollment Period (AEP) allows you to make changes in your Medicare coverage. Changes become effective on January 1 of the following year. After enrolling in a Medicare Advantage Plan (MAP), you have a trial period of three months to decide about keeping the plan.

• Dis-enroll from your Medicare Advantage Plan and go back to your Original Medicare
• Enroll in a Stand-Alone Part D Prescription Drug Coverage Program to go with Original Medicare
• Switch to a different Medicare Advantage Plan

Medicare Plans are subject to change annually, so it is wise to review your options in Texas in the fall of each year. Learn about any changes in prescription drug coverage and medical needs such as vision, hearing, and dental care to ensure optimal coverage and minimal Medicare costs in the year ahead.

Comparing Medicare Advantage Plans in Texas

Medicare Advantage Plans (Medicare Part C) are not a one-size-fits-all commodity. One of these four Medicare Advantage Plans in Texas will probably be right for you:

• Basic coverage includes Medicare Part A and Medicare Part B benefits plus Urgent/Emergency Care
• Medicare Part D Advantage Plans add prescription drug benefits
• Medicare Advantage Plans with Check-Ups include coverage for General Wellness, Vision, and Hearing Check-Ups
• Medicare Advantage Plans offer combination plans that cover the basics, check-ups, and prescription drug benefits, reducing Medicare costs.

Popular Medicare Advantage Plans in Texas

Choosing your best Medicare Advantage Plan in the state of Texas needs to be an informed decision. You need to understand what different kinds of Medicare Advantage Plans offer. Ask your insurance agent about:

• HMO – Health Maintenance Organization
• PPO – Preferred Provider Organization
• POS – Point of Service Plan
• SNP – Special Needs Plan
• Regional PPO Plans
• Private Fee for Service Plan
• Medicare Savings Plan, Cost Plan

Texas Medicare Advantage HMO Plans

In a Health Maintenance Organization (HMO), you choose your medical provider from the plan’s network. If you see a physician outside the network, except in an emergency, it will not be covered by your health insurance. To see a specialist, you will have to see your primary care provider first for a referral.

HMO Medicare Plans seek to provide high-quality care while controlling costs. If your primary care physician is able to help, a specialist’s high costs may be avoided. Cost savings in HMO health plans can help reduce out of pocket costs while providing more Medicare services like vision, dental, and hearing.

Texas Medicare Advantage PPO Plans

With a Preferred Provider Organization (PPO), you have the flexibility of going to any physician you choose without a referral. Having a primary care physician is not required.

You also have the option of seeing a doctor outside the provider network, but you will have to pay more. Choosing a physician within the network will result in lower co-pays and full coverage.

Texas Medicare Advantage Special Needs Plans

People with chronic conditions like diabetes or heart disease may benefit from a Special Needs Plan (SNP). These Medicare plans are good for residents of nursing homes or skilled nursing facilities and people who qualify for both Medicare and Medicaid.

Learn about other options like Regional Medicare Plans by consulting a Medicare insurance agent.

Are Medicare Advantage Plans Popular

Over one-third (36%) of all Medicare recipients in 2020 are enrolled in Medicare Advantage Plans. The total number of Medicare beneficiaries is 67 million, and 24.1 million of them are in Medicare Advantage Plans.

Since 2000, the number of people choosing Medicare Advantage Plans has increased yearly. The number of Medicare Advantage enrollees has increased by 9% from 2019 to 2020. The number of Medicare beneficiaries enrolled in Medicare Advantage Plans is projected by the Congressional Budget Office (CBO) to reach 51% by 2030.

Do Medicare Advantage Plans in Texas Cover Prescription Drugs

Currently, 90% of Medicare Advantage Plans (MA-PDs) include Prescription Drug benefits, and 89% of Medicare Advantage beneficiaries have plans that include Prescription Drug benefits. About 60% of enrollees in MA-PD plans do not have a monthly premium and pay only the Medicare Part B premium.

Statistics show that 18% of Medicare recipients enrolled in Medicare Advantage Plans with a Part D prescription drug plan pay at least a $50 monthly premium, including about 6% who pay a $100 (or more) monthly premium in addition to the $144.60 monthly Part B premium.

The Medicare Advantage Prescription Drug Premium includes Part D prescription drug coverage and all the benefits of Medicare Part A and Part B. The average premium among MA enrollees with prescription drug benefits who pay a monthly premium is $63. If you include those who do not pay a premium, the average monthly premium for Medicare Advantage Plans with prescription drug benefits is $25 a month in 2020.

Average premiums for Medicare Advantage Plans with Prescription Drug benefits have decreased by $4 a month between 2019 and 2020.

Do Medicare Advantage Plans in Texas Have Network Restrictions

Seeking medical care at certain medical facilities in Texas (or any state) will mean you receive incomplete coverage, or with certain Medicare Advantage Plans, no coverage at all.

Each insurance company has its own network and will provide full coverage for care obtained within the network. Before you visit a doctor’s office or medical facility, check to be sure it is in the company’s network.

Medicare recipients in an HMO need to live in a network area or have network facilities nearby, as HMO carriers do not provide coverage outside the network area (except emergency care).

For seniors not living within their network area or who travel a great deal, a PPO offers more flexibility in coverage. While full PPO coverage is reserved for in-network care, partial coverage is available out of network. If a recipient wishes to see an out-of-network doctor, they can still get partial coverage.

Medicare Supplement Plans vs Medicare Advantage Plans

In comparing Medicare Advantage Plan benefits to other options, a good starting place would be comparing them to those of Original Medicare.

With Original Medicare alone, 80% of Medicare-approved costs are covered by Medicare Part B. You would still be liable for the remaining 20% of the costs. In addition to paying the monthly Part B deductible, some other charges you would have to pay include:

• Ambulance transportation
• Emergency Room visit co-payments
• Co-payment for hospital services such as casts, splints, or lab services
• 20% of doctor’s services
• Insulin for diabetics, unless it is administered by an insulin pump
• 20% of certain medical supplies

Another advantage of Medicare Advantage Plans is that each plan has a yearly out-of-pocket limit. You can check with the insurance representative in your service area to learn the amount of your limit.

Original Medicare has no limit to out-of-pocket expenses.

Finally, Medicare Advantage Plans help with much-needed services like vision, dental, and hearing check-ups. Eyeglasses, dentures, and hearing aids will be partly or completely covered. Original Medicare does not carry any coverage for these services.

Additional Resources

For more information about Medicare Advantage Plans in Texas please visit medicare.gov.