Texas Medicare insurance should be easy. Get the help and benefits you deserve today.

Texas Medicare Benefits

Texas Medicare insurance should be easy. Get the help and benefits you deserve today.

Medicare Advantage Plans Can Lower Overall Expenses

Medicare Advantage Plans, also known as Part C coverage, are private insurance plans that are regulated by CMS(Centers for Medicare and Medicaid Services). These plans are approved to take the place of Medicare Part A and B and some plans even include the Part D prescription drug coverage.

There are several types of Medicare Advantage plans but the two most common MAPD plans are HMO and PPO plans. Differences between the two are haw the doctor networks apply. HMO Medicare Advantage plans have a more restrictive provider network but for the most part have lower out of pocket cost and most times lower plan premiums. PPO Medicare Advantage Plans generally have a larger provider network with fewer restrictions and you can receive care out of network in a non emergency provider visit. The PPO plans tend to have higher monthly plan premiums than their HMO counterparts.

Lots of Value Added Extras

Texas Medicare Advantage plans offer many additional benefits that are not included in original Medicare at little or no additional cost or premium. How can they do this? Simple, the federal government compensates the plans for providing the coverage on a per member basis and that equates to them paying a large majority of the premium for the member. This also allows several added benefits that you don’t get with original Medicare like:

  • Set co pay amounts
  • Free Gym Memberships thru the Silversneakers Program
  • Out of  Pocket Maximums
  • Medicare Dental Benefits
  • Vision Benefits
  • Discounts of additional services

These plans can offer more than what your traditional Medicare coverage does. Now keep in mind the above benefits may not be available for all plans and it will depend on what county you live in if a MAPD plan operates there.

Here are some additional important factors to consider before selecting a MAPD. First, again it should be stated that most Medicare Advantage plans have a network of doctors and hospitals and unless you are selecting a PPO plan must use the providers in the network except in cases of emergency treatment. Next, most HMO Advantage plans require your main (primary) doctor to refer you to any other doctor in the network. Again, most require this referral practice but there are a few “Open Access” plans that are still HMO’s however don’t require the selection of a primary care doctor or referrals to seek medical care.

Another point is your doctor may be in the provider network today but 6 months late leave the group forcing you to select other providers in the network. We suggest you always ask your doctor or hospital if they are in network.

Next, once you have selected your plan you’re on it for the entire year or until the next annual enrollment period so make the correct selection so you will be happy. There are some cases where you can exit the plan midyear but for the most part you’re on it for the year.

Due to the above statement we suggest you follow this advice, speak with an insurance broker that specializes in the Medicare insurance market. Reviewing your options and making informed decisions will go a long way in making your healthcare treatment painless and worry free.

For additional information on MAPD plans contact us today!

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