Texas Medicare Advantage Plans

Medicare Advantage Plans are health plans approved by the federal government and run by private companies. These plans are also sometimes referred to as Medicare Part C. Medicare Advantage Plans are not supplemental insurance and must follow rules set by Medicare.

Although Medicare Advantage Plans in Texas will provide benefits equal to those in Medicare Part A and Medicare Part B, Medicare Advantage Plans may have different co-payments, coinsurance, and deductibles than original Medicare coverage. These plans also have a maximum out of pocket limit to protect members expenses. All Medicare Advantage plans must cover all medically-necessary services that Original Medicare does.

Medicare Advantage Plans might offer added benefits, such as vision, hearing, dental, and/or health and wellness programs like the popular Silversneaker program and most will include prescription drug coverage. Some of these benefits may have an additional cost.

Types of Medicare Advantage Plans

Health Maintenance Organization (HMO) - Offers low to no co-payment for doctor office visits and no deductibles. However, you are required to receive a referral from your Primary Care Doctor before seeing a specialist, and you must use doctors and hospitals that are within your network.
Preferred Provider Organization (PPO) - These plans also offer low co-payments that are usually slightly higher than those of an HMO. But also allow freedom of choice when choosing a doctor or hospital as long as they are part of their network. There is also the ability to see doctors outside the provider network.
Private Fee-for-Service (PFFS) Plans - PFFS plans usually offer the most flexibility. As they allow you to choose any doctor or hospital of your choice because there is no provider network. However, your doctor or hospital must accept the plans conditions prior to treating you, except in the case of emergencies.

What are the differences between Medicare Advantage Plans and Medicare Supplements?

Medicare Advantage Plans

Medicare contracts with private insurance companies to administer your Medicare health plan benefits. With some plans, you pay no premium however you will continue to pay your Part B premium.
Some plans will include Texas Medicare Part D Prescription Insurance.
May have co-pays for doctor visits and other services.
Typically you are required to see a doctor within a network, unless the plan you have chosen offer freedom of choice.
Maximum Out of Pocket Protection

Medicare Supplement Plans

The government administers Original Medicare health plan benefits.
You can purchase a Medicare Supplement in Texas plan to assist in paying all or part of your remaining medical bills.
Monthly premiums are higher than those of a Medicare Advantage plan.
Prescription coverage is not typically provided.
You have the freedom to choose any doctor or hospital that accepts Medicare.
Premiums can increase with your age.

When Can You Join, Change, or Cancel a Texas Medicare Advantage Plan?

You can join, change, or cancel a Medicare Advantage Plan if the following applies:

When you first become eligible for Medicare (3 months before you turn age 65 to 3 months after the month you turn age 65).
If you have Medicare due to a disability, you can join during the 3 months before to 3 months after your 25th month of disability benefits.
From October 15th to December 7th each year. However, your coverage will begin on January 1st of the following year.
If you have triggered a Special Enrollment Period (SEP)

Our Position on Advantage Plans

We offer MAPD plans from a host of companies but before you decide it's the correct choice for you we suggest speaking with an insurance broker or agent that specializes in products available in the Medicare market. We offer both supplements as well as advantage and we are more than qualified to explain all your plan options.