What Medicare Advantage Plan Options Do You Have In Texas?
Medicare Advantage plans are offered by private insurers and bundle Part A and Part B benefits. Here are the best Medicare Advantage plans in Texas for 2020.
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35% of Medicare beneficiaries in Texas are enrolled in Medicare Advantage plans
Medicare Advantage plans bundle Medicare Part A and B services
There are nearly 3,000 Medicare Advantage plans in the state from 19 different insurers
You can shop for a plan and compare costs with the Medicare Plan Finder
Plans are available with $0 monthly premiums
If you're looking for an alternative to Original Medicare, Medicare Advantage plans are a useful and convenient option.
In Texas, 10% of the population gets their health insurance through Medicare. Within the state, Medicare Advantage plans are very popular. In fact, 35% of Medicare participants — approximately 1.5 million people — opt for Medicare Advantage plans instead of Original Medicare coverage.
If you're considering enrolling in a plan, here's how to find the best Medicare Advantage plans in Texas for 2020.
What are Medicare Advantage Plans?
Unlike Original Medicare, which is managed by the federal government, Medicare Advantage plans are managed and provided by private insurance companies that contract with Medicare. The private companies provide all of your Medicare Part A and Part B benefits together — both hospital insurance and medical insurance — and may provide other services like prescription drug coverage, routine dental and vision care, and wellness programs.
Medicare Advantage plans, sometimes called Medicare Part C, aren't paid for by Medicare. Instead, you have to pay a monthly premium. Depending on your plan, you may also have a yearly deductible, as well as copayments and coinsurance.
Not everyone is eligible for a Medicare Advantage plan. If you have end-stage renal disease, you generally cannot sign up for a plan. Instead, you'll get coverage through Original Medicare.
Available Medicare Advantage Plans in Texas
Medicare pays a fixed amount each month for your care to companies that provide Medicare Advantage plans. Because the care is partially subsidized, there are rules set by Medicare these companies have to follow to offer Medicare Advantage plans. These rules determine what coverage these plans have to provide.
As of 2020, there are 2,996 different Medicare Advantage plans in Texas offered by the following 19 insurance companies:
Blue Cross Blue Shield of Texas
Care N' Care Insurance Company
Christus Health Plan Generation
Imperial Insurance Company of Texas
Kelsey Care Advantage
Memorial Hermann Health Plan
Mutual Omaha Medicare Advantage
Prominence Health Plan
Scott & White Health Plan
Not all insurers and plans are available in all areas. Some plans are only available in certain counties, and plan options, costs, and benefits can vary.
Each plan can charge different out-of-pocket costs, and can have different rules for how you get services. For example, plans can require you to get a referral before you see a specialist, or stay within network to get coverage.
How to Choose the Best Medicare Advantage Plan
When choosing a Medicare Advantage plan, keep in mind that Medicare Advantage plans cover all Medicare services. But some plans cover additional services, and can be more expensive. To find the best Medicare Advantage plans in Texas and enroll, follow these three steps:
1. Decide Which Type of Plan You Want
The type of plan you choose can have a big impact on cost and coverage options, so make sure you understand the different types:
Health Maintenance Organization (HMO): With an HMO, you must stay within network except in emergencies. You typically have to select a primary care physician, and get referrals before you can see a specialist. Prescription drug coverage is usually included under an HMO.
Preferred Provider Organization (PPO): PPO plans have networks of doctors and healthcare providers. You'll pay less if you stay within network, but you are free to use professionals outside of network, too. In most cases, prescription drug coverage is included under a PPO.
Private-Fee-For-Service (PFFS) plans: With a PFFS plan, the insurer determines how much it will pay doctors and hospitals for services. Depending on your plan, you may be able to choose your own healthcare providers, or you may have to stay within network. However, you must ensure that they accept the plan's payment terms. Some PFFS plans offer prescription drug coverage.
Medicare Medical Savings Account (MSA) plans: MSA plans combine a high-deductible insurance plan with a medical savings account that you can use to pay for your healthcare expenses. The plan only covers your healthcare costs once you meet your yearly deductible. MSA plans do not cover Medicare Part D prescription drugs.
2. Use the Plan Finder to Compare Costs
Once you know what kind of Medicare Advantage plan you want, you can use the Medicare Plan Finder to shop for available plans in your county.
You can create an account and enter your current medications to get the most accurate drug costs when comparing Medicare Advantage plans. When you enter your zip code, the Medicare Plan Finder will show you what Medicare Advantage plans are available in your area.
For example, we searched for Medicare Advantage plans in Travis, Texas, zip code 78701. There are 21 available plans for that area, ranging from HMO plans with a $0 monthly premium to PPO plans with a $95 monthly premium. Drug plan deductibles, in-network and out-of-network maximums, and coverage options vary by plan.
3. Fill Out the Enrollment Form
With some plans, you can enroll online. With others, you'll have to fill out a paper enrollment form and mail it in. You can also call 1-800-MEDICARE for assistance.
To join a Texas Medicare Advantage plan, you'll have to give your Medicare number and the date your Part A or Part B coverage began. If you're not sure, that information is printed on your Medicare card.
Get Help With Enrollment
If you need help finding the best Medicare Advantage plan for you, there is free assistance available through local benefit counselors. To find a counselor near you, visit the Texas Department of Insurance website or call the Area Agencies on Aging at 1-800-252-9240.
Kat Tretina is from Orlando, Florida and specializes in writing about finance and healthcare.