Know your options for Medicare Advantage Plans in Texas and find out how to enroll.
TABLE OF CONTENTS
If you are age 65 or older, you can qualify for Medicare, the government health insurance program. Others who qualify include individuals with disabilities who receive Social Security, and those with end-stage renal disease.
Medicare Part A is hospital insurance and Medicare Part B is medical insurance that covers things like doctor’s visits and lab tests. If you qualify for Medicare, you can also get Medicare Part D, which is prescription drug coverage. Most people pay a monthly premium for Part D.
Beyond Medicare Parts A and B, you can get a Medicare Advantage plan to cover expenses that Original Medicare does not. Medicare Advantage can include vision, hearing, dental, fitness programs, OTC drugs, and even transportation to medical appointments.
Medicare Advantage plans can be an alternative to Original Medicare, which can include gaps in coverage. As you determine the best Medicare coverage for your situation, consider this guide as insight for comparing plans and understanding your benefits as a Texas resident.
You have choices in Medicare coverage. While you can opt to stick with Original Medicare, a Medicare Advantage Plan – also known as Part C – may be a better alternative for you.
|Original Medicare||Medicare Advantage Plans|
|Original Medicare covers your Part A hospital insurance and Part B medical insurance.||Medicare Advantage Plans combine Part A, Part B, and additional benefits.|
|You can add Part D prescription drug coverage.||Prescription drug coverage is usually included.|
|You’re able to use any medical provider in the U.S. that accepts Medicare.||You’ll usually need to use doctors in your plan’s network.|
|You can buy supplemental coverage to manage out-of-pocket costs, including your coinsurance.||Your Medicare Advantage Plan may have lower out-of-pocket costs than Original Medicare.|
|Vision, hearing, dental, and other benefits aren’t covered.||Your plan may offer additional benefits, including vision, hearing, and dental.|
With 221 Medicare Advantage Plans available in Texas, you likely have several options in your area. To help you choose the best plan for you, consider what is most important to you before selecting a plan. There are several factors to keep in mind:
There are several types of Medicare Advantage plans in Texas, including
There are 221 different Medicare Advantage plans available in Texas, with two of them rated 3.5 or higher by the National Committee for Quality Assurance (NCQA).
|Number of Medicare Advantage Plans available||Medicare Advantage Plan types available||Medicare Advantage Plans rated 3.5 or higher by NCQA|
You’re eligible for Medicare when you turn 65 or if you’re younger and have a qualifying disability. A qualifying disability means at least one of the following applies:
When you become eligible for Medicare, you are also eligible for Medicare Advantage Plans. There are specific times of the year when you can enroll for the first time in a Medicare Advantage Plan: during your Initial Enrollment Period and the Open Enrollment Period.
Medicare Advantage Open Enrollment occurs between January 1 and March 31 of each year. This period is only for beneficiaries already in a Medicare Advantage Plan, and you can change plans or switch to Original Medicare. You cannot switch from Original Medicare to Medicare Advantage during Medicare Advantage Open Enrollment.
There are exceptions to these enrollment periods called Special Enrollment Periods. Certain events or circumstances may make you eligible to change your Medicare Advantage Plan outside of the open enrollment periods, such as if you move outside of your existing plan’s service area or to a location with new plan options you didn’t have before. If you think you may qualify for a Special Enrollment Period, call 1-800-MEDICARE and explain your situation.
|Enrollment period||When it happens||Medicare plans you can choose||What you can do|
|Initial Enrollment Period||Three months before you turn 65, the month you turn 65, and three months after||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan||Sign up for Medicare Part A and Part B. Complete your Part B enrollment to avoid a late enrollment penalty.|
|General Enrollment Period||January 1 – March 31||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan. If you enroll in Medicare during this period, your MAP enrollment is April through June.||Sign up for Medicare if you missed your IEP|
|Open Enrollment Period||October 15 – December 7||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan||Join, switch, or drop a plan|
|Medicare Advantage Open Enrollment Period||January 1 – March 31||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan||If you’re enrolled in a Medicare Advantage Plan, you can change your plan or switch to Original Medicare|
|Special Enrollment Period||When you have a qualifying event||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan||Make changes to your plan|
Most Medicare Advantage HMO and PPO plans and all SNP plans provide prescription drug coverage like you would get from Medicare Part D. Some PFFS plans may provide prescription drug coverage, but not all do. Evaluate a plan’s prescription drug coverage when deciding which Texas Medicare Advantage Plan to use.
Prescription drug coverage may vary by cost, coverage, and convenience among Medicare Advantage Plans. Your monthly premium may include a premium for the drug coverage in the plan. There is usually a copayment or coinsurance amount that you have to pay for each prescription after you reach your annual deductible.
Some plans use different cost tiers with different costs for different drugs. For instance, you may pay less for generic drugs than brand-name drugs or less for brand-name drugs within different tiers. If your plan uses tiers, the formulary will list all covered drugs and their tiers. Verify your preferred or local pharmacies are included in the plan’s network.
Texas-wide Medicare Advantage Resources
|Resource||Contact||How they help|
|TexasHealthcareCosts.org||Phone: 800-252-3439||Get information on more than 200 of the most common surgeries, tests, and other procedures|
|TexasHealthPlanCompare.com||Phone: 800-578-4677||Find and compare health plans. View monthly costs, deductibles, maximum amount you will need to pay for covered services, and more|
|TexasHealthOptions.com||Phone: 800-252-3439||Learn how to compare health plans, benefits, and networks|
|Texas Health and Human Services||Phone: 800-252-9240||Find a Benefits Counselor|
Local Medicare Advantage Resources
|Resource||Contact||How they help|
|Area Agency on Aging of Central Texas||Phone: 800-447-7169||AAACT helps seniors and their caregivers navigate through the complicated through the complicated decisions they face|
Federal Medicare Advantage Resources
|Resource||Contact||How they help|
|Benefits Checkup by the National Council on Aging||Phone: 800-794-6559||The National Council on Aging (NCOA) is a respected national leader and trusted partner helping older adults meet the challenges of aging|
|Centers for Medicare & Medicaid Services||N/A||A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services as a guide to navigating your Health Care options|
|Medicare & You Guide by Centers for Medicare & Medicaid Services||N/A||A PDF guide comparing and contrasting Original Medicaid with Medicaid Advantage|
|Medicare.gov||Phone: 800-633-4227||The main government website for signing up for (or making changes to) your Medicare coverage|
|Understanding Medicare Advantage Plans||N/A||A PDF primer on the Medicaid Advantage program|
Tammy Burns is an experienced health insurance advisor. She earned her nursing degree in 1990 from Jacksonville State University, obtained her insurance billing and coding certification in 1995, and holds a health and life insurance license in Alabama, Georgia, Iowa, Mississippi, and Tennessee. Burns is Affordable Care Act (ACA)-certified for health insurance and other ancillary, life, and annuity products. She maintains an active nursing license and practices private-duty nursing.
Burns’ background as a nurse, insurance biller and coder, and insurance consultant includes infectious disease, oncology, gynecology, phlebotomy, post operative, family medicine, geriatrics, home health, hospice, human resources, management, billing, coding, claims, fixed annuities, group and individual health and life products, and Medicare. She’s always been driven by a desire to help people, spending more than 25 years as a practicing nurse in hospitals, private doctors’ offices, home health, and hospice. As a nurse, Burns supported patients filing insurance claims with Medicare, Medicaid, and private insurance companies as well as responding to billing questions from confused patients.
Seeing firsthand how unsuspecting patients are frequently confused by an overly complex system they don’t understand led Burns to become an insurance agent and health care consultant, now helping people understand the medical system. Since becoming an insurance agent in 2013, she has worked with some of the largest and most reputable insurance carriers and agencies in the nation, and she has built a large and loyal clientele by way of her commitment to transparency and personalized service.