October 6, 2016
If you live in Texas and are looking for Medicare Advantage coverage, you may have options depending on which plans are available in your area.
Generally, Medicare Advantage works the same way in Texas as it does in other states: as an alternative way to receive your Original Medicare, Part A and Part B, benefits. What differs will be the specific Medicare-approved insurance companies and plans available, which will depend on your location and zip code.
Medicare Advantage plans provide Part A and Part B benefits through private insurance companies that have a contract with the federal program. If you are enrolled in a Medicare Advantage plan, you will still get all of the same benefits that you would if enrolled in Original Medicare (except for hospice care, which is still covered by Medicare Part A). Some plans offer additional benefits not included in Original Medicare, such as health and wellness programs, and routine vision and dental benefits. Many Medicare Advantage plan include prescription drug coverage (Medicare Advantage Prescription Drug plans). You will need to continue to pay your Part B premium if you enroll in a Medicare Advantage plan.
Many Medicare Advantage plans offer prescription drug coverage; these are known as Medicare Advantage Prescription Drug plans. You can’t have both a Medicare Advantage plan and a stand-alone Medicare Part D Prescription Drug Plan.
You may enroll in a Medicare Advantage plan if you have both Medicare Part A and Part B, live in the local area of the plan you wish to enroll in, and do not have end-stage renal disease (ESRD). You can enroll, switch plans, and disenroll during the following periods:
There are different types of Medicare Advantage plans. As a Medicare beneficiary living in Texas, availability will depend on your county and, in some cases, whether you meet certain eligibility criteria:
When you’re choosing a Medicare Advantage plan in Texas, it’s important to consider all of your options and research what’s available. Although all Medicare Advantage plans are required to provide at least the same amount of coverage as Original Medicare, there can be differences in cost and any additional benefits they may offer. Some plans may even offer premiums as low as $0, although you must continue to pay your Part B premium for any Medicare Advantage plan you join, along with any copayments, coinsurance, and deductibles.
Ultimately, the county and zip code you reside in determine which plans are available to you. It may be important to shop around if you’re looking for a Medicare Advantage plan that includes prescription drug coverage. Out-of-pocket costs may vary for Medicare Advantage plans and may depend on the prescription drugs you take, whether the plan covers them, and which cost tier the prescription drugs fall under. Remember to consider costs like copayments, deductibles, and out-of-pocket maximums, in addition to the plan premium.
*Out-of-network/non-contracted providers are under no obligation to treat Preferred Provider Organization (PPO) plan members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.