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Medicare Advantage Plans in Texas

According to recent information from the Kaiser Family Foundation, about 1.2 million Medicare beneficiaries have enrolled in Medicare Advantage plans in Texas. This enrollment in Medicare Advantage plans represents just about 33% of everybody enrolled in Medicare Part A and Part B within the state.

People with Medicare Part A and Part B might choose an MA plan to help enhance the coverage that Original Medicare coverage. Sometimes you may see this kind of Medicare insurance referred to as Medicare Part C plans in Texas. If you’d like to learn if a Medicare Advantage plan in Texas can offer you the right combination of premiums and benefits, take a few moments to read this overview.

Medicare Advantage Plans in Texas: When Can I Enroll?

Almost every Texan with Medicare Part A and Part B can choose to enroll in a Medicare Advantage plan in Texas. The only medical question allowed on Texas Medicare Part C applications is about ESRD. As discussed later, people with ESRD might have to enroll in another plan.

To enroll in an MA or MAPD plan in Texas, you will need to do it during one of these election periods:

  • Initial Coverage Election Period: Many Texas seniors will make use of their Initial Coverage Election Period, or ICEP, for three months before and three months after their 65th birthday. Some Texas beneficiaries delay Part B, so they also delay their ICEP. Disabled and younger recipients can substitute the first month of eligibility for their birthday.
  • Annual Election Period: Also called Open Enrollment, the Annual Election Period runs between October 1 and December 7 of each year. This is a time when everybody can enroll in a new Medicare Advantage plan in Texas.
  • Special Election Period: The government also may allow people to enjoy a Special Election Period of 63 days because of certain circumstances. These could include losing group medical insurance or moving to a new service area.

There is also a Medicare Advantage Disenrollment Period. This describes the six weeks between January 1 and February 15 each year. At this time, people can drop Part C and return to Original Medicare. After that, people who only have Medicare Part A and Part B can also pick up a Part D plan for prescriptions if they need to.

Popular Kinds of Texas Medicare Advantage Plans

In Texas, most Medicare beneficiaries will select from one of these three kinds of Medicare Advantage plans:

Health Maintenance Organization HMO plans:

This popular kind of managed care Medicare Advantage plan requires members to get almost all covered health-care with in-network providers. An HMO will also require a primary care doctor to give a referral to a specialist. They usually offer lower rates and out-of-pocket costs than other kinds of plans.

Preferred Provider Organization PPO plans:

PPOs offer cheaper premiums with in-network providers. While in-network doctors will be cheaper, the PPO will also cover out-of-network providers. It also won’t require members to have a PCP or primary care doctor.

Private Fee-for-Service PFFS plans:

These insurance policies don’t use a network, but it’s still wise to confirm that local doctors and hospitals accept them.

End Stage Renal Disease ESRD:

There is a special ESRD Medicare plan. Typically, this one health condition prevents enrollment in a Medicare Advantage plan in Texas.

Special Needs Plans SNPs:

In some cases, a Texas beneficiary may benefit from choosing Special Needs Plans. These Special Needs Plans are tailored to a specific population, like people in nursing homes or diabetics, so they can manage chronic health conditions or institutional conditions.

Dual-Eligible: These are special plans for people who get both Original Medicare and Medicaid.

Enrollment Statistics for Medicare Plans in Texas

These are some highlights of the enrollment figures for Texas Medicare Advantage plans:

  • Number enrolled in a Medicare Advantage plan in Texas: About 1.2 million
  • Percentage of total Medicare recipients enrolled in MA: About 33%

This list shows the top Texas counties by population:

  • Harris County, TX: 4,652,980
  • Dallas County, TX:2,618,148
  • Tarrant County, TX: 2,054,475
  • Bexar County, TX: 1,958,578
  • Travis County, TX: 1,226,698

How Does a Medicare Advantage Plan in Texas Cover Prescriptions?

If a beneficiary wants to include Part D within their Medicare Advantage plans in Texas, they should look for Medicare Advantage Prescription Drug plans MAPDs. These are very common and some even come with a $0 premium.

Like any Medicare Part D Prescription Drug Plan, these come with a formulary that lists covered drugs. The Medicare Advantage Prescription Drug plans also have Prescription Drug tiers that may cover various drugs with different benefit levels. For instance, you may have different deductibles or copays for brand-name than generic medicine. It’s best to consider how well both the drug and the medical benefits will help lower costs.

You can also buy a Medicare Part D Prescription Drug Plan on its own to work with a Medicare Advantage plan in Texas that doesn’t come with drug coverage.

Network Restrictions for Medicare Advantage Plans in Texas

Most Medicare Advantage plans in Texas use networks to help control costs. For instance, you will usually need to see a network doctor or hospital unless it is an emergency if you have an HMO. Some plans may have a national network that you can use, but these are more likely to be PPOs with somewhat higher premium rates. If you end up moving out of your area, you will probably need to enroll in a new Medicare Advantage plan, but this move should trigger one of your Special Enrollment Periods.

Additional Benefits of Medicare Advantage Plans in Texas

A Texas Medicare beneficiary may decide to enroll in a Medicare Advantage plan because of concerns over the coinsurance and co-payments they could have to pay with only Original Medicare. Also, there are no health questions to answer on the application, and the main requirement is being enrolled in Medicare Part A and Part B.

In addition, a Medicare Advantage plan in Texas may come with some additional perks that aren’t addressed by Medicare Part A and Part B at all. Some features of Medicare Part C plans in Texas that could make it more attractive than just Medicare Part A and Part B include these common examples:

  • Help with routine vision and dental
  • Help with hearing care
  • Extra wellness programs

It’s best to compare all of the various coverage options before selecting one Medicare Advantage plan or another.

Texas Resources to Help Compare Medicare Options

These resources may help provide more information about Original Medicare and Medicare insurance in Texas:

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