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Medicare Advantage Plans in Texas

How Medicare Advantage plans work in Texas

Medicare Advantage (MA, also known as Medicare Part C) plans are alternatives to Original Medicare (Part A and Part B) . When you enroll in a MA plan, you transition from Original Medicare to a completely private health insurance program. Many MA plans in Texas include additional benefits that you won't get from Original Medicare, like routine vision, dental, and prescription drug coverage.

There are several Medicare Advantage plans in Texas that are specifically designed for certain illnesses. These plans, known as Medicare Special Needs Plans (SNPs) , set up their coverage, provider networks, and prescriptions to offer the best service to individuals with specific conditions. As of 2013, Texas had 41 Special Needs Plans available: 15 for chronic conditions, 2 for institutional conditions, and 24 for dual eligible enrollees (enrollees on both Medicare and Medicaid).

Medicare Advantage plan facts for Texas

In 2012, over 700,000 Texas residents were enrolled in a Medicare Advantage plan. This was about 22.8% of the state's total Medicare population.

Medicare Advantage plans are rated on a scale from 1 to 5 based on their service, quality of care, and benefits for chronic conditions, with 5 being the highest rating. In 2011, the average rating for MA plans in Texas was 3.18 stars. Only 2.8% of the state's residents enrolled in a plan with a rating of 4 or higher.

Medicare Advantage Prescription Drug plans

Some Medicare Advantage plans provide prescription drug coverage on top of medical coverage. These are called Medicare Advantage Prescription Drug plans (MAPDs). If you enroll in an MAPD, you don't need to buy a separate Part D plan for your medications.

Comparing Medicare Advantage plans in Texas

There are some important points to keep in mind when looking to enroll in a Medicare Advantage plan . The MA market is different in each county, and not every plan is readily available all throughout Texas. Your options will depend on where you live.

As you shop for plans, compare the costs of a Medicare Advantage plan to its list of benefits. Many plans charge low premiums, some as low as $0 per month (although you remain responsible for paying your Part B premium no matter what), but lower premium plans may not include comprehensive coverage, making you responsible for higher deductibles and/or copayments.

If you wish to join an MAPD for your prescription drug coverage benefits, be sure to examine its drug formulary document. Each plan covers a different set of medications, so you should try to find one that covers the costs of your specific medications.

Data provided by the Kaiser Family Foundation.

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Medicare has neither reviewed nor endorsed this information.