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Medicare Advantage Plans in Texas

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How Medicare Advantage plans work

Medicare Advantage (Medicare Part C) offers an alternative way of receiving your Original Medicare benefits. When you enroll in a Medicare Advantage plan in Texas, your Medicare Part A and Part B coverage comes from a private, Medicare-approved health insurance company instead of directly from the government. The same is true in other states.

Medicare Advantage plans are required to include the same benefits you get from Original Medicare, Part A and Part B (with the exception of hospice care, which is still covered by Medicare Part A). Many Medicare Advantage plans in Texas (as in other states) include additional benefits that you won’t get from Original Medicare, like routine vision, dental, and prescription drug coverage. (Original Medicare includes limited prescription drug coverage in certain situations.)

There may be several types of Medicare Advantage plans in your part of Texas. Some Medicare Advantage plans are specifically designed around certain illnesses. These plans, known as Medicare Special Needs Plans (SNPs), set up their coverage, provider networks, and drug formularies to focus on beneficiaries with specific health conditions.

Medicare Advantage Prescription Drug plans

Some Medicare Advantage plans in Texas (as in other states) provide prescription drug coverage on top of medical coverage. These are called Medicare Advantage Prescription Drug plans. If you enroll in this type of plan, you don’t need to enroll in a separate Medicare Part D Prescription Drug Plan for your medications. A Medicare Advantage Prescription Drug plan gives you all your Medicare coverage in a single plan.

Here are a few other things you need to know about Medicare Advantage plans.

  • You have to be enrolled in Medicare Part A and Part B to qualify.
  • You can only sign up during certain time periods. You can generally enroll when you’re first eligible for Medicare. Another opportunity comes around every year, during the Annual Election Period (October 15 – December 7). In some situations, such as when you lose coverage, you may qualify for a Special Election Period during which you can enroll.
  • You’re still in the Medicare program if you’re enrolled in a Medicare Advantage plan, and you still need to continue paying your Medicare Part B monthly premium.
  • You must live in the service area of the Medicare Advantage plan you sign up for.
  • If you have end-stage renal disease (ESRD), you might not qualify for most Medicare Advantage plans (except Special Needs Plans). You can call a Medicare Advantage plan directly, or call Medicare at the number at the bottom of this page, to discuss your specific situation.

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 Medicare Advantage market may be different in each county, and not every plan is readily available all throughout Texas. Plan availability and costs may vary.

As you shop for plans, you might 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; but don’t forget to look at all the out-of-pocket costs for each plan, such as deductibles and/or copayments.

Do you take prescription medications? You may want to make sure that a Medicare Advantage plan covers them before you sign up. Each plan maintains its own formulary (a list of prescription drugs the plan covers). The formulary may change at any time. You will receive notice from your plan when necessary.

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