Are you familiar with Medicare Part C? You may have heard of it referred to as a Medicare Advantage policy. Still others call it a “Medicare replacement” policy due to how it functions. The majority of Medicare supplement insurance policies work side-by-side with your current Medicare benefits; Advantage plans, however, replace them entirely. In exchange, they provide comprehensive gap coverage, and give you the option to add more benefits to the policy. To learn more, just keep reading.

Federal Regulations for Medicare Advantage

When you sign up for Medicare Advantage, you are transferring financial responsibility for paying your Medicare claims from the government to a private insurance company. To help seniors, Advantage plans are regulated by the government to guarantee good Medicare coverage. By law, your Advantage plan will provide no less than the same benefits as Medicare Parts A and B. However, many companies will offer you a great deal more coverage in order to attract customers.

Medicare Advantage Enrollment In Texas

Texas is one of the more favorable states when it comes to Medicare Advantage. Out of all the Medicare-qualified seniors, 33% have replaced their federal medical benefits with an Advantage policy. Keep in mind though that there are significant differences from one Advantage plan to another. In the chart below, you can see how the differences in plans influence their popularity:

Plan Type Enrollment Percentage
HMO Plans 59%
Local PPO Plans 13%
Special Needs Plans 11%
Regional PPO Plans 9%
Private Fee-For-Service Plans 5%
Other (Cost Plans, MSA’s, etc.) 3%

Plan Coverage & Cost

There are many different factors which will influence your rate. Poor health or advanced age may drive your rate up, while early enrollment or the state you live in might drive the price down. Determining your exact quote can be a complicated process. For comparison purposes, take a look at what seniors near you are paying for their Advantage plans:

Most Popular Medicare Advantage Plans in Texas

Do you want a Medicare Advantage plan which can deliver excellent care management, pays out claims promptly, comes with an affordable monthly premium, and is managed by a financially stable, well-regarded company? Then look no further than our star rated plan reviews. The closer a plan gets to five stars, the better it will help you manage your health care needs.

Helpful Medicare Advantage Tips & Tricks

Doctor/Provider Network Restrictions

Medicare Part C borrows from some traditional types of health insurance in that it incorporates a provider network into the policy. Your provider network will determine where and how you get the care you need. More restrictive networks (HMOs, for example) are low-cost, but also low on choice. PPOs and PFFS networks are larger and more flexible, but you have to pay more for those plans.

  • HMO Plans – HMO plans are fairly strict and require you to stay exclusively in-network if you want help from your insurance company with the costs. There are exceptions if you need to get emergency care out of network, but that’s about it. You have to choose a primary care doctor, and you have to visit them first if you have a health ailment. From there, your primary will give you referrals within your selected network of doctors, hospitals, and other approved facilities.
  • PPO Plans – If you want more choice when it comes to your health care providers, you may prefer a PPO plan. But keep in mind that this comes at a cost. Having a greater variety of doctors and facilities to choose from will make your plan more expensive; and your medical costs will be more expensive if you get care outside of your insurance company’s preferred provider network.
  • PFFS Plans – Private Fee-For-Service plans don’t work like an HMO or a PPO plan. Instead, you’re allowed to see whoever you wish as long as your insurance company and the doctor, hospital, or facility agree to the payment terms set by your insurance company. If there is no agreement, you will have to pay your own medical costs. If there is an agreement, you’re good to go. But these payment terms change all the time, so you’ll have to work a little harder to make sure your insurance company and your health care providers are still on the same page for every single appointment you make.
  • Special Needs Plans – If you have a serious chronic illness with expensive medical costs, you may qualify for a Special Needs Plan. These plans restrict your network of doctors and facilities in order to keep costs as affordable as possible in the face of your expensive illness. You can only get out-of-network care in the event of an emergency, or if you negotiate care beforehand with your insurance – although they rarely grant exceptions.

Doctor/Providers List

Finding a doctor who accepts your Medicare Advantage plan:

  • HMO Plans – A Medicare Advantage HMO plan has a few advantages over a regular private HMO health insurance plan. The fact that the federal Medicare program is helping you pay for your policy can make it that much more affordable. But you’ll still have to deal with the hassle of managing care through a primary care physician and making sure you stay in-network in order to get your costs covered.
  • PPO Plans – Medicare Advantage PPO plans can make expensive PPO plans more affordable for aging seniors. This is especially important since quality care at an affordable price becomes increasingly necessary as you age. But having the freedom to choose the care providers you want and to get that care at a price you can afford – which Medicare Advantage PPO plans offer – is a very attractive option to most seniors.
  • PFFS Plans – You’ll still get the variety of choice with a Medicare Advantage PFFS plan that you would with any other PFFS plan. But you may not have as much trouble getting your care providers to agree to your insurance company’s payment terms if your insurance company has Medicare Advantage clout. This can help you get the affordable care that you need from the right providers.
  • Special Needs Plans – Getting the care you need at an affordable cost will be less challenging if your health care needs are substantial enough to qualify for a Special Needs Plan. But a Medicare Advantage SNP can make that easier to achieve, also. These plans are less expensive than private options because you are getting financial help from the federal Medicare program. But your network will still be somewhat restricted to only the most affordable doctors, hospitals, and facilities. Going out of network will still be 100% your financial responsibility. And you will still have to negotiate for non-emergency out-of-network care with a low likelihood of approval.

You can and should use the Physician Search Tool available on the Medicare website if you have a doctor or doctors that you want to continue seeing when you switch to Medicare Advantage. Not all doctors and facilities are available in every single plan. It’s important to do a little background check first using that tool so that you know which plan will work best for you.

Drug, Vision and Dental Coverage

Vision coverage is important as you age, especially with regard to things like driving and maintaining your independence. With a Medicare Advantage policy, you can add vision coverage if it is available in your area and manage all of your health care needs under a single policy. With other Medicare supplement policies, vision coverage is not available and you will have to purchase a separate policy on your own. Either method is still relatively affordable – but vision coverage through Medicare Advantage ads an extra degree of convenience.

This is also true for dental coverage. Most Medicare Advantage plans have affiliations with dental health care networks in your area and will give you the option to purchase extra coverage and add it onto your policy. From there, you can manage all of your needs through your Medicare Advantage insurance company. This is much simpler than purchasing a separate policy if you decide to go with a Medicare supplement or if you don’t purchase Medicare supplement insurance at all.

Enrollment Options & Best Time To Enroll

If you do not enroll in Medicare and Medicare Advantage during either your IEP or an SEP (see more on those terms below), you may have a harder time getting approved for coverage. And some seniors, even if they enroll at the right time, will face difficulty with the approval process if they have a serious pre-existing condition, such as ESRD. Most states have low-cost options for retired persons in this dilemma, and you can learn more about them through your state department of insurance or through a local insurance agent. Also, feel free to take a look at our Medicare Advantage Enrollment Options page.

  • Initial Enrollment Period: Within your first 6 months of Medicare enrollment, you can enroll in a Medicare Advantage policy.
  • Annual Enrollment Period (AEP): From October 15th through December 7th each year, you are free to change or cancel your Medicare Advantage and part D drug plan.
  • Special Enrollment Period (SEP): Any sort of special circumstance in which you may need to change or get new coverage outside of a regular enrollment period, such as moving out of your service area, losing your employer/plan coverage, or your provider ceasing coverage in your area.

What Medicare Advantage Plan Is Best For Me?

There are a few main goals when it comes to choosing the right Medicare Advantage program. You want to purchase a plan from a financial stable company that will be around for as long as you are. You want to choose a plan that comes with an affordable premium. And you want to purchase a policy from an insurance provider that will manage your care well with a wide range of benefits. Making such an important decision and getting it right on the first try – especially within the narrow enrollment period associated with Medicare enrollment – is a tall order.

But it doesn’t have to be. You can make the shopping process much smoother, quicker, and easier by letting us help. And you can find the perfect plan at the right price all within your enrollment period, too! We can get you accurate quotes in only a few minutes from the best insurance providers near you. All you have to do is reach out and contact us.

by Lindsay Malzone, Lindsay Malzone is the Medicare expert for She's been contributing to many well-known publications as an industry expert since 2017. Her passion is educating Medicare beneficiaries on all their supplemental Medicare options so they can make an informed decision on their healthcare coverage.