Introduction to Medicare Advantage in Texas (Medicare Part C)

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, 29% 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

Medicare Advantage plans are not one-size-fits-all; they have the capacity to be tailored to your specific medical needs. Depending on your insurance provider, your provider network of choice, and what other types of coverage you need in order to stay healthier, longer. For this reason, calculating an accurate quote requires that you reach out to an insurance agent for help.

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.

Doctor/Providers List

Drug, Vision and Dental Coverage

You can add ancillary benefits to a Medicare Advantage plan, which is a feature that most Medicare supplements do not offer. MAPD plans incorporate Part D prescription drug coverage, and you can add vision or dental to any plan you sign up for. Just remember that the more you add, the more you will have to pay in monthly premiums. But it may be more cost-effective to consolidate all of your medical needs onto the same, single, easy-to-manage policy if you shop around intelligently.

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?

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