Medicare Advantage Plans in Texas

Private insurance companies sell Medicare Advantage or Medicare Part C plans as an alternative to Original Medicare. For example, a Medicare Advantage plan in Texas offers the same benefits as Medicare Part A and Part B plus additional coverage for health care services not included in Original Medicare.

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Top-rated Medicare Advantage Plan Providers in Texas

Based on nationwide enrollment, the three leading insurance companies are:

  • Care Improvement Plus
  • WellCare
  • Aetna
  • Advantra
  • Cigna
  • Blue Cross Blue Shield
  • Humana

Popular Types of Medicare Advantage Plans in Texas

Best plans for network freedom: PPOs

  • Medicare Advantage PPOs (Preferred Provider Organization plans) provide a more comprehensive network of healthcare providers, medical suppliers, and facilities for enrollees to use.
  • PPOs don’t require referrals.
  • PPO monthly premiums vary from $0 to $100.00.

Best plans for lower out-of-pocket costs: HMOs

  • Most HMOs and Health Maintenance Organization plans have zero $0 monthly premiums.
  • Lower copays than PPO Plans
  • HMOs have low premiums because they use network providers and require enrollees to get referrals from a primary care physician.

Best for low income or health issues: Special Needs Plans (SNPs)

  • SNPs are unique insurance plans that provide coverage for people with limited income or chronic health conditions like end-stage renal disease or ALS.
  • Those dually eligible for Medicare and Medicaid have lower copays, coinsurance, deductibles, and premiums.

Medicare Advantage plans are prevalent in every U.S. state. They provide comprehensive, high-quality insurance, and they are very affordable.

Statistics about Medicare Advantage in Texas:

1. People enrolled in Medicare Advantage: 1,453,573

2. People enrolled by plan type:

  • Local HMO plans: 770,950
  • Local PPO plans: 472,168
  • Regional PPO plans: 174,295

3. The percentage of enrollees in Medicare Advantage in Texas is 41 percent of all Medicare beneficiaries.

4. There are over 26 million people enrolled in Medicare Advantage in the United States, which means that out of all Medicare beneficiaries, 42 percent are enrolled in Medicare Advantage.

How much does Medicare Advantage in Texas cost?

How much you pay for a Texas Medicare Advantage plan depends on where you live, which health insurance provider you choose, and your coverage options. For example, most states have an HMO with a $0 monthly premium. And in some service areas, you may find a PPO with a zero-dollar premium.

While prices vary from county to county, the average monthly premium in Texas for an MAPD plan is $21.52. In addition, the average drug deductible is $191.58.

How much do Advantage Plans cost in Texas?

PO Plan $0 to $21.52

HMO Plan $0.00

When can I enroll in a Texas Medicare Advantage plan?

These are the Medicare Advantage enrollment periods:

What is the Initial Enrollment Period (IEP)?

For those who are 65:

If you are getting Social Security retirement benefits when you turn 65, you have seven months, known as the Initial Enrollment Period. Your IEP begins three months before the month of your 65th birthday, includes the entire month of your birthday, and ends three months after the month of your 65th birthday.

For people receiving disability benefits:

Eligibility for Medicare includes people getting Social Security or RRB benefits due to a qualifying disability, end-stage renal disease, or ALS. The IEP begins three months before the 25th month of receiving disability benefits includes the 25th month, and ends three months after.

How does the Open Enrollment Period (OEP) or Annual Election Period (AEP) work?

During the Annual Election Period, those eligible can sign up for Medicare Advantage, switch from one plan to another, or return to Medicare Part A and B.

During AEP, you can also sign up for Part D Medicare coverage. AEP runs from October 15 to December 7, and any changes you make will take effect on January 1 of the new year.

How does the Medicare Advantage Open Enrollment Period work?

Beneficiaries can switch from a Medicare Advantage plan to Original Medicare or a different Part C plan during the Open Enrollment Period, which runs from January 1 to March 31 every year. Any change you make takes effect the first day of the month following your switch.

Special Enrollment Periods

If they meet the requirements, Medicare Advantage enrollees can change their healthcare coverage during special enrollment periods.

The requirements for Special Enrollment Periods are:

  • Moving out of your plan’s service area
  • Moving back to the United States
  • Moving into or out of a skilled nursing or long-term care facility
  • Being released from prison
  • Eligibility for Medicaid changes, or you have dually eligible for Medicare and Medicaid.
  • Medicare ends a plan’s coverage.
  • You leave your Medigap plan and return to Medicare Advantage coverage

What is the Five-star Special Enrollment Period?

Medicare may grant a special enrollment period if a new plan with a five-star rating is available in your area and you want this coverage.

What is the Special Enrollment Period for “Extra Help”?

For those enrolled in Extra Help or Medicaid services, they can change coverage once during the following periods:

  • January – March
  • April – June
  • July – September

Medicare Advantage Highlights:

If you are considering a Medicare Advantage plan, here are some things you should know about Medicare Advantage in Texas:

  • The Centers for Medicare and Medicaid Services work with state governments to regulate all Medicare Advantage plans to ensure that Medicare beneficiaries get at least all Medicare Part A and Part B benefits.
  • The insurance company selling the Medicare Advantage plan is responsible for claims, customer service, and administration of their health plans.
  • Enrollees in Medicare Advantage plans must continue paying their Part B premium through Original Medicare to remain eligible for Medicare Part C coverage.
  • Texas Medicare Advantage plans are becoming more popular every year.
  • In Texas, most Medicare Part C insurance plans require that beneficiaries use network providers for medical care and supplies.
  • MAPDs — Medicare Advantage Prescription Drug Plans — include prescription drug coverage bundled into one plan.
  • Most Medicare Advantage plans include extra benefits like vision, dental, and hearing care; wellness and fitness club memberships like SilverSneakers; Medicare over-the-counter medication allowances; transportation to and from medical appointments; and meal delivery services.

Ready to Learn More?

We help educate Medicare beneficiaries on their Medicare Advantage options and help them go through the process of reviewing and comparing plans. We work with most of the nation’s top-rated Medicare Advantage carriers. Call us today or request a quote online to learn more about plan options.

Texas Medicare Resources

Understanding the Medicare benefits of Medicare Parts A and B can be challenging. Learn more about Medicare, Medicare plans, options for saving on out-of-pocket costs for healthcare services and health insurance, and more with these resources. You can also call us so we can help you find the best rates on M.A. policies in Texas with top-star ratings!

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