If you're on Medicare in Texas or will be joining Medicare soon, it's important to figure out how to cover the high out-of-pocket costs not paid by the government. One way to do this is by signing up for Medicare Advantage, a type of private insurance that can offer more benefits than Original Medicare.
That said, you can choose from a wide range of Medicare Advantage Plans in Texas. Here's how to decide if any are right for you.
What is Medicare Advantage in Texas?
Medicare Advantage, also known as Medicare Part C, is a private insurance alternative to Original Medicare. When you sign up for one of these plans, your health care bills are covered by the insurance company instead of the government. The government regulates these plans, so they must offer coverage similar to what you'd receive from Medicare.
Medicare Advantage plans in Texas can charge a monthly premium, but there are also free versions. You can register for a Medicare Advantage plan when you first turn 65 and qualify for Medicare, as there is a seven-month initial enrollment period around your birthday. After that, you can only join from Oct. 15 to Dec. 7 to enroll in a plan that starts the following year on Jan. 1.
How Does Medicare Advantage Compare to Other Medicare Plans?
Medicare Advantage plans can offer more coverage than Original Medicare, so you'd owe less out-of-pocket for deductibles and copayments. For example, Original Medicare Part A charges a $1,556 deductible for an inpatient hospital stay in 2022, whereas a Medicare Advantage plan could cover this cost. In addition, private insurance companies have more flexibility to give extra benefits, like vision care, gym memberships and dental, which do not come with Original Medicare.
Medicare Advantage plans in Texas can include prescription drug coverage as well. However, Original Medicare requires you to purchase an additional plan, Medicare Part D, for prescriptions.
While Original Medicare offers the same coverage to everyone nationwide, Medicare Advantage plan benefits change by location and insurance company. This can also impact which doctors you have access to in Texas.
Medicare Advantage plans use a provider network, with some being more restrictive than others. With an HMO, you can only see in-network providers except for emergencies. A PPO allows out-of-network visits but costs more, while a PFFS lets you see any provider. Original Medicare doesn't have provider restrictions.
How Do Texas Medicare Advantage Plans Compare?
Texas has a large and growing Medicare Advantage market. According to the Centers for Medicare and Medicaid Services, the state had 289 plans available in 2021, and is set to add another 41 additional plans for 2022, adding more options than any other state in the nation.
The number of plans available depends on where you live. Residents in more populated areas, like Harris or Dallas County, have more options, with several dozen plans available. In smaller areas, like Lubbock or Midland County, there might be only a dozen or so plans. Still, regardless of where you live, there are options to choose from in the Texas Medicare Advantage market.
When it comes to enrollment, 36% of Medicare-eligible Texas residents joined a Medicare Advantage plan, according to the Kaiser Family Foundation. This is slightly above the national average of 34%.
What Should You Look for in a Plan?
As you review Medicare Advantage plans in Texas, some points to consider include:
- Plan premium: Some Medicare Advantage plans in Texas charge a premium, which can run over $200 per month. There are also free plans with no premium charge. Generally, a plan that charges a higher premium will offer more benefits, have lower out-of-pocket costs and use a more open provider network than a low-premium or free plan.
- Out-of-pocket charges: A Medicare Advantage plan can also charge out-of-pocket costs when you need health care, like a deductible or copayments. Check the coverage terms so you can see how much you might end up needing to pay.
- Provider network: Your access to providers depends on the network type for a Medicare Advantage plan. If you are considering a plan with a more restricted network, like an HMO or a PPO, check that your doctor is part of the network or else you may have trouble seeing them.
- Extra plan benefits: Medicare Advantage plans can include extra benefits, like dental and vision. See what else you would receive along with health care for a plan.
- Company rating: Check online to see if there are any reviews about an insurance company using sites like the BBB and Consumer Affairs. That way, you can get an idea of their reputation from past customers in Texas. You can also use the Medicare star ratings to gauge the quality of plans.
- Customer support: If you have questions while on a plan, how do you get help? Does the company have local insurance agents, or is it just a 1-800 number?
How Can You Compare Plans?
Navigating all the Medicare Advantage plans in Texas can feel overwhelming, but the government created a free comparison tool available through Medicare.gov. On this search tool, they rate every Medicare Advantage Plan in Texas based on their plan coverage, customer service and previous member satisfaction surveys.
The website also lets you enter in your prescription drugs, so you can see how much you'd owe per year on a plan. If you see some plans that look like they might be a fit, you can then pull up the insurance company's website for more specifics. From there, you can schedule a meeting with one of their representatives to ask questions and register. You can also sign up directly through Medicare.gov's search tool.
What Tips Can Help You Compare Plans?
- Start the process early: Since there's a limited registration window, give yourself time to properly compare everything, so you aren't rushing right at the deadline. While the open enrollment period starts on October 15, companies publish their plan information before then, allowing you a head start.
- Consider your other benefits: You might not need all the benefits from Medicare Advantage plans. For instance, you may already have dental or prescription drug coverage. You can then look for plans that don't cover these, so you avoid paying for benefits you already have.
- Remember that you can change your mind: After you enroll in a plan, it is still possible to change depending on the time of year. You can switch between plans as often as you want during Open Enrollment (October 15 to December 7). From January 1 to March 31, you can make one last plan change. That way, if you later find one you like better, you can swap.
- Reach out for help: If you have any questions about the plans or policy details, you can meet with a health insurance agent. They are trained to cover these questions and assist with enrollment. You can also contact support staff through Medicare.gov and the Texas Health Information, Counseling and Advocacy Program, provided by the state government.
- Check every year: The Texas Medicare Advantage market offers new plans each year. Even if you are satisfied with your previous year's coverage, consider checking again during each annual enrollment to see what else is available.
Medicare Advantage is about choice, which takes a little more research. However, by following this advice, you can find the right fit for your health care needs in Texas.