Medicare Advantage Plans - Texas Medicare Solutions

Medicare Advantage, also called Medicare Part C, is  an alternative way to receive the Original Medicare benefits for people with Medicare Part A (hospital insurance) and Part B (medical insurance). Provided by private insurance companies that are contracted in contract with Medicare, Medicare Advantage plans give the same level of coverage as provided by Medicare Part A and Part B. If you are already enrolled in Original Medicare – Part A and Part B – you can choose to enroll in Medicare Part C or Medicare Advantage (MA). It is important to note that Medicare Advantage plans vary by county so a person enrolling in a Medicare Advantage Plan in San Antonio may have different options than someone enrolling in Dallas, Waco or even the Rio Grande Valley.

You may be wondering why someone would choose to enroll in a Medicare Advantage plan when they already have Medicare. First of all, Medicare Advantage plans cover all the same benefits of Original Medicare , including emergency and urgent care. Hospice care remains covered by Original Medicare.

Here are some differences between Original Medicare and Medicare Advantage plans. These differences can be in how much you would pay out of your pocket for healthcare. For instance, you may have a smaller deductible, or a lower coinsurance and copayment.

Besides, these differences can also be in terms of the coverage you get. Many Medicare Advantage plans can cover dental, vision, hearing, over-the-counter items, and even personal emergency response systems. Many Medicare Advantage plans also include prescription drug coverage, known as Medicare Advantage Prescription Drug plans (MAPD).

Remember that even if you enroll in a Medicare Part C plan, you would remain enrolled in Original Medicare and you must keep on paying your premiums for Medicare Part B.

To know which plan is best for you, it’s good to understand the different between different types of Medicare Advantage plans:

 – Health Maintenance Organization (HMO) Plan:  It allows you to visit doctors and other healthcare professionals, participating in its provider’s network.

 –  Preferred Provider Organization (PPO) Plan: It includes both in- and out-of-network providers. This gives you the freedom to select any doctor that accepts Medicare.

–   Private Fee-for-Service (PFFS) Plan: This plan decides how much it will pay to doctors and other health care professionals as well as how much you must pay when you receive care. If your doctor denies the terms of payment, then your PFFS plan will not cover services from that doctor.

–   Special Needs Plan (SNP):This plan is for people with specific special needs. The 3 SNPs cover Medicare enrollees residing in institutions, people with dual eligibility for Medicare and Medicaid, and patients with chronic conditions like end-stage renal disease or diabetes. SNPs always include prescription drug coverage.

–   Health Maintenance Organization – Point of Service (HMO-POS) Plan:These plans cover both in- and out-of-network services, but at varying rates.

–  Medical Savings Account (MSA) Plan: It comprises both a high deductible and a bank account to aid you in paying that deductible. The sum of money deposited the account may vary from plan to plan. The amount is tax free until to use it for IRS-approved medical expenses, which includes deductibles too.

At Texas Medicare Solutions, our local agents not only can help you understand the subtleties of different types of Medicare Advantage plans, but they can efficiently guide you through the process of choosing the right one.

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As mentioned earlier, your Medicare Advantage plan is required to offer you the very same benefits that you get from  Original Medicare. The only exception is hospice care, but it is covered by Original Medicare Part A. Medicare Part C plans in Texas may come with extra benefits like dental services, routine vision, and prescription drug coverage.

Depending on your location in Texas, you can choose from a range of Medicare Advantage plans. Some plans do include networks of doctors. In case you consult with a doctor beyond the network, you may need to pay additional amount for the health services, or you might not have any coverage altogether. It is therefore important to choose an MA plan with the network that include your doctor as this helps you save out-of-pocket health care costs.

Some MA plans, known as Medicare Advantage Prescription Drug plans (MA-PDPs) offer prescription drug coverage over and above the benefits of Original Medicare. If you have this plan, you don’t require to have an individual Medicare Part D Prescription Drug Plan for your medicines.

First things first, you must be eligible for Original Medicare if you want to enroll in a Medicare Advantage plan. The plans may vary depending on your area of service. In case you are suffering from end-stage renal disease, you are less likely to qualify for most MA plans, except Special Needs Plan.

Enrolling in a Medicare advantage plan is incredibly easy with Texas Medicare Solutions. fixYou can schedule an appointment with our licensed Medicare Advantage agents specialist at your convenient time and place, or simply buy over the phone! Because plans vary depending on your location, we believe that there is value in having a local insurance agent. We understand that a Medicare Advantage Plan in San Antonio may differ from one in Dallas, Waco, or Mcallen.

In Texas, you can enroll in a Medicare Advantage plan at your first eligibility for Medicare. It is called Initial Enrollment Period (IEP), which includes 3 months before and after the month you turn 65. It includes your birth month and a duration of 7 months.

If case you qualify for Original Medicare due to some disability, your eligibility starts 3 months in advance of your 25th month of receiving disability benefits via Railroad Retirement or Social Security benefits. This duration also includes your 25th month and 3 months after that make for a total period of 7 months.

Besides, you can enroll in a Medicare Part C plan during the Annual Election Period (AEP), which starts on October 15 and lasts until December 7 each year.

Some may qualify for a Special Enrollment Period (SEP).

You may need to keep in mind a few important points when you compare multiple Medicare Advantage plans at a time. Remember that a specific type of plan can be different in different counties. Moreover, not all plans are available in your area. Both cost and coverage may also vary from plan to plan.

When looking for a Medicare Advantage plan, it is best to review the summary of benefits with a licensed independent insurance agent who can review all the copays and extra benefits with you.

If you are on prescription medicines, there are several Medicare Part C plans with prescription drug coverage to choose from. Every MA-PD plan comes with a formulary, which is a list of covered prescription medications. It’s important to review the formulary and make sure all of your medications are covered.