Who Offers Medicare Advantage Plans in Texas?

Medicare is a health insurance program for those 65 or older, those 65 and younger with a qualified disability, and those with End Stage Renal Disease. One can enroll in Medicare during a seven-month window surrounding your 65th birthday: three months prior, the month of, and three months after. Those with a medical condition can apply upon diagnosis. 

Original Medicare has two parts, Part A and Part B. Each covers a separate portion of health insurance and medical need. Medicare Part D is prescription coverage. Then there is Part C, which is a combination of Parts A, B, and D; it is commonly known as Medicare Advantage (MA). We at CoverMile aim to help you understand MA better and show you who provides Medicare Advantage plans in Texas near you.

What is Medicare Advantage?

Medicare Advantage coverage options are the same as Original Medicare. The only difference is whom you purchase the plan from. Instead of purchasing it directly from Medicare, Medicare contracts with health insurance companies to bundle the three parts into one; however, you must first have Original Medicare, then transition into an MA plan.

There are major differences in how each part covers individuals.

Medicare Part A – Hospital Insurance

When you have a Medicare Advantage plan, your Medicare Part A hospital insurance cost is no different than if you obtained it alone; most receive it for free. However, if you pay a premium for your Part A, you will continue to do so under an MA plan.  If you have not met Medicare tax requirements, you will need to pay a premium. For 2024, Medicare Part A premium is $505 for those who had fewer than 30 quarters, for those with 30 to 39 quarters this premium is reduced to $278.

Medicare Part A covers:

  • Inpatient Hospital Care
  • Skilled Nursing Facility
  • Hospice
  • Surgery
  • Lab Testing
  • Home Health Care

Medicare Part B – Medical Insurance

The second part of Medicare Advantage is Medicare Part B. You pay a monthly premium for this portion of Medicare. For 2024, the standard premium for Part B is $174.70.

Part B covers medically necessary services:

  • Doctor’s Visits
  • Outpatient Care
  • Durable Medical Equipment
  • Home Health Care
  • Mental Health
  • Preventive and Screening Services

The primary difference with Medicare Advantage Plans in Texas is that you must obtain health care within a network of physicians and facilities, or you will either receive reduced care or no coverage at all. Under Original Medicare you have coverage anywhere in the US as long as they accept Medicare.

Medicare Part D – Prescription Coverage

When you purchase Medicare Part A or Part B, neither offer prescription coverage alone. Part B offers limited benefits for Alzheimer’s medication and flu and pneumonia shots, this includes COVID-19. One would need Medicare Part D to include medication benefits.

In addition, Part D is not a plan you can purchase by itself, you must purchase either Part A or B, or both to enroll in prescription Part D. When you purchase a Medicare Advantage Plan, Medicare Part D is included.

One of the primary things to note about Medicare Advantage Plans in Texas is that, unlike Original Medicare, you will have an out-of-pocket max. Once you have reached your deductible, paid through your coinsurance, and reached your out-of-pocket max, your Medicare Advantage Plan will pay 100 percent of healthcare expenses. Original Medicare does not have a Part A or Part B yearly cap.

How Do I Apply for Medicare Advantage Plans in Texas?

There are three opportunities to apply for Medicare Advantage in Texas. Each involves different times to sign up for Medicare.

  1. During your Initial Coverage Election Period.

This will be the standard enrollment period surrounding your sixty-fifth birthday; three months prior, the month of, and three months after.

  • During the Annual Election Period (AEP) each year.

Medicare Open Enrollment is between October 15th and December 7th of each year. You can enroll or make changes to your current Medicare coverage. Any such changes will go into effect on January 1st of the following year.

  • During the Medicare Advantage Open Enrollment Period. (OEP).

If you are currently enrolled in a Medicare Advantage plan, you have the opportunity to make changes to your current plan from January 1st through March 31st.  Your new plan will take effect the month following your change.

Like health insurance, Medicare provides a Special Enrollment Period (SEP) for life moments like losing a job that provided health coverage or moving into a new zip code that takes you out of the coverage area of an insurance carrier. If you have questions about enrollment our Medicare insurance agents in Austin, Texas can help you apply for a Medicare Advantage Plan. Contact CoverMile today.

Who Offers Medicare Advantage Plans In Texas?

Below we have researched the top five Medicare Advantage Plans in Texas. Since MAPs are sold by insurance companies, each will vary in the costs and benefits provided. When you shop for a MAP, you should consider these factors:

  • Monthly premium (this will be in addition to your Part B premium)
  • Provider network.
  • Out-of-pocket max
  • Cost-sharing benefits (deductibles, coinsurance, copays)
  • Drug coverage
  • Additional benefits they may provide

Another thing you will notice is that instead of Medicare offering the plan itself, since the insurance companies are offering the plans, you will find networks. Most companies will offer up to four networks.

HMO: You have a network of doctors and facilities you work within. You choose a Primary Care Physician (PCP), and they help you manage your care and provide referrals to coordinate your medical care. These will have lower premiums and copays.

PPO: You can see in- or out-of-network doctors but will pay less for in-network. You pay higher premiums with flexibility.

SNP: These plans are built for those who also qualify for Medicaid. They offer two types of plans CSNP and DSNP. Chronic Condition Special Needs is for those with Diabetes, Heart Disease, Lung Disorders, and other serious conditions. Dual Eligibility SNP is for those who qualify for both Medicare and Medicaid.

PFFS: Private Fee For Service is a non-referral medical plan. If you need to see a doctor or specialist, you can go straight to the doctor you want to see, no referral is needed.

For 2024, there are 4.5 million Texans enrolled in Medicare. There are 376 Advantage plans available with the average plan costing $9.36. However, all Texans live in a county where they can find a zero-dollar premium plan. We have reviewed five plans that offer the best benefits that include a zero-dollar premium.

Humana Medicare

Humana offers Medicare Advantage plans that offer:

  • $0 Monthly Premium
  • $0 Medical Deductible
  • $0 Primary Care Copay
  • $20 Specialist Copay
  • Routine Dental Exams
  • Glasses and Contact Allowance
  • Coverage for Hearing Aids
  • $0 copay on Tier 1 Prescriptions on some plans
  • Gym Membership

The Humana Medicare Advantage plans we searched for in the area offer monthly premiums from zero dollars to seventy-two dollars and have a max out-of-pocket from zero dollars up to $7200. Keep in mind that not all plans cover all services.

UnitedHealthcare Medicare

UHC Medicare plans offer:

  • $0 Monthly Premium
  • $0 Medical Deductible
  • $0 Primary Care and TeleMed visits
  • $15 Specialist Copy
  • Up to $2000 Dental
  • Eye exam and Eyewear Allowance
  • Coverage for Hearing Aids
  • $0 copay for Tier 1 Preferred Generic Medication
  • Gym Membership

UHC Medicare Advantage plans offered cost zero dollars up to forty-eight dollars per month.  Their max out-of-pocket can be from zero dollars up to $7550. Not all plans cover all services.

Blue Cross Blue Shield Medicare

BCBS of Texas plans cover:

  • $0 Monthly Premium
  • $0 Medical Deductible
  • $0 Primary Care Visit and Telehealth
  • $15 Specialist Visit
  • Dental Coverage Options
  • Eye Exams and Eyewear Allowance
  • Hearing Exams Covered and Hearing Aid Allowance
  • Zero-dollar Copay for Tier 1 Preferred Medications
  • SilverSneakers Fitness Program on some plans

BCBS of Texas Medicare Advantage offers plans from zero dollars up to $238 per month with an out-of-pocket max from zero dollars up to $7550. Not all plans cover all services.

Cigna Medicare

Cigna offers HMOs, PPOs and SNPs. Their plans cover:

  • $0 Monthly Premium
  • Medical deductible
  • $0 Primary Care visit
  • $0 Specialist Visits
  • Dental Coverage Options
  • Eyecare and Eyewear options
  • Hearing services
  • Silver&Fit Healthy Aging program
  • OTC medication allowance
  • Zero-dollar copay on Tier 1 medication for a 90-day supply

Premiums from Cigna Medicare Advantage were all zero dollars per month (this may change depending on the area you live in). Plan options were a zero-dollar deductible and out-of-pocket maximums up to $6900. Not all plans cover all services.

Aetna Medicare

Aetna Medicare offers HMO, PPO, SNP, and PDP plans that cover:

  • $0 Monthly Premium
  • $0 Medical deductible
  • $0 Primary Care Visits
  • Specialist Visits
  • Dental Coverage Options
  • Eyecare and Eyewear options
  • Hearing services
  • $0 Tier 1 Rx deductible and copay and 90-day supply
  • SilverSneakers fitness program

Medicare Advantage premiums for Aetna Medicare are zero dollars up to $23 per month. Plan deductibles run from zero dollars and $280 with out-of-pocket up to $8850. Not all plans cover all services.

CoverMile is the Medicare Insurance Agents Near Me

When you are looking for the best Medicare Advantage Plans in Texas that can help cover your medical needs including costly prescriptions, contact CoverMile and we can assist you with finding the best health insurance provider in your area. Medicare insurance agents in Austin TX and surrounding areas are waiting to start your quote today.

Frequently Asked Questions

  1. Is Medicare Advantage in Texas expensive?

    The cost of a Medicare Advantage Plan in Texas can be as low as $0 for the plan itself. You will also pay for your Part B premium which for 2024 is $174.70 as well as a Part D premium. If you have not met your free Premium Part A stipulation you will also need to pay this portion.

  2. Am I required to sign up for Medicare Advantage when I turn 65?

    Under normal circumstances, you will sign up for Medicare during your Initial Open Enrollment Period. If you have health insurance through an employer or a spouse’s employer, you can wait to sign up until that coverage ends. You have eight months after that coverage ends to sign up without penalty.

  3. Can I use a Medicare Advantage Plan when I travel?

    In some cases, such as UnitedHealthcare, Medicare Advantage Plans can be used when you travel. Benefits are generally for emergency use only and can be as low as $0 copay.

  4. Do all insurance companies offer Medicare Advantage Plans in Texas?

    Many health insurance companies offer Medicare Advantage Plans in Texas. UnitedHealthcare and Humana Medicare are just two of the many. Medicare insurance agents in Austin TX such as CoverMile can help you find a MAP that offers health insurance to the county you live in.

  5. Are all Medicare Advantage Plans in Texas the same?

    Medicare Advantage Plans are sold by individual health insurance companies. Just as health insurance is priced differently, MAPs can differ in their cost as well as the benefits offered. However, most will offer Medicare Part A, Part B, and Part D in their bundle. The primary difference lies within Part D of the program and the add-ons they offer.