PolicyScout’s Guide to Medicare Advantage Plans in TexasFind out which Medicare Advantage plans are available in Texas and how you can apply.
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Compared to Original Medicare, Medicare Advantage plans can offer added health benefits and lower healthcare costs.
But, with all the different plans and providers, signing up for a Medicare Advantage plan can be confusing.
Learn how you can find the best private Medicare health care plans in the Lone Star state with our guide to Medicare Advantage plans in Texas.
What Is Medicare?
The federal government’s Medicare program is a health insurance scheme for over-65s, people with disabilities, and those that suffer from ESRD (End-stage Renal Disease) and ALS (Lou Gehrig’s disease).
The Medicare Parts Explained
Medicare is divided into different “Parts” that separate expenses and coverage for medical services, tests and items.
Medicare Part A insurance covers hospital expenses and is for treatment you receive as an inpatient.
Medicare Part B insurance pays for outpatient or general medical expenses as well as preventative services.
Medicare Part C, also known as Medicare Advantage, are private health insurance plans that offer the same coverage as Original Medicare (Part A and B cover).
They often cover Part D prescription drug costs and offer additional benefits, such as dental, hearing, and vision expenses.
Medicare Part D insurance covers self-administered prescription drugs. For example, medication for blood pressure, back pain, or chronic conditions.
Your Medicare Coverage Options in Texas
There are a few different ways to get coverage in Texas once you become eligible for the federal Medicare program. If you are new to Medicare, you can get Original Medicare, Medicare Advantage, Part D, or Medicare Supplement Insurance.Here’s what the common Medicare plans mean:
Original Medicare is a government-run health insurance program that pays for Part A and Part B medical expenses.
Medicare Supplement Insurance Plans are a type of health insurance that helps beneficiaries pay out-of-pocket costs and other expenses not covered by Original Medicare.
Part D Plans, also known as Prescription Drug Plans (PDPs), are health insurance policies offered by private health insurance that help with the cost of prescription medications.
Medicare Advantage plans are private health insurance policies that provide the same benefits as Original Medicare. Most Medicare Advantage plans usually cover additional medical expenses that Original Medicare does not pay for, such as dental and vision coverage.
There are two main types of Medicare Advantage plans in Texas:
MA (Medicare Advantage without prescription drug coverage) - These plans do not offer prescription drug coverage and only cover Part A and Part B expenses.
MA-PD (Medicare Advantage with prescription drug coverage) - These are Medicare Advantage plans that offer coverage for prescription medication (Part D) expenses.
Understanding the different MA and MA-PD plan structures
Medicare Advantage plans also have unique structures which can influence costs, benefits, and coverage. Here are some of the different MA and MA-PD plan networks:
Health Maintenance Organization (HMO) plans provide health insurance through a specific network of health care providers, and you are only covered for service in-network.
HMO point-of-service (HMO-POS) plans cover some health care costs outside your network, but premiums and copayments are usually higher than HMO plans.
Preferred Provider Organization (PPO) plans allow you to see any provider that accepts insurance. You don’t need a referral from your primary physician to get specialist help.
Private Fee-for-Service (PFFS) plans allow members to see any health care provider enrolled in Medicare who accepts your plan.
Special Needs Plans (SNPs) are for people with specific needs or diseases. For example, these can be people who live with chronic conditions or live in assisted living facilities.
Private Medicare Coverage in Texas
Over the past ten years, private Medicare in Texas has increased steadily. Approximately half of all Texas Medicare beneficiaries are enrolled in a Medicare Advantage plan.
The penetration rate is a good indicator of Medicare Advantage membership growth and is the number of Medicare-eligible people who have joined a Medicare Advantage plan.
For example, if ten people are eligible for Medicare and six have a Medicare Advantage plan, the penetration rate is 60% (6 out of 10 people).
In Texas, Medicare Advantage had a 45.2% penetration rate in 2021. This means that for every 100 Medicare-eligible people, around 45 of them had a MA or MA-PD health plan.
This graph shows how quickly Medicare Advantage membership is growing in Texas.
Total Number of Medicare Beneficiaries in Texas: Medicare Advantage, 2014 - 2020
According to the Kaiser Family Foundation, the number of Medicare-eligible people on a Medicare Advantage plan has nearly doubled between 2014 and 2020.
Similarly, the number of Medicare Advantage plans offered by health care companies has increased in the last three years which can make choosing a plan harder to do.
In 2019, there were 137 MA and MA-PD plans for sale in the state.
In 2021, 289 Medicare Advantage plans were available for purchase.
Do you want to know which plans are available in your county? Enter your zip code to find out. Feel free to contact our team of expert Medicare consultants to discuss your Medicare Advantage options on 1-888-912-2132 today.
Key Facts about Medicare Advantage in Texas
Learning about Medicare in your state can help you understand what to expect when joining a private health plan. Here are some key takeaways you should consider about Medicare in Texas.
The price of Medicare Advantage coverage is relatively low. In 2021, the average monthly premium for Texas Medicare Advantage plans was $11.42.
According to the Kaiser Family Foundation, there are 4,251,525 Medicare beneficiaries in Texas:
1,744,523 are members of a Medicare Advantage plan.
2,507,002 Medicare enrollees use Original Medicare.
A large number of medical professionals accept Medicare in Texas. Of the 60,392 physicians in Texas, only 763 opted out of Medicare (Less than 1.3% of doctors).
This means that if you are a Medicare beneficiary, chances are you’ll be able to find a physician who will treat you and accept Medicare rates.
All Medicare-eligible people in Texas can buy a $0-premium Medicare Advantage plan. (These are plans that don’t charge members a monthly premium to join).
However, you will still have to pay your Part A and Part B premiums when you sign up for a $0-premium plan.
Which Health Insurance Companies Offer Medicare Advantage in Texas?
In 2021, over 20 different health insurance providers offered Medicare Advantage plans in Texas. Some well-known names include:
Amerigroup Insurance Company
Blue Cross and Blue Shield of Texas
Community First Health Plans
Imperial Insurance Companies
Memorial Hermann Health Plan
Prominence Health Plan
Scott and White Health Plan
Terms you need to know:
Premiums are monthly fees that people pay to be members of Medicare Part B, Medicare Advantage, and Medicare Supplement Plans.
Deductibles are set amounts that beneficiaries have to pay before their Medicare insurance starts.
Coinsurance amounts are the portions of medical costs that Medicare beneficiaries have to pay.
Copayments are amounts that people have to pay for services, tests, and items. These are set by your health insurance company.
Out-of-pocket expenses are any costs that aren’t covered by Medicare or a private health plan.
How to Choose a Medicare Advantage plan in Texas
If you’re considering a Medicare Advantage plan, use these tips to find a provider and plan that suits your medical needs.
1. Check to see if your provider has plan options in your area. Many people are unaware that Medicare Advantage providers offer different plans depending on where you live.
In Harris County, for example, there are over 50 Medicare Advantage plans to choose from. However, there are just six Medicare Advantage plans in King County.
2. Decide if you want to get an MA-PD (Medicare Advantage Prescription Drug) or an MA (Medicare Advantage) plan.
3. Look at the costs associated with the plan you would like to sign up for, and check if you can afford your plan if the price goes up because of inflation.
4. Ensure that you can cover the monthly premiums and out-of-pocket costs (costs your plan won’t cover), such as deductibles, coinsurance, and copayments.
5. You should also research the plan's and the health insurance company's Medicare Star Rating. For good measure, make sure you find out what other third-party reviews, such as ConsumerAffairs and JD Power, have to say about the insurance company.
What are Medicare Star Ratings?
The Centers for Medicare and Medicaid Services (CMS) publishes an annual report on the performance and quality of Medicare plans and health insurance providers. This is done with a scoring system known as the Medicare Star Ratings System.
Each plan and provider is given a score from one to five, indicating how well the plan performed during the previous year.
Here’s what the different star ratings mean:
⭐⭐: Below average
If you want to learn more, read our guide to Medicare Star Ratings. You can check out your plan’s current star rating by visiting the Medicare.gov website. Simply search for your county, find your plan, and check the number of stars it received.
6. Talk with friends and relatives who have Medicare about their experiences with a certain provider or plan.
7. Speak with a licensed Medicare insurance agent about the plan's advantages and coverage. You'll soon be able to tell if the plan is perfect for you. See which Medicare Advantage companies in 2022 provide exceptional service, benefits, and coverage.
8. Check to see if there are other health care companies in your area that offer similar coverage. Compare plans and providers before making a final decision.
Important Enrollment Dates for Medicare in Texas
If you want to join a Medicare Advantage plan in Texas, here are some important enrollment dates to remember:
Initial Enrollment Period
This is your first chance to sign up for Medicare once you are eligible and begins three months before your 65th birthday. During the IEP, you can sign up for Medicare Part A and B or join a Medicare Advantage plan or Prescription Drug Plan.
General Enrollment Period
From January 1st to March 31st, you can sign up for Medicare Part A and Part B coverage, as well as a Medicare Advantage Plan if you missed the deadline.
Special Enrollment Period
The dates for the Special Enrollment Period are different for each person. This period refers to specific situations where you can enroll outside the regular enrollment periods (for example, if you move states or your employer's health coverage ends).
For more information, feel free to read our guide to Medicare Open Enrollment Period 2022.
How Can I Find Out More About My Health Care Options?
Our Medicare Hub is a fantastic place to start if you want to learn more about Medicare, Medicare plans, and your health care options.
We also have a team of professional Medicare advisors available to answer any queries you may have. We can provide expert information and assistance on all Medicare-related matters if you require one-on-one assistance with your health coverage.