Insurance

How Texas Medicare Advantage Plans Operate

Many Texans confuse Medicare supplements with Medicare Advantage plans, or don’t really understand the difference. A Texas Medicare Advantage plan (MA) is a private health insurance plan that pays instead of Medicare. Unlike a supplement, which pays after Medicare first pays its share, an advantage plan operates on a fee for service schedule – you pay a certain copay for coinsurance for each medical service received.

Many Texans confuse Medicare supplements with Medicare Advantage plans, or don’t really understand the difference. A Texas Medicare Advantage plan (MA) is a private health insurance plan that pays instead of Medicare. Unlike a supplement, which pays after Medicare first pays its share, an advantage plan operates on a fee for service schedule – you pay a certain copay for coinsurance for each medical service received.

Medicare Advantage Basics

Enrollment into a MA plan means that you desire to access your original Part A & B (and often also D) benefits through the plan’s stated network of physicans and hospitals. These providers will send their bills for your services to the plan, so you can put your red, white and blue card in a safe place at home – you will not be using it. Instead, when you are seeking medical treatment, you will present your advantage plan card to the service provider, and the provider will collect from you the allowable copayment or coinsurance that is required of you for that service.

Thoroughly review a plan’s summary of benefits before enrolling. Ask yourself these questions to narrow your search: Can I afford the monthly premium, if any, for this plan? Are my preferred doctors and hospitals in the network or accepting this particular plan? Can I afford the cost-sharing required if I develop a chronic illness? Does the plan also cover my Part D drugs? Often, your risk tolerance and your attachment to certain providers can help guide you toward the plan that is right for you.

Are My Doctors In the Plan’s Network?

Most MA plans follow an HMO or PPO-based network model in Texas. The plan will have an online directory where you can look up physicians. Each plan will have specific rules regarding necessary referrals or prior authorizations to obtain treatment at a specialist or a hospital. In Texas, we also still have a few PFFS plans in some counties, which allow you to see any doctor who is willing to accept the plans payment terms and conditions and bill the plan for services it provides to you.

Monthly Premiums for MA Plans

To enroll in any plan, you must continue to pay your monthly Part B premium as well as the stated premium for the plan. Premiums vary by plan and county, but in some Texas counties, there are plans with monthly rates as low as $0. While some people feel suspicious about such low premiums, the reality is that the plan is simply being paid by the federal government itself to offer you benefits at least equal to Parts A & B.

It’s often intimidating to pick a suitable plan. The plans for which you are eligible will be based on your county of residence, and there may be several. You also should evaluate each plan’s extras, such as routine hearing exams, preventive dental and vision exams.

You will find that the plan’s benefits, copays, premiums and even drug formulary can change from one year to the next. Be sure to allow time each September to review the notice of change that you will receive from your carrier. If you enroll in your plans through an independent licensed insurance agent whose specialty is health insurance products for people 65 and older, that agent can help you through this process each year. You don’t pay anything for the services of an agent, but he or she will be there to guide you and help you with your Medicare questions throughout the years.

Looking to find a great medicare advantage plan in Texas ? Then visit www.texasmedicareplan.com to find information about Texas Medicare Advantage Plans.