If you live or are moving to Texas, Medicare Advantage gives you another way to get your Original Medicare benefits. Coverage and cost can vary from plan to plan. There are also plans that do extra coverage for services like prescription drugs, vision, and dental care benefits.
The Basics of Medicare Advantage in Texas
There is another way of getting your Original Medicare benefits and that is through a Medicare Advantage (Medicare Part C) plan. A private insurance company approved by Medicare will provide your Medicare Advantage plan in Texas. They will also take care of your Medicare Part A and Part B coverage. Coverage and costs will vary depending on which plan you pick.
With a Medicare Advantage plan, you will get at least the same level of benefits you get from Original Medicare. Also you may get extra benefits with a Medicare Advantage plan in Texas, including but not limited to:
- Dental services
- Prescription drugs
- Routine vision care
Where you reside in Texas will determine what types of Medicare Advantage plan options you have. If you choose a Medicare Advantage plan you may be able to only use a network of doctors with some exceptions. Seeing a provider outside of the network may result in extra expenses or no coverage at all. You should pick a Medicare Advantage plan that has your provider in the network if you want to save money.
Does Texas have Medicare Advantage Prescription Drug Coverage?
You can also get prescription drug coverage as an add-on to the Original Medicare benefits you get with some Medicare Advantage plans. These types of plans are Medicare Advantage Prescription Drug Plans (also called MA-PDPs). With this type of plan, you don’t have to sign up for stand-alone Medicare Part D Prescription Drug plans. You will get both your health care and your prescription drugs in one plan with a Medicare Advantage Prescription Drug Plan.
Signing up for a Medicare Advantage plan in Texas
You must be eligible for Original Medicare if you want to sign up for a Medicare Advantage plan.
A Medicare Advantage plan does not exempt you from the Medicare program. You still have to pay your monthly premium for Medicare Part B.
Where you currently live in Texas will determine what type of Medicare Advantage plans are available.
Most Medicare Advantage plans will not accept you if you have end-stage renal disease (ESRD), unless it is a Special Needs Plan. If you want to discuss your specific situation with Medicare, you can contact a Medicare plan by calling them. You can also call Medicare at the number at the top of this page.
When to Sign Up for a Medicare Advantage Plan in Texas
In Texas, you can sign up for a Medicare Advantage plan during your Initial Enrollment Period, or IEP. This is a time frame beginning when you first qualify for Medicare. The IEP starts 3 months before the month you turn 65. It will include the month you turn 65 and end three months after the month you turn 65, which totals to 7 months. You can also qualify because of disability. If you do then you will be eligible on the 22nd consecutive month of receiving disability benefits from Railroad Retirement Board or Social Security. This period ends on your 28th month for a total of 7 months.
The Annual Election Period, or AEP is also a time frame that you can sign up for a Medicare Advantage plan. This time frame begins on October 15 and runs through December 7 each year. You may also qualify for a Special Enrollment period if you meet certain requirements. For example, losing your group healthcare coverage.
How to Compare and Contrast Medicare Advantage plans in Texas
When you are comparing Medicare Advantage plans, there are some vital points to know. You will not be able to get a certain plan in your area as might not be available. Also each county may have a different specific plan where coverage and costs can vary. And you must pay your monthly premium for Part B every year.
As you compare plans, look at the benefits the plan offers as well as the cost for the plan. There are some plans that have low monthly premiums, even free premiums. But, you may have to pay a higher amount for other costs like coinsurance, deductibles, and copayments.
If you need prescription drugs, then there may be a Medicare Advantage plan in your area that has prescription drug coverage. Your plan will have a list of all the covered medications or a formulary. Your formulary is subject to change from time to time. If it does change, your plan will notify you right away. You will want to sign up to a plan that has medications that fit your needs.
Enter your zip code on this page if you want to compare Medicare Advantage plans in Texas.