If you’re a resident of Texas and eligible for Medicare, you may have a lot of questions when it comes to choosing a plan. How does Medicare work? What do the different types cover? How is Medicare Advantage different from original Medicare? And how do you begin the process of enrolling?
There’s a lot of information to digest, but knowing some of the basics about how Medicare works in general is a great place for Medicare Texas shoppers to begin.
Medicare is a federal government health program that helps people age 65 or older, and people of any age with certain disabilities, pay for their medical care.
You may have heard the phrase “original Medicare.” This refers to the Medicare components made available directly through the federal government. There are two parts of original Medicare.
- Part A covers hospital expenses, specifically inpatient care received at a hospital, skilled nursing facility or hospice care facility, plus some home health costs.
- Part B covers general health expenses, such as those you would incur when you seek outpatient medical care from your regular doctor or a specialist.
Most people don’t pay a premium for Part A. This is because it’s funded through a payroll tax that you or your spouse likely paid during your working years. Part B does have a premium, which varies.
While parts A and B may seem to cover a lot, many Medicare Texas enrollees find that they still pay a lot out of pocket. This is because copays, coinsurance, and deductible amounts often add up, especially if you frequently need health care. And the cost of prescription drugs, which original Medicare doesn’t cover at all, can be expensive.
The good news is that there are options for expanding or replacing the original Medicare coverage the government provides. These options are offered through private insurance companies.
Medicare Supplement plans
Medicare Supplement plans are sometimes called Medigap plans. They help pay costs original Medicare doesn’t, including copays, coinsurance, and deductibles. They also may add coverage for dental and vision services, private duty nursing, hearing aids, and more.
Part D plans
These are prescription drug plans. They offer coverage to help pay for prescription drugs. Part D plans are almost essential for anyone enrolled in Medicare who is on regular medication.
Medicare Advantage plans
These plans are available as a full replacement for original Medicare. They cover all of the same benefits as parts A and B and more.
Medicare Advantage (Part C) plans typically include all the benefits you’d get from adding a supplemental or prescription drug plan, plus perks, programs, and discounts that can help you make your health a priority.
And since they’re offered through private insurance companies, you get to pick and choose a plan that best suits your needs and preferences.
Texas Medicare Advantage options include plans from the following private insurance companies:
- Aetna Medicare
- Blue Cross and Blue Shield of Texas
- Care N’ Care Insurance Company
- Clover Health
- Devoted Health
- Imperial Insurance Companies, Inc
- KelseyCare Advantage
- Lasso Healthcare
- Memorial Hermann Health Plan
- Scott and White Health Plan
These companies offer plans in many counties in Texas. However, Medicare Advantage plan offerings vary by county, so enter your specific ZIP code when searching for plans where you live.
To qualify for Medicare in Texas, you must be either:
While coverage isn’t available until your 65th birthday, you can begin the application and enrollment process a few months before your birthday. Your Texas Medicare initial enrollment period begins 3 months before you turn 65 and continues for 3 months after.
If you choose not to enroll during this time, such as if you are still full-time employed and prefer to stay enrolled in your employer-sponsored group plan, you may qualify for a special enrollment period later if your coverage status changes.
There’s also an open enrollment period specifically for Medicare Advantage plans every year from January 1 through March 31. During this time, you can sign up for Medicare Advantage for the first time or switch Medicare plans in Texas.
If you’re shopping for a Texas Medicare Advantage plan, be aware that not all plans are the same. They vary in plan design, provider network, cost structure, and more.
You may want to consider the following when weighing your options:
- Which plan design works best for you? Do you prefer an HMO in which a primary care doctor oversees you care and refers you to specialists as needed? Or would you rather the flexibility of a PPO that would allow you to see any specialist in your network at your choosing?
- What is the provider network like? Texas is a big state. You want to be sure to choose one of the Medicare plans in Texas with a network that makes geographic sense for your lifestyle. If you travel, be sure to ask about coverage outside of the state as well.
- What will you have to spend? Look beyond just monthly premiums. Find out what you can expect to spend when you see a doctor or fill a prescription. Sometimes it ends up being cheaper overall to pay a higher premium for lower out-of-pocket costs at the point of care.
- What extras are offered? Gym memberships and fitness programs aren’t just perks; they can save you money if you might otherwise pay for them yourself. And if you have a chronic condition, you might benefit from a plan that offers a health management or health coaching program dedicated to helping members manage that condition.
If you’re shopping for Medicare in Texas, you can learn more about plans in your state through these organizations:
Ready to take the next step toward enrolling in a Medicare plan in Texas?
- Apply online through the Social Security Administration. The application is fast and easy.
- Research Medicare Advantage plans in Texas that are offered in your area. Reference the list above to know where to get started.
- Contact a Texas Medicare insurance agent who can offer individualized advice and quotes for Medicare plans in Texas.
This article was updated on October 2, 2020 to reflect Medicare costs in 2021.
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