What is a Texas Medicare Advantage Plan?
The advantages of Medicare Advantage (MA) plans are found in what they can cover that Original Medicare cannot. Specifically, the MA plans available in Texas can include minor healthcare benefits such as prescriptions, vision, hearing, dental, fitness, telehealth, and more. In contrast, Original Medicare only covers major medical healthcare services.
Many people love the extra benefits they get with their MA plan. However, before you jump in with both feet, take the time to fully understand the trade-offs. The extra benefits and perks are nice, but they come at a cost. Specifically, when you join a Medicare Advantage plan in Texas you are agreeing to accept the plan's managed care health system. As an MA plan member, you agree to let the plan be a gatekeeper and fully control your access to doctors and other healthcare providers.
Medicare vs. Medicare Advantage: What's the Difference?
The big differences between traditional Medicare coverage and what you get with Medicare Advantage are easy to see by pointing out the pros and cons. Neither type of insurance is perfect. They each suit different needs.
Pros and Cons: Medicare vs. Texas Medicare Advantage Plans
- When you have Original Medicare you are free to use any Medicare-approved doctor you choose. When you join a Medicare Advantage plan, your choices are limited to the plan's network of Texas providers.
- If you travel frequently or you are a snowbird and winter or summer in another state, your Original Medicare coverage remains the same. It goes where you go. This is not true with Texas Medicare Advantage plans, which are only required to cover you if you have a medical emergency.
- With OriginalMedicare there are no limits on your out-of-pocket costs. However, all Texas Medicare Advantage plans have an annual maximum out-of-pocket (MOOP) limit. If you reach the MOOP spending limit on your copays and coinsurance, the plan picks up the tab for the remainder of the year.
- If you want prescription coverage and have Original Medicare you must purchase a Medicare Part D plan. However, most Medicare Advantage plans include a Texas Medicare Part D plan. Just be aware that a stand-alone Part D plan gives you the best opportunity to get your most expensive prescriptions at the lowest cost.
- In the Medicare Advantage program, the government allows plans to set their own copays and coinsurance for each healthcare service offered. This makes comparing plans difficult, at best. However, in the Original Medicare system deductibles and coinsurance are fixed, making them predictable. Plus, you can get a Medigap plan to help pay these costs.
Medicare Supplements vs. Medicare Advantage
We're frequently asked:
- Why are Medicare Advantage plans bad?
- What are the disadvantages of Medicare Advantage plans?
- Is it better to have Medicare Advantage or Medigap?
Let's take just a minute to dispel any misconception that these plans are bad or might have serious disadvantages.
Why Texas Medicare Advantage Plans are Bad
People that claim Medicare Advantage plans are bad simply misunderstand what they are and how they work. Over 20 percent of all Medicare beneficiaries in the state of Texas choose Medicare Advantage and like the care they get. However, these plans are not suitable for everyone.
MedicareWire advises people who have one or more serious chronic conditions to keep their Original Medicare, particularly if you have specialists treating you and you want to stay with them. Our opinion is that Medicare Advantage is an excellent option for those who qualify for both Medicare and Medicaid (dual eligible) and for extremely healthy, active seniors.
Similarly, traditional Medicare, plus Medicare supplement insurance, work best for people with chronic health conditions, as well as those who can afford a higher monthly premium. Most experts agree that this is the best health insurance seniors can get in Texas.
The Disadvantage of Medicare Advantage Plans if You Live in Texas
The disadvantage of Medicare Advantage plans is the strength of Texas Medigap plans. You see, when you take doctor choice out of the equation, the big difference between Medicare Advantage and Medigap is when you pay for services.
With most Medicare Advantage plans you pay a little each month (the monthly premium) and a copay when you use medical services. With most Medigap plans you pay most of your costs upfront with your monthly premium. As a result, your costs are more predictable than they might be if you have Medicare Advantage and use a lot of healthcare services
Is it better to have Medicare Advantage in Texas or Medigap?
- If you can afford Medigap Plan F or G, then keep your Original Medicare and add one of these supplements.
- If you are a healthy senior and have good health in your family heritage, Medigap Plan N will let you save money by sharing some costs when you see your doctor.
- If you are a healthy senior but you cannot afford a Medigap Plan F, G, or N, Medicare Advantage is a good choice.
- If you are turning age 65, have one or more chronic health conditions that require frequent doctor visits, and you do not qualify for both Medicare and Medicaid (dual eligible), the most Medigap coverage you can afford is the best option.
- If you qualify for both Medicare and Medicaid, regardless of your health condition, Medicare Advantage is your best option.
- If you have special needs (i.e., a full-time nursing home resident, diabetes, etc.) and an appropriate Medicare Advantage Special Needs Plan (SNP) is available, this is your best option.
Frequently Asked Questions About Texas Medicare Advantage Plans
The best way to get the correct answer is to enter your zipcode in this Texas Medicare Advantage plan tool. Unlike Medicare Supplements, Advantage plans are different in each county..
More than 90% of all Medicare Advantage plans in Texas include a Part D plan for prescriptions, but not all. However, coverage is different with each plan. It is very important to verify that a plan covers your most important medications before you join. You can do so using this tool.
To understand the pros and cons of Medicare Advantage, you need to compare it with Original Medicare and factor in your health and financial situation. This article can help you compare which type of plan is best.