Understanding the difference between Medicare Advantage plans (MA) and medicare supplements in Texas is often tricky. In essence, Texas Medicare Advantage plans are private Medicare health plans that pay for your medical services instead of original Medicare. Supplements pay some or all of the difference between what Medicare pays and what you owe; conversely, when you enroll in an MA plan, the plan pays for part of your care, and you pay the required coinsurance or copay for each different medical service.

The Basics of How Medicare Advantage Works

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.

MA plans offer a summary of benefits that you should review before enrolling. Some of the questions you should ask yourself are: Do my favorite physicians and hospitals participate in this plan’s network or agree to accept this plan? What premium, if any, will I pay each month to be a member of this plan? Are my Part D drug plan needs covered? What copayments or coinsurance will I be responsible for if I develop a serious condition? Determining which plans your chosen providers are working with, and how comfortable you are with stated cost sharing, goes a long way to narrowing your choices.

Which Physicians Can I See On This Plan?

In Texas, most advantage plans are modeled after a traditional HMO or PPO plan. Directories of participating doctors and hospitals are available online. If you need to obtain a referral or authorization before seeking treatment with a certain doctor or care center, the plan’s rules will state this. Should you enroll in a PFFS model plan, you’ll be able to see any provider as long as he or she agrees to accept the payment conditions and terms and bill the plan for your services.

Do I Have to Pay a Monthly Premium For Medicare Advantage?

In addition to the Part B monthly cost you already pay, you may also be responsible to pay a premium for your plan each month. While plan premiums vary, many Texas counties offer plans with $0 premiums. The reason that some plans can offer you such low premiums is that government pays the plan a monthly fee to administer your original Part A & B benefits to you.

Choosing a plan from so many options is sometimes frustrating or confusing. After all, you not only have to determine which plans you are eligible for based on the county in which you live, but you also need to compare some of the extras offered by various plans, such as routine dental or vision benefits.

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.

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