Medicare Advantage Plans in Texas

Medicare Advantage is a private insurance product that offers all the coverage of Original Medicare, plus additional services like fitness programs and prescription drug coverage. Available Medicare Advantage plans and the cost of each vary by area across Texas.

Medicare Advantage is available in Texas to anyone who is enrolled in both Parts A and B of Original Medicare, which for most U.S. citizens first becomes an option when they reach 65 years of age. While there is just one standard Original Medicare plan, there are more than 300 Medicare Advantage plans available in Texas in 2023. However, not every plan is available in every part of the state.

Medicare Part A covers services you receive in an inpatient hospital setting. Medicare Part B covers outpatient care, including wellness visits, examinations in your doctor’s office and therapy sessions.

Medicare Part C — another name for Medicare Advantage — is offered by private insurance companies under guidance from the federal Medicare program. All Medicare Advantage plans must offer at least the same coverage as Parts A and B, but many also offer benefits like prescription coverage (known as Part D), dental, vision and hearing.

You must be enrolled in both Parts A and B of Original Medicare in order to switch to Medicare Advantage.

The cost of Medicare Advantage in Texas varies based on what plans are available in your area and what coverage you want. You can find available plans by entering your zip code at Medicare.gov, or by contacting a GoHealth licensed insurance agent to help find the right plan for your needs.

The average cost of a Medicare Advantage plan in Texas 2023 is $8.94 Some people may qualify for a plan with a $0 monthly premium, and in 2023 every person on Original Medicare in Texas had at least one $0 Medicare Advantage plan offered in their area.

Your costs will also depend on rules set by your individual plan. Many Medicare Advantage plans require you to receive care within a particular network of providers to receive the maximum coverage for your healthcare services.

The federal government sets Medicare Advantage eligibility requirements since Medicare is a federal public health insurance program.

Any U.S. citizen age 65 and over is eligible for Original Medicare, as are people regardless of age who have received Social Security disability for at least 24 months, as well as people living with End Stage Renal Disease and Amyotrophic Lateral Sclerosis.

Medicare has set up specific periods for when you can enroll. For most people, your Initial Enrollment Period (IEP) is the three months before you turn 65, your birthday month and the three months after your birthday.

A Special Enrollment Period also may be available based on specific circumstances, like a new disability or a move to an area where your current plan isn’t currently offered.

If you don’t have access to a Special Enrollment Period and didn’t enroll in Medicare Advantage during your Initial Enrollment Period, you can enroll in a new plan during the Medicare Open Enrollment Period, held annually from Oct. 15 to Dec. 7. Coverage purchased during this time begins Jan. 1. Also, from Jan. 1 to March 31 each year, you can change from one Medicare Advantage plan to another.

Whether or not you include prescription drug coverage in your Medicare Advantage plan is up to you. Most plans offer options with and without drug coverage. Without a Part D plan added to your Medicare Advantage coverage, you should expect to pay the entire cost of your outpatient prescription medications, unless you have other insurance.

You may add Part D coverage to your plan when you are first eligible or during the Medicare Open Enrollment Period, also called the Annual Enrollment Period. Still, if you don’t sign up when you are first eligible, you may have to pay an enrollment penalty for the period if you didn’t have other creditable coverage — and the penalty is paid for the rest of your life. This penalty will be added to your regular monthly premium.