Medicare Advantage Plans in Texas

Medicare Advantage is a private insurance product that offers all the coverage of Original Medicare and may add an array of additional services like prescription drug coverage as well as hearing, vision, and dental services. There are 376 Medicare Advantage plans available in Texas as of 2024, but your access to specific plans depends on your ZIP code.

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.

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 monthly premium for a Medicare Advantage plan in Texas as of 2024 is $9.36. Every person on Medicare in the state has at least one Medicare Advantage plan with a $0 premium offered in their area.

Your overall 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. However, these plans also set a limit on your out-of-pocket expenses for the year.

The federal government sets Medicare Advantage eligibility requirements.

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.

Most Medicare Advantage plans include Part D prescription 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 that penalty continues to be added to your regular monthly premium for the rest of your life.