Compare Medicare Advantage plans and quote side-by-side to get the best rate here.
If you’re approaching retirement in the Lone Star State, you’ve probably already thought about your health insurance options. A common option for seniors is Medicare, a federal health insurance program offered through both the government and individual insurance providers authorized to offer plans. Medicare has multiple plan options that can get confusing if you don’t begin your research ahead of time. The best Medicare in Texas for you might vary depending on your income and health needs. Our guide will help you learn more about Medicare and know your options.
What Is Medicare?
Medicare is a federal health insurance program for men and women over the age of 65 and younger men and women with select disabilities. Medicare was designed to help make medical care costs more affordable when compared to private health insurance options. There are multiple parts of Medicare, and each part represents a different type of coverage. You can get original Medicare through the federal government or a Medicare Advantage plan through private insurance providers.
Compare Medicare Plans in Texas
If you’re still learning about how Medicare’s many parts work, choosing a plan can quickly become complicated. Let’s take a look at a few factors that you may want to consider when shopping for a Medicare plan.
- Costs: When shopping for a Medicare plan, be sure to account for all the unique costs that come with care. This includes premiums, deductibles, copays and out-of-pocket maximums.
- Choice of provider: Some Medicare Part C plan providers require you to see doctors and specialists who are within the plan’s network while others do not. It’s a good idea to write down the names of all the current healthcare providers you want to continue working with to check whether they are in-network or not as you compare coverage options.
- Extra benefits: One of the biggest reasons why Medicare enrollees choose a Medicare Advantage plan over original Medicare is that these plans often include extra benefits not covered by original Medicare. Knowing which benefits you’re looking for before you begin shopping for a plan can make narrowing down your options easier.
Not sure where to begin your search? Consider a few of our highlighted providers using the chart below.
If you're ready to jump right to comparing plans, check out some of the most notable Medicare providers below.
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Parts of Medicare Explained
The first thing that you’ll notice when you begin comparing your Medicare options is that Medicare contains 4 individual parts. Parts A, B, C and D all offer a different type of health insurance coverage.
Medicare Part A
Medicare Part A is the hospital insurance portion of original Medicare. Medicare Part A covers inpatient treatments that you receive within a hospital setting, skilled nursing care, hospice care and some in-home care treatments. Most people don’t pay a premium for Part A coverage.
Medicare Part B
Medicare Part B is the medical insurance portion of the original Medicare. Part B covers things like routine visits to your primary care doctor, blood tests, health and wellness screenings, outpatient care and most types of medical supplies. Everyone pays a premium for Part B coverage. In 2020, the Part B premium was $144.60, and this standard premium may change annually or depending on your income.
Medicare Part C
Medicare Part C is not part of the original Medicare. Instead, Part C coverage combines the benefits of both Part A and Part B coverage with a single all-inclusive policy provided by a private insurance company. These plans are commonly referred to as Medicare Advantage plans.
Insurance companies must be authorized by the federal government in order to offer Medicare Advantage plans. Every Medicare Part C plan available must include all the benefits that come with the original Medicare. Many Medicare Part C plan providers also include coverage for additional benefits not covered by original Medicare (for example, dental insurance or hearing benefits). Premiums, deductibles and copayments vary by insurance provider.
Medicare Part D
Medicare Part D is prescription drug coverage. This part of Medicare helps you pay for medications and prescriptions that you take outside of a hospital setting. Medicare Part D plans are offered by private insurance companies, but each plan must include at least some form of coverage for all major classes of drugs.
Part D plan providers are not required to extend coverage to every drug in a given class. If you’re already taking medication, be sure to check your Part D plan’s formulary to be sure that your coverage extends to the drugs you need.
Medicare Open Enrollment 2021
If you miss your Initial Enrollment Period, you can participate in the Medicare Open Enrollment period. During this time, you can join, switch or drop a Medicare or Medicare Part C plan. Open Enrollment begins on October 15 and ends on December 7 each year. If you sign onto a policy during Open Enrollment, your coverage will begin on January 1 of the next year.
Types of Medicare Advantage Plans
If you decide that a Medicare Advantage plan is better for you than original Medicare, you’ll need to be aware of the multiple types of Part C coverage. Differences in types of Medicare Advantage plans largely come down to which healthcare providers you can see on your plan.
Health Maintenance Organizations (HMOs) are the most affordable type of Medicare Advantage plans. With an HMO, you’ll be required to see healthcare providers within the HMO’s participating network. However, your HMO cannot require you to see a specific healthcare provider if you’re in need of emergency care or dialysis.
Preferred Provider Organizations (PPOs) provide you with more flexibility when using your plan benefits but usually come at an increased cost. With a PPO plan, you can choose to see any healthcare provider that you like and use your benefits, regardless of whether they are in-network or not. Most PPOs also allow you to save money by choosing an in-network provider. A PPO plan might be worth the increased cost if you are already working with medical professionals who you are satisfied with.
Special Needs Plans (SNPs) are customized Medicare Advantage plans available only to applicants who suffer from a specific chronic condition that requires specialized care. For example, you may find SNPs available for those who suffer from chronic heart failure and those living with HIV/AIDS. If you do not have the condition upon which the SNP is based, you cannot enroll in this coverage option. SNPs might be the best Medicare in Texas for you if you have highly specific ongoing care needs.
Medicare in Texas: An Overview
You’re eligible to enroll in Medicare within a short window of time:
- 3 months before you turn 65
- 3 months after you turn 65
You could pay a late penalty if you don’t enroll within this time frame. You also qualify for Medicare if you’re under 65 with certain disabilities, and if you’ve experienced a life event such as a marriage, move or change in citizenship.
Medicare is a national health insurance program that consists of 4 parts:
- Part A: Covers inpatient hospital stays, skilled nursing facilities and home care in some cases.
- Part B: Covers doctor or specialist visits.
Note: Parts A and B together are known as Original Medicare.
- Part C: Medicare Advantage plans offered by private insurers bundle Part A, Part B and Part D. If you choose Part C, you waive Original Medicare.
- Part D: Covers prescription drug coverage. You can buy a standalone Part D plan or one that complements an Original Medicare or Medicare Advantage plan.
You can also buy a Medicare Supplemental Insurance plan or Medigap plan. Medigap plans, offered by private insurers, are intended to fill in gaps not covered by Original Medicare.
Main Types of Medicare Advantage Plans in Texas
The 2 types of Medicare Advantage plans are:
- Health maintenance organizations (HMOs): You must choose from a network of doctors and hospitals if you use an HMO. Your primary care doctor will have to write a referral if you need a specialist. HMOs focus on health and wellness, so if you’re overweight, have high blood pressure or smoke, you’ll need to take measures to improve. HMO plans are usually cheaper than PPO plans because they’re a bit more restrictive.
- Preferred provider organizations (PPOs): PPOs are health plans that involve a large network of doctors, specialists and hospitals that all agree to charge established rates for care and services. You’ll pay lower rates if you see a doctor or specialist that’s in the network, and if you choose one that’s out of network, you’ll pay more. PPOs allow more freedom to choose where you go for care, and no referrals are required. They’re usually more expensive.
Where to Find Help and How to Sign Up
The Texas Health Information, Counseling and Advocacy Program is a good resource if you need help sorting out your Medicare options or help with your copays, premiums or other out-of-pocket expenses. It provides:
- Medicare plan information and education
- Assistance with eligibility questions and signing up
- Grievances and appeals
This program offers trained benefits counselors ready to help you. You can use the program if you’re eligible for Medicare or Social Security Administration benefits due to a disability.
You can also visit the government’s Medicare Plan Finder, an easy-to-use resource that will give you Medicare Advantage plan information based on your zip code and individual needs. The tool lets you compare different types of plans, features and prices as well as sign up on the site, so it’s a one-stop shop. You can also enroll in Medicare Advantage plans by visiting the website or calling a customer service agent.
Texas Medicare Law
Texas is subject to the same rules as every other state for Original Medicare. Since Medicare is a federally-operated program, there are strict rules regarding eligibility, services and rates.
Medicare Advantage plans follow the same rules and are governed by the Centers for Medicare and Medicaid Services (CMS). CMS enacts and enforces fair Medicare Advantage plan practices that private insurance companies must follow. Companies that violate policies regarding provider services, marketing practices and pricing can have their plans terminated, suspended and fined, sometimes for millions of dollars.
All Medicare beneficiaries have certain rights:
- Your privacy and healthcare information should be protected and shared only with those you agree to share it.
- You’re protected against unethical practices.
- You should get the health care services stated in your Original Medicare and/or Medicare Advantage plan.
You have the right to receive fair and ethical treatment with Original Medicare and Medicare Advantage plans. Medicare.gov has a grievances and appeals section to help you make a claim if you need an issue resolved.
Average Cost of Medicare Advantage in Texas
Medicare Advantage plans in Texas range from $2,080 (Aetna) to $7,850 (Original Medicare). Plan rates vary depending on features, your location and income. Medicare uses a 5-star rating system — 1 is the lowest and 5 is the highest — to rate Medicare Advantage plans in areas such as customer service and quality. Here are the star ratings in the chart below:
|Plan Name||Type of Plan||Company||Estimated Health and Drug Costs||Star Rating|
|Aetna Medicare Plus||PPO||Aetna||$2,080||4|
|Imperial Insurance Company||HMO||Imperial||$2,240||Not yet rated|
|Aetna Medicare Prime||HMO||Aetna||$2,690||3.5|
|WellCare Texan Plus||HMO||WellCare|
|Original Medicare||Parts A & B||Medicare.gov||$7,850||N/A|
Medicare Insurance Provider Reviews in Texas
Here are a few fast facts regarding Medicare beneficiaries in Texas, according to CMS:
- Nearly 2.4 million beneficiaries are enrolled in Medicare Part A and/or Part B.
- Approximately 1.5 beneficiaries are enrolled in a Medicare Advantage plan.
- There are 177 Medicare Advantage plans available.
- 32% of people with Medicare Part D receive Extra Help, which is a low-income subsidy that helps pay for drug coverage.
Private insurance companies compete for your business and they do so by offering competitive rates and valuable health and wellness programs.
Here are our top picks for Medicare Advantage plans in Texas, based on data we’ve gathered from CMS, Medicare.gov, J.D. Power and U.S World & News Report.
1. Best Overall in Texas: Humana
Humana’s GoldPlus HMO plan is a 4-star plan, affordably priced and recommended by Medicare.gov. It received high marks from J.D. Power’s annual Medicare Advantage plan survey in customer service, billing and payment, pricing, provider choice and overall satisfaction.
Many Humana plans also feature:
- Free fitness programs
- Dental and vision coverage
- Prescription drug plans
- Meal delivery after an overnight hospital stay
- Telemedicine visits
A large Medicare Part C coverage provider in Texas, Humana offers a variety of affordable HMO plan choices. Many of Humana’s plans have $0 premiums, and you can see healthcare providers offered through Humana’s wide service network. Many of Humana’s plans also include additional benefits not covered by the Original Medicare (like dental and hearing benefits).
2. Cheapest Medicare Plan in Texas: Aetna
Aetna’s MedicarePlus, a 4-star PPO plan, is a bargain at $2,080. It’s ranked 8th in J.D. Power’s survey and recommended by Medicare.gov.
You can save money on prescription drugs if you choose the plan’s provider network and can choose your own primary care doctor, specialists and other health care providers.
Aetna’s plans also feature fitness, health coaching and wellness programs. If you already have a team of medical professionals that you want to continue seeing, you may want to choose PPO coverage from Aetna. This plan option allows you to see any medical professional that you want while also using your coverage benefits. Aetna’s PPO plans in Texas also come with $0 monthly premiums in most parts of the Lone Star state.
3. Best for Medicare Part D Coverage: WellCare
You can add Medicare Part D coverage to both a Medicare Advantage Plan (if the plan doesn’t already cover prescription drugs) or Original Medicare coverage.
WellCare offers a variety of affordable prescription drug plan choices throughout Texas. With WellCare, you may pay a copay of as little as $1 for preferred generic drugs, and monthly plans are available from about $15 a month in most parts of Texas.
4. Best for Plan Comparisons: HealthInsurance.net
Comparing all of your Medicare options can quickly become a hassle — especially if there are a multitude of providers offering coverage in your area.
HealthInsurance.net makes it easy to quickly compare plan costs and options in your area. Enter your zip code to start viewing plan choices available in your area without requesting a quote from each individual provider.
5. Best for Pre-Medicare Coverage: Pivot Health
As you age, you’ll likely find that your health insurance premiums tend to begin to take up a larger percentage of your income if you continue with Affordable Care Act (ACA) insurance plans.
Pivot Health offers a unique and affordable option to traditional ACA-compliant plans for those preparing to transition to Medicare coverage. Pivot’s “Bridge to Medicare” plan option includes benefits like unlimited access to telehealth services to help you avoid draining your retirement savings on healthcare expenses before you qualify for Medicare.
6. Best Coverage for Medicare in Texas: Cigna
Cigna’s PPO and HMO plans offer reasonable rates and receive above-average star ratings across the board.
Both feature fitness programs, prescription drug plans and low monthly premiums.
Hearing and eye exams are covered and some dental benefits are offered. Cigna’s HealthSpring plan was ranked 3rd in J.D. Power’s 2018 Medicare Advantage study. Cigna plans also feature a 24-hour nurse advice line and televisits.
Great Plan Choices in Texas
There are plenty of good resources available to help you research Medicare Advantage plan options in the Lone Star state. Many offer competitive rates, low copays, zero monthly premiums and other extras like fitness programs and hearing and vision coverage.
Make a list of your health concerns and needs. Do you take a lot of medications? If so, you’ll need a prescription drug plan that’s affordable. If hearing, dental and eye care coverage are important, it makes sense to choose a Medicare Advantage plan over Original Medicare because you can get these benefits rolled into one plan.
Carefully consider every aspect when choosing a plan to make sure it’s right for you. Once you turn 65 and make your choice, you’re committed to it until open enrollment, which runs annually from October 15 through December 7.
Frequently Asked Questions
Medicare has 4 parts named Parts A, B, C, and D. Part A provides hospitalization coverage while Part B provides outpatient coverage, like doctor visits. Parts A and B make up Medicare’s core coverages. Part C is provides private-market Medicare plans, called Medicare Advantage Plans. Part C coverage often includes additional benefits. Medicare Part D provides coverage for prescription drugs. Get a Medicare Insurance Quote through the top providers here.
Because there are 4 parts to Medicare, there can be different cost structures. Most people won’t have to pay for Medicare Part A (hospitalization). Eligibility for premium-free Part A is based on your work history during which you paid Medicare taxes. Many people do pay a monthly premium for Medicare Part B, however, which covers outpatient medical services, like doctor visits. Deductibles also apply to services covered under Medicare Parts A and B, so you’ll pay a part of the annual cost.
Medicare Parts C and D are optional coverages and have premium costs of their own. Medicare Part C refers to Medicare Advantage Plans that offer additional coverage in exchange for a monthly premium. Part D, the prescription plan, reduces the cost of medications but also requires a monthly premium. Subsidies may be available for low income households to help reduce overall Medicare costs.
If you signed up for Social Security before age 65, you were enrolled in Medicare automatically but benefits will begin at age 65. In most cases, there are penalties for not enrolling at age 65, so it pays to sign up on time. Click here to get a medicare quote in minutes from the best providers.
If you have employer coverage, you may be able to delay Medicare coverage while your work plan is still in force. However, the size of the employer determines whether you’ll pay a penalty for not enrolling at age 65. Employees (and their spouses) of companies that offer group health insurance to 20 or more people are usually exempt from late sign-up penalties if they are covered by the employer’s plan.
In 2021, the average Texan who had Medicare Part C insurance paid $21.52 each month for their Medicare Advantage coverage.
The answer to this question depends on your healthcare needs, how much you can afford to pay in premiums each month and the county that you live in. While we recommend beginning your search with our partner providers, there is no single company that offers the best Medicare in Texas.
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