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Texas Medicare Advantage Plans for 2022

There are many people who are enrolled in some of the best Medicare Advantage plans in Texas for 2022. If you have recently enrolled in Medicare Part A and Part B or if you will be eligible in the near future, you might want to join them and look into Medicare Advantage plans in Texas yourself. It’s possible to just stick with Original Medicare (Medicare Part A and Medicare Part B), but opting for a Medicare Advantage plan can help you significantly reduce your out-of-pocket expenses and can provide you with some extra perks.

What is Medicare Advantage in Texas?

Medicare Advantage, or Medicare Part C plans are sold by private insurance companies as an alternative to Original Medicare. Medicare Advantage in Texas offers the same benefits as Medicare Part A and Part B plus additional coverage for health care services not included in Original Medicare.

If you are considering a Medicare Advantage plan, here are some things you should know about Medicare Advantage in Texas:

  • The Centers for Medicare and Medicaid Services work with state governments to regulate all Medicare Advantage plans to ensure that Medicare beneficiaries get, at least, all Medicare Part A and Part B benefits.
  • The insurance company selling the Medicare Advantage plan is responsible for claims, customer service, and administration of their health plans.
  • Enrollees in Medicare Advantage plans in Texas must continue paying their Part B premium through Original Medicare to remain eligible for Medicare Part C coverage.
  • Texas Medicare Advantage plans are becoming more popular every year.
  • In Texas, most Medicare Part C insurance plans require that beneficiaries use network providers for medical care and supplies.
  • MAPDs — Medicare Advantage Prescription Drug Plans — include prescription drug coverage bundled into one plan.
  • Most Medicare Advantage plans in Texas include extra benefits like vision, dental, and hearing care; wellness and fitness club memberships like SilverSneakers; Medicare over-the-counter medication allowances; transportation to and from medical appointments; and meal delivery services.

What is the best Medicare Advantage plan in Texas in 2021?

Best plans for network freedom: PPOs

  • Medicare Advantage PPOs (Preferred Provider Organization plans) provide a wider network of healthcare providers, medical suppliers, and facilities for enrollees to use.
  • PPOs don’t require referrals
  • PPO monthly premiums vary from $0 to $100.00.

Best plans for lower out of pocket costs: HMOs

  • Most HMOs, Health Maintenance Organization plans, have zero $0 monthly premiums.
  • Lower co-pays then PPO Plans
  • HMOs have low premiums because they use network providers and require enrollees to get referrals from a primary care physician.

Best for low income or health issues: Special Needs Plans (SNPs)

  • SNPs are special insurance plans that provide coverage for people with limited income or chronic health conditions like end-stage renal disease or ALS.
  • Those dually eligible for Medicare and Medicaid have lower copays, coinsurance, deductibles, and premiums.

What Medicare Advantage plans are available in Texas?

In the state of Texas, the following number of Medicare Advantage plans, according to plan type, are available:

  • Local HMOs: 80

  • Local PPOs: 46

  • Regional PPOs: 4

What’s changing about Medicare Advantage in Texas in 2022?

Enhancements to Medicare Part C and Medicare Part D program beneficiary real-time benefit tools

Enrollees will have access to real-time comparison tools to get information about:

  • Part D plan formularies
  • Benefits
  • Cost-sharing
  • Less expensive alternative therapies
  • Copays for more cost-effective drugs

The allowance of a second preferred-drug specialty tier for Part D Medicare plans

This change will help:

  • Lower copayments for drugs on the specialty tier
  • Allow Part D plan providers to get lower drug prices

Quality rating system enhancements:

This enhancement will:

  • Publish star rating updates routinely
  • Clarify and simplify calculations and “Quality Bonus Payment” rating regulations

Increase reporting of pharmacy performance

Up until 2021, prescription drug plans don’t need to report evaluations they make on the performance of network pharmacies. These new regulations mandate that Part D plans report on the ways they evaluate pharmacy performance.

The establishment of pharmacy performance measures reporting requirements

This change will:

  • Mandate that Part D plans report the means by which they evaluate pharmacy performance
  • Increase transparency regarding the process

The implementation of opioid provisions of the SUPPORT act

This change mandates that Medicare Part D plans inform and educate beneficiaries of the following:

  • Risks of opioid use
  • Alternative treatments for pain relief
  • How to throw away opioids and other controlled substances safely

Codification of existing Part C and D program policies for supplemental benefit requirements

This change aims to lighten the administrative load for PACE organizations.

How much does Medicare Advantage in Texas cost?

How much you pay for a Texas Medicare Advantage plan depends on where you live, which health insurance provider you choose, and what coverage options you have. Most states have an HMO available with a $0 monthly premium. And in some service areas, you may find a PPO with a zero-dollar premium.

While prices vary from county to county, the average monthly premium in Texas for an MAPD plan is $21.52. The average drug deductible is $191.58.

When can you enroll in a Texas Medicare Advantage plan?

These are the Medicare Advantage enrollment periods:

What is the Initial Enrollment Period (IEP)?

For those who are 65:
If you are getting Social Security retirement benefits when you turn 65, you have a seven-month time period known as the Initial Enrollment Period. Your IEP begins three months prior to the month of your 65th birthday, includes the entire month of your birthday, and ends three months after the month of your 65th birthday.

For people receiving disability benefits:
Eligibility for Medicare includes people getting Social Security or RRB benefits due to a qualifying disability, end-stage renal disease, or ALS. The IEP begins three months before the 25th month of receiving disability benefits includes the 25th month, and ends three months after.

How does the Open Enrollment Period (OEP) or Annual Election Period (AEP) work?

During the Annual Election Period, those eligible can sign up for Medicare Advantage, switch from one plan to another, or return to Medicare Part A and Medicare Part B.

During AEP, you can also sign up for Part D Medicare coverage. AEP runs from October 15 to December 7, and any changes you make take effect on January 1 of the new year.

How does the Medicare Advantage Open Enrollment Period work?

Beneficiaries can switch from a Medicare Advantage plan back to Original Medicare, or to a different Part C plan during the Open Enrollment Period which runs from January 1 to March 31 every year. Any change you make takes effect the first day of the month following your switch.

Special Enrollment Periods

If they meet the requirements, Medicare Advantage enrollees can make changes to their healthcare coverage during special enrollment periods.

The requirements for Special Enrollment Periods are:

  • Moving out of your plan’s service area
  • Moving back to the United States
  • Moving into or out of a skilled nursing or long-term care facility
  • Being released from prison
  • Eligibility for Medicaid changes, or you have dually eligible for Medicare and Medicaid
  • Medicare ends a plan’s coverage
  • You leave your Medigap plan and return to Medicare Advantage coverage

What is the Five-star Special Enrollment Period?

Medicare may grant a special enrollment period if there is a new plan with a five-star rating available in your area and you want this coverage.

What is the Special Enrollment Period for “Extra Help”?

For those enrolled in Extra Help or Medicaid services, they can change coverage once during the following periods:

  • January – March
  • April – June
  • July – September

When can I make changes to my Medicare Advantage plan?

The most common time to change a Medicare Advantage plan is during the Annual Election Period. If you don’t have access to a special enrollment period, you are locked into your plan for the 12-month period which runs from January 1 to December 31.

Are Medicare Advantage plans in Texas “bad”?

Medicare Advantage plans are popular in every U.S. state. They provide comprehensive, high-quality insurance and they are very affordable.

To illustrate this point, here are some statistics about Medicare Advantage in Texas:

1. People enrolled in Medicare Advantage in Texas: 1,453,573

2. People enrolled by plan type:

  • Local HMO plans: 770,950
  • Local PPO plans: 472,168
  • Regional PPO plans: 174,295

3. The percentage of enrollees in Medicare Advantage in Texas is 41 percent of all Medicare beneficiaries.

4. How many people are enrolled in Medicare Advantage nationwide?

As of 2021, there are over 26 million people enrolled in Medicare Advantage in the United States, which means that out of all Medicare beneficiaries, 42 percent are enrolled in Medicare Advantage.

Common Questions on Medicare Advantage in Texas

Are there disadvantages to Medicare Advantage?

  • You may have network restrictions that limit your choice of healthcare providers and facilities.
  • Medicare Advantage plans can be less predictable than Medicare Supplement (Medigap) plans regarding out-of-pocket costs.
  • Medicare Advantage plans are more hands-on by enrollees because they must stay within the network, pay copays, their Part B premium, and make sure they are getting the right coverage to match healthcare needs.
  • Medicare Advantage isn’t standardized like Medigap, so they can change coverage, networks, drug formularies, and premiums.

What are the four types of Medicare Advantage policies available in Texas?

  • Health Maintenance Organization (HMO)
  • Preferred Provider Organization (PPO)
  • Private Fee-for-Service (PFFS)
  • Special Needs Plans (SNP)

Which companies are the top three Medicare Advantage plan providers?

Based on nationwide enrollment, the three top insurance companies are:

  1. United Healthcare
  2. Humana
  3. Blue Cross Blue Shield

What are Medicare SNPs?

SNP stands for Special Needs Plans. They are Medicare Advantage plans in Texas that provide insurance for Medicare beneficiaries who have limited income or chronic health issues.

Do Medicare Advantage plans include prescription drug coverage?

More and more Medicare Advantage plans have added prescription drug plans to their coverage. Discuss all your coverage options with an insurance agent so you know you are getting the coverage you need.

Do Medicare Advantage plans cover the SilverSneakers program in TX?

Fitness club memberships are in demand, and many plans include them in their benefits.

Related Topics

Texas Medicare Resources

TX State Links

Understanding the Medicare benefits of Medicare Parts A and B can be tough. Learn more about Medicare, Medicare plans, options for saving on out-of-pocket costs for healthcare services and health insurance, and more with these resources. You can also give us a call so that we can help you find the best rates on MA policies in Texas with top star ratings!

Ready to learn more?

We help educate Medicare beneficiaries on their Medicare Advantage options and help them go through the process of reviewing and comparing plans. We work with most of the nation’s top-rated Medicare Advantage carriers. Give us a call today, or request a quote online to learn more about plan options.

Key Take Aways
  • In Texas, PPO Medicare Advantage Plans are very popular for many Medicare beneficiaries.
  • You can make changes to your Advantage plan each year during the Annual Election Period.
  • You must continue to pay your Medicare Part B Premium with most Medicare Advantage plans.