How to find the best Medicare Advantage plan in Texas
Of the 4.6 million Medicare beneficiaries in Texas, more than half are enrolled in a Medicare Advantage plan. 2 million beneficiaries in Texas also have Part D prescription drug coverage that’s included in their Medicare Advantage plan. Based on these numbers, it’s clear that seniors in the state are interested in Medicare Advantage as a bundled alternative to Original Medicare.
So, what is the best Medicare Advantage plan in Texas? We know which plans are popular in Texas and which insurance carriers people tend to go with, but there is no single “best” plan for everyone. The best Medicare Advantage plan for you depends on your unique health, lifestyle, and financial situation.
Key takeaways:
The best Medicare Advantage plan in Texas is different for everyone. Consider what coverage you need based on your health and financial needs before choosing a plan.
KelseyCare Advantage and UnitedHealthcare plans both have high Medicare star ratings for Medicare Advantage plans in Texas.
What is a Medicare Advantage plan?
Medicare Advantage plans, also called Part C plans, are a bundled and private health insurance alternative to Original Medicare. Medicare Advantage plans often include additional benefits beyond those provided by Original Medicare like dental, vision, hearing, and drug coverage.
Because they are offered by private insurance companies, Medicare Advantage plans have their own premiums, deductibles, and copayments. In some ways, Medicare Advantage plans can be more restrictive and expensive than Original Medicare. Learn more about Original Medicare vs Medicare Advantage.
What’s included in a Texas Medicare Advantage plan?
Medicare Advantage plans vary widely between policies and carriers. All plans are required to cover the same outpatient and hospital services as Original Medicare (Part A and Part B). There are additional benefits that some plans provide, like:
Routine vision, dental, and hearing services
Transportation benefits
Prescription drug coverage
Special Needs Plans (SNPs) are a type of Medicare Advantage plan that meets the needs of people with low-incomes, chronic conditions, and who need institutional care. These policies often come with additional services and benefits that cater to this population.
Key facts about Medicare Advantage plans in Texas
You have 376 Medicare Advantage plans to choose from in Texas in 2024.
$9.36 is the average monthly premium for a Texas Medicare Advantage plan.
25 insurance providers offer Medicare Advantage plans in Texas, including Aetna, Blue Cross Blue Shield, Cigna, Humana, and Wellcare.
What is the best Medicare Advantage plan in Texas?
One way that Medicare beneficiaries can understand the quality of a Medicare Advantage plan is through Medicare star ratings. The Centers for Medicare and Medicaid (CMS) uses Medicare star ratings to evaluate and compare the quality of both Medicare Advantage and Part D plans. They rate every plan from 1-5 stars, with a five-star plan being the highest quality plan.
In Texas, CMS gave 5 stars to plans offered by KelseyCare Advantage and UnitedHealthcare. Some Devoted Health, Humana, and UnitedHealthcare plans received 4.5 stars.
These high ratings indicate that these Medicare Advantage plans are the best in Texas overall, based on customer service and performance. The star rating system doesn’t, however, take into account certain factors that could be unique to you. For example, if you have a chronic condition that requires special care or you have prescriptions that aren’t covered by these plans, they may not be the best options for you.
How to find the best Medicare Advantage plan in Texas
The best Medicare Advantage plan in Texas for you takes your healthcare needs into account. When choosing a plan, pay close attention to the following factors:
Cost
Medicare Advantage plans have yearly limits on your out-of-pocket costs for medical services. After you reach this limit, you don’t need to pay for covered services for the rest of the year. Especially if you spend a lot on healthcare, make sure to choose a plan that doesn’t have a high limit for out-of-pocket costs. You may also want to consider staying on Original Medicare and adding a Medigap plan. Learn more about Medicare Advantage vs Medigap here.
Coverage
It may help to make a list of all the services you need covered each year. If you have a chronic condition, like diabetes or cardiovascular disease, you may need coverage for drugs, specialists, and/or fitness programs. Keep in mind that Medicare Advantage requires prior authorization for many services. If your service or treatment is denied prior authorization, you’ll have to pay for the full cost of the service.
Prescription drugs
Many Medicare Advantage plans include Part D (prescription drug) coverage. You can also enroll in a standalone Part D plan if you choose a Medicare Advantage plan that doesn’t have drug coverage. Make sure that your drug coverage includes your prescriptions on its formulary (list of covered drugs).
Providers and hospitals
Medicare Advantage plans limit you to care within the plan’s network and service area for non-emergency care. Some plans (PPOs) provide a lower level for coverage for out-of-network providers and some don’t provide out-of-network coverage at all (HMOs). You also will likely need a referral from your primary care physician to see a specialist. Consider a plan that doesn’t bind you to in-network providers or restrictive service areas. Learn more about HMO vs PPO Medicare Advantage plans here.
Quality of care
If you know that you’ll need to see specialists more often, you may want to consider a plan that allows you access to more providers without needing a referral.
Travel
Some Medicare Advantage plans offer additional benefits during travel. If you travel frequently, you may want to consider it a priority for healthcare coverage. Keep in mind that Medigap (also called Medicare Supplement plans) provide the best healthcare coverage for people who travel a lot domestically.
Enrolling in the best Medicare Advantage plan in Texas
While there is no single “best” Medicare Advantage plan for every beneficiary in Texas, you can find a plan that works best for you. If you’re new to Medicare, you can sign up for a Medicare Advantage plan during your Initial Coverage Election Period. If you’re already on Medicare, you can switch your coverage from Original Medicare to a Medicare Advantage plan during the Medicare Open Enrollment Period.
Picking a Medicare Advantage plan is a big decision, and you don’t have to do it alone! A Chapter Medicare Advisor can talk to you about what you need from your health insurance plan. There’s a lot to understand when it comes to Medicare, and Chapter can help you compare, choose, and enroll in a plan that best fits your health and financial circumstances. Get started today by calling us at 855-900-2427 or scheduling a time to talk.