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Medicare Advantage in Texas

Beneficiaries have two options for Medicare coverage: Original Medicare and Medicare Advantage. Medicare Advantage, often called Medicare Part C, is an alternate method to get Medicare coverage. With Medicare Advantage, you’ll get a bundled package of health benefits from a private insurance company—much like you’re probably used to with employer-sponsored health plans.

Eighteen insurers sell Medicare Advantage plans in the state of Texas,¹ offering a combined total of 137 plans.² However, availability of Medicare Advantage plans depends on where you reside in Texas. Currently, 37% of Texas beneficiaries are enrolled in some type of Medicare Advantage plan.³

Medicare Advantage plan benefits

Medicare Advantage plans cover everything Original Medicare (Parts A and B) covers, but many Medicare Advantage plans in Texas pay for a lot more. These are a few of the most common extra benefits covered by Medicare Advantage plans:

Prescription drug coverage
Eye exams and glasses
Dental coverage

Fitness programs
Hearing aids
Over-the-counter allowances

If you have a chronic illness in Texas, you may be able to buy a Medicare Advantage plan that covers other services that could improve your well-being, such as meal delivery, non-medical transportation, home modifications, and pest control.⁴

Medicare Advantage plan costs in Texas

Medicare Advantage premiums depend on where in Texas you live and which plan you enroll in. You might even be able to find plans with $0 premiums in Texas. However, the chart below shows the average monthly premium for a Texas Medicare Advantage plan is just under $45.


Average annual cost	$6,602.68
Average monthly premium	$44.73
Average drug deductible	$193.64
Annual max out-of-pocket	$5,872.23

Table created from data at https://www.healthmarkets.com/content/medicare-advantage-costs-index. Data as of 6/2/2020.

Medicare Advantage insurers in Texas

Here are some insurance providers that provide Medicare Advantage plans in Texas:

Aetna
Allwell
Amerigroup Healthcare
Blue Cross Blue Shield (BCBS)
Care N’ Care Insurance Company
Cigna
Devoted Health
Humana

Imperial Health
KelseyCare Advantage
Lasso Healthcare
Memorial Hermann Health Plan
Mutual of Omaha
Oscar
Scott and White Health Plan
WellCare

Top-rated Medicare Advantage providers

The Centers for Medicare and Medicaid Services (CMS) rates Medicare Advantage plans each year on a 5-star scale (5 stars is best). Only 20 of the 400 Medicare Advantage plans rated nationwide were awarded the prestigious 5-star CMS rating.⁵

The CMS doesn’t rate every Medicare Advantage plan in Texas. Some are too new to be measured. Others don’t have enough data. But of the plans that receive ratings, Texas’ Medicare Advantage plans receive an average of 3.5–4 stars.⁵

Find the Medicare Advantage plan that fits you best

HMO
Low premiums
Must stay in-network
Must choose a primary care physician
Referrals required to see a specialist

PPO
Pay more expensive premiums
Can go out of network at a higher cost
Don’t need to choose a primary care physician
Don’t need referrals to see a specialist
Typically have a smaller network with local PPO
Typically have a larger network with regional PPO

PFFS
May or may not have a network
In-network expenses lower than out-of-network
Plan is accepted by any doctor who agrees to the plan’s terms
Need written acceptance for coverage before each service

MSA
Similar to a health savings account (HSA)
Accompanied by high-deductible health plan (HDHP)
Money accumulated in savings rolls over each year
Cannot deposit personal funds into an MSA

Texas is a big state with a quantity of Medicare health plans to match its size. In total, there are 80 local HMO plans, 46 local (and 4 regional) PPO plans, 4 PFFS plans, and 3 MSA plans.²

If you're looking for a Texas Medicare Advantage plan, give us a call. A licensed Medicare insurance agent can help you find the best plan for your area—and your health needs.

Local resources in Texas

Texas Department of Insurance: Regulates Texas’ insurance industry and protects consumers with regulations and a portal for customer complaints.

Texas Health Information, Counseling and Advocacy Program: Provides education about Medicare and Medicaid, helps with enrollment, and advises beneficiaries on a course of action.

Texas Kidney Health Care: Assists Texans who have end-stage renal disease with payment for dialysis treatments, transplants, and associated costs.
Texas Children’s Health Insurance Program: Helps people afford health insurance for their children up to age 18.

Sources

1. Medicare, “Find a Medicare Plan”

2. Kaiser Family Foundation, “Medicare Advantage Plans, by Plan Type”

3. Kaiser Family Foundation, “A Dozen Facts about Medicare Advantage in 2020”

4. Avalere, “Medicare Advantage Beneficiaries Will Again See a Jump in Supplemental Benefit Offerings in 2020”

5. CMS.gov, “2019 Star Ratings Fact Sheet”

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