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:
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|
Medicare Advantage insurers in Texas
There are 18 insurance providers that provide Medicare Advantage plans in Texas:
Need help getting started? Call: 833-241-9711
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
Two of these 5-star Medicare Advantage plans can be found in Texas. The first, provided by Kelsey-Seybold Medical Group, is available in 13 counties and boasts 34,967 enrollees.5 The second, provided by UnitedHealth Group, is available in 53 counties and boasts 256,417 enrollees.5 However, the UnitedHealth Group 5-star plan is a Special Needs Plan, available only to beneficiaries who are eligible for both Medicare and Medicaid.6
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
|Must stay in-network|
|Must choose a primary care physician|
|Referrals required to see a specialist|
|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|
|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|
|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.
Speak to a licensed agent
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”
5. CMS.gov, “2019 Star Ratings Fact Sheet”
6. UnitedHealthCare, “Health Plans for Texas"
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