Understanding the difference between Medicare Advantage plans and medicare supplements in Texas is often tricky. In essence, Texas Medicare Advantage plans are private Medicare health plans that pay for your medical services instead of original Medicare. Medicare supplements pay some or all of the difference between what Medicare pays and what you owe; conversely, when you enroll in Medicare Advantage, the plan pays for part of your care, and you pay the required coinsurance or copay for each different medical service.
The Workings of A Medicare Advantage Plan
By enrolling in a Medicare Advantage plan, you commit to obtain your Medicare A, B, and sometimes D services/benefits from providers in the plan’s network. Since your providers can no longer bill Medicare when you have joined a Medicare Advantage plan, you can store your Medicare card away in a protected place for as long as you remain enrolled the plan. Each time you access a medical service, you will share in the costs of that service as stated in the plan’s summary of benefits. For instance, you might pay $5 or $10 for a primary care doctor visit, $30 or $40 for a specialist visit, and $100 for an ambulance ride, and so on.
Medicare Advantage plans offer a summary of benefits that you should review before enrolling. Some of the questions you should ask yourself are: Do my favorite physicians and hospitals participate in this plan’s network or agree to accept this Medicare Advantage plan? What premium, if any, will I pay each month to be a member of this plan? Are my Part D drug plan needs covered? What copayments or coinsurance will I be responsible for if I develop a serious condition? Determining which plans your chosen providers are working with, and how comfortable you are with stated cost sharing, goes a long way to narrowing your choices.
Which Physicians Can I See On This Plan?
In Texas, most Medicare Advantage plans are modeled after a traditional HMO or PPO plan. Directories of participating doctors and hospitals are available online. If you need to obtain a referral or authorization before seeking treatment with a certain doctor or care center, the plan’s rules will state this. Should you enroll in a PFFS model plan, you’ll be able to see any provider as long as he or she agrees to accept the payment conditions and terms and bill the plan for your services.
Medicare Advantage Plan Monthly Premiums
In addition to the Medicare Part B monthly cost you already pay, you may also be responsible to pay a premium for your Medicare Advantage plan each month. While plan premiums vary, many Texas counties offer plans with $0 premiums. The reason that some plans can offer you such low premiums is that Medicare pays the plan a monthly fee to administer your Medicare A & B benefits to you.
It’s often intimidating to pick a suitable plan. The plans for which you are eligible will be based on your county of residence, and there may be several. You also should evaluate each plan’s extras, such as routine hearing exams, preventive dental and vision exams.
A word of caution: the benefits of each Medicare Advantage plan change from one year to the next. If you opt for Medicare Advantage, be prepared to spend a little time each autumn reviewing what changes are happening from one year to the next in the plan’s premiums, copays, network and drug formulary. Since this takes considerable time, you would do well to establish a relationship with an insurance agent who focuses on Medicare-related insurance products. The price you pay for the benefits you receive is exactly same if you use an agent, but you enjoy the added benefit of having an experienced advisor to help you with changing Medicare needs over the years.
Looking to find a great medicare advantage plan in Texas ? Then visit www.texasmedicareplan.com to find information about Texas Medicare Advantage Plans.