Ten Important Facts to Know About Medicare Advantage Plans in Texas

Once you become eligible for Medicare, you can get enrollment in Medicare Advantage Plans offered by Medicare advantage plans in Texas. To know more about Medicare Advantage plans, continue reading the article describing 10 important things about Advantage plans.

Medicare advantage plans coverage

Medicare Advantage plans in Texas will provide coverage offered by original Medicare Part A coverage (hospital care) as well as Medicare Part B coverage (medical care).

Advantage plans offer extra benefits

While original Medicare offers very limited coverage against prescription drugs, most Medicare Advantage plans cover prescription drugs aside from coverage of extra medical benefits including routine dental care, vision care, hearing coverage plus fitness benefits.

An advantage plan is under the control of Medicare

You are always included in the Medicare program equipped with Medicare advantage plans in Texas, while all your benefits and health coverage will be under the control of your Medicare advantage group. Equally, you enjoy all rights and protections under original Medicare and entitled to appeal for a coverage decision.

Advantage plans offer out of pocket maximums

Contrasting with original Medicare, Medicare Advantage plans in Texas pay maximum out of the pocket against your paid medical expenses. The amount of out of pocket maximum is increased annually.

Advantage plans require two premiums

While some Medicare Advantage plans come with premiums as minimum as $0, it has plenty of plans that require paying to get covered under the plan. In addition, you are equally responsible to pay a certain amount of premium to the federal government for having coverage under Medicare Part B plans

Advantage plans won’t cover pre-existing ailments

If you suffer from any pre-existing health condition, like blood pressure, blood sugar, or cancer, it won’t cover illness related to the condition. However, people with ESRD, (end-stage renal disease) may enroll them for Special Needs Plan under a Medicare advantage plan to avail of its benefits.

Advantage plans have a vast network

Many Advantage plans are formed as PPOs (Preferred Provider Organizations) or HMOs (Health Maintenance Organizations). You can have healthcare services from doctors and healthcare clinics that are listed under PPOs and HMOs by paying an extra cost. The costs you pay may not come under out-of-pocket maximums.

Advantage plans can be discontinued

Subsequent to your initial enrollment period is over, if you’re not satisfied with the Advantage plan, you can discontinue the plan in continuation of the Medicare Open Enrollment Period. The Medicare open enrollment period is from October 15th to December 7 of every year.

Calculate out-of-pocket expense in the Advantage plan

Medicare Part B usually charges you a Coinsurance @20% for its covered services. Thereby, you can calculate coinsurance amount simply by 20% of the medical bill, once you get the same from your doctor. And when it comes to copayments for covered service you get a fixed dollar amount under Medicare advantage plans in Texas. For example, $10 for visiting a primary care doctor.

Advantage plan service provider may quit Medicare

Medicare Advantage plans are having annual contracts with Medicare and can consider not renewing their service contract for the coming year. In that case, you will have the opportunity to enroll yourself with another service provider or return to original Medicare.