Texas, the third largest State for Medicare beneficiaries, has about 4.5 million enrollees in 2024.
Medicare, the health insurance program in the United States, is a fee-for-service plan administered by the federal government and funded by the General Revenue and Federal Insurance Contributions Act.
Medicare plans in Texas are designed to meet the ever-growing healthcare needs of senior adults aged 65 and above, those with certain disabilities, and people with end-stage renal disease (ESRD).
The federal government directly administers Original Medicare. In contrast, Medicare Advantage plans in Texas are administered by private health insurance companies. These plans lower the costs associated with hospital bills and medical care by providing comprehensive coverage for inpatient and outpatient care.
Let us learn more about Medicare Advantage plans in Texas and how they benefit residents.
Medicare Advantage Plans in Texas
Texas, the second-largest US State, has more than 25 million residents, most of whom are older adults. About 12% of this population is 65 and above.
Since Texas’s life expectancy is just under 76, services such as Medicare are vital in the region to provide senior adults with healthcare coverage.
Growing medical needs with age often result in unmanageable healthcare finances. Medicare Advantage plans in Texas aim to mitigate the financial damage caused by increasing hospital bills. Consequently, about 4.4 million people, a whopping 17.6% of the total population, leverage Medicare plans to lower out-of-pocket healthcare expenses.
Individuals enrolled in Original Medicare have the option to join a Medicare Advantage plan, an alternative to Original Medicare, consolidating the benefits of Parts A and B with additional benefits through a private insurance provider.
As of 2024, about 1.7 million Medicare beneficiaries are a part of Medicare Advantage plans in Texas. This State is served by an impressive 376 Medicare Advantage plans.
Since there are numerous Medicare Advantage plans available in the State, it’s vital for you to look into the benefits each plan offers and the premiums, costs, and deductibles associated with it.
Medicare Advantage Networks
The Medicare Advantage plans in Texas feature networks available in certain areas of the State. Each plan option is based on a ZIP code. These plans have varying copayments, premiums, and deductibles.
However, the standard plans start at $0 premium. Every Medicare-eligible person in Texas has access to this $0 premium Medicare plan. Notably, the average monthly premium for a Medicare Advantage plan in Texas is $9.36.
Since Medicare Advantage plans consist of networks, they have one restriction—a limited choice of healthcare providers. As Medicare Advantage plans have contracts with certain healthcare professionals and hospitals, you cannot seek treatment outside of the network of choice.
If you want to consult a physician outside your network, you require pre-authorization or a referral from your primary healthcare provider.
General Analysis | Ratings of Medicare Plan Providers in Texas
| Insurance Company | Medicare Rating | A.M. Best rating | Better Business Bureau (BBB) rating | J.D. Power ranking |
| Aetna | 3.9 stars | A | A+ | 6th out of 9 |
| Anthem | 3.9 stars | A | F | 7th out of 9 |
| Blue Cross Blue Shield | 3.9 stars | A | B | 5th out of 9 |
| Humana | 4.2 stars | A- | A+ | 2nd out of 9 |
| UnitedHealthcare | 4.2 stars | A | Not rated | 4th out of 9 |
Types of Medicare Advantage Plans
In Texas, there are four types of Medicare Advantage plans.
- Health Maintenance Organizations (HMOs)
- Preferred Provider Organizations (PPOs)
- Special Needs Plans (SNPs)
- Private Fee-For-Service Plans (PFFS)
Let us look into the primary Medicare Advantage plans available to Texas residents.
Health Maintenance Organizations (HMOs)
An in-network provider, typically called an HMO provider, is an approved healthcare expert within the plan’s network.
In an HMO plan, beneficiaries receive care from a doctor, healthcare physician, or a hospital within their network of choice.
In emergencies, beneficiaries require pre-authorization or referral from their primary healthcare provider to consult another specialist outside their network. HMO plans mostly include prescription drug coverage.
Preferred Provider Organizations (PPOs)
PPO, another type of Medicare Advantage plan, allows you to receive medical care from both in-network and out-of-network providers. But seeking out-of-network care typically costs more than your standard plan. But this plan doesn’t restrict you to your primary care doctor.
You also don’t require a referral from your primary care physician to consult physicians outside your network. However, you incur relatively lower costs for medical experts and hospitals within the plan’s network.
Special Needs Plans (SNPs)
SNPs are ideal for beneficiaries with specific diseases who require specialized healthcare. Individuals with chronic conditions, living in nursing homes, or those who have both Medicaid and Medicare receive tailored benefits.
Generally, beneficiaries are limited to the network of providers within the plan. Pre-authorization is required to consult physicians outside the network. SNPs also include prescription drug coverage.
Private Fee-For-Service Plans (PFFS)
PFFS allows you to consult any Medicare-approved provider within your State. Hence, you’re not obligated to see a specific healthcare expert. Thus, PFFS plans work the same as Original Medicare, but you can visit any doctor at any hospital if they agree with the plan’s payment terms and conditions. These plans have fewer restrictions.
However, this plan establishes the pay rate for the doctor, the hospital, and the healthcare provider, as well as your out-of-pocket expense for the care you receive. In some PFFS, you have a network of providers where you incur lower costs. However, your plan may not always have prescription drug coverage.
Comparison of the Top-Rated Medicare Advantage Plans in Texas
As of 2024, the following are the best Medicare Advantage plans in Texas. Here’s a comparison.
| Insurance Company | CMS Star Rating | States Available | Members in High-rated Plans | Member Experience |
| Humana | 4.3 | 49 states | High (90% or more) | Above average |
| UnitedHealthcare | 3.8 | 49 states | Medium (50% to 89%) | Average |
| Blue Cross Blue Shield | 3.8 | 48 states | Medium (50% to 89%) | Above average |
| Aetna | 3.9 | 46 states | Medium (50% to 89%) | Above average |
Benefits Of Medicare Advantage Plans in Texas
Medicare Advantage plans provide a range of supplemental benefits with your standard coverage options. These benefits include coverage for wellness programs, hearing services, dental care, vision care, transportation services, meal accommodation, telehealth services, OTC benefits, chronic condition management, etc. Hence, Medicare Advantage plans have a holistic approach to healthcare coverage.
Since Texas has about 300 Medicare Advantage plans, it’s vital to look into the benefits your plan of choice offers before enrolling yourself to choose the best available health coverage. Here are the common benefits offered with Medicare Advantage plans in Texas.
Hospital and Medical Insurance
Medicare Advantage plans combine hospital and medical insurance, providing the same coverage as Original Medicare. This ensures that you receive primary coverage with your healthcare services.
Prescription Drug Coverage (Part D)
Most Medicare Advantage plans include prescription drug coverage to lower the out-of-pocket costs associated with prescription medications.
Dental Care
Medicare Advantage plans also offer preventive dental services, including routine checkups, scaling, and medically deemed necessary dental procedures.
Vision Care
Certain Medicare Advantage plans provide coverage for routine eye examinations, eyeglasses, and contact lenses, promoting better eye health.
Hearing Services
Some Medicare Advantage plans offer coverage for hearing exams. These plans typically cover hearing aids and other necessary equipment.
Wellness Programs
Many Medicare Advantage plans include wellness programs, such as gym memberships, fitness classes, and yoga classes, to help beneficiaries achieve a healthy lifestyle and combat healthcare problems that arise from a lack of fitness.
Transportation Services
Some Medicare Advantage plans offer assistance with transportation services. These plans ensure you access medical care at facilities more conveniently.
Over-the-Counter Benefits
Medicare plans with OTC benefits allow beneficiaries to purchase over-the-counter items, non-prescription medications, drugs, and health-related products.
Chronic Condition Management
Chronic condition management includes specialized care for individuals with long-term health problems. Medicare Advantage plans with this benefit are ideal for individuals who require comprehensive healthcare.
Cost of Medicare Advantage Plan in Texas
In 2024, the average monthly premium for a Medicare Advantage plan in Texas is $9.36. However, certain plans require you to pay out-of-pocket premiums, deductibles, copayments, and coinsurance.
Sometimes, these costs are associated with supplemental benefits and may vary from provider to provider. Therefore, you must familiarize yourself with deductibles, copayments, and coinsurance to avoid higher out-of-pocket premiums.
- Deductibles are expenses that you cover before Medicare provides coverage for health services. Thus, deductibles apply to all Medicare Parts.
- A copayment is a fixed payment for a doctor’s visit or a prescription drug. This amount is paid after you pay your deductibles, thus covering certain benefits.
- Coinsurance is a cost-sharing method where you have to pay a percentage of the total amount for specific services after paying your deductibles. The rest of the cost is covered by your insurance plan.
Medicare Advantage plans usually charge a copayment instead of the 20% coinsurance you pay under Original Medicare. Also, Medicare Advantage plans significantly vary from provider to provider and plan to plan. Therefore, it’s best to look into your plan’s requirements before signing up.
Medicare Eligibility and Enrolment in Texas
What makes you eligible for Medicare in Texas, and how can you enroll? Medicare has the same eligibility criteria across all the States. You qualify for Medicare if:
- You are 65 years old or above
- You have a medical disability
- You have end-stage renal disease (ESRD)
- You have amyotrophic lateral sclerosis (ALS)
You can qualify for Medicare if you are approved by the Social Security Administration for either your age or disability. You must enroll yourself during the initial enrollment period or wait for the general enrollment period.
If you receive your Social Security benefits four months before your 65th birthday, you get enrolled into Medicare automatically. Otherwise, you must apply for Medicare through mail or by contacting a local Social Security office.
Why Is Medicare Vital for Texas Residents?
Texas is the second-largest State in terms of both area and population. In Texas, 1 in 7 people are aged 65 or above.
With 28% of this population over the age of 50, healthcare coverage is deemed necessary in the region. Medicare provides extensive healthcare services for senior adults in Texas.
Moreover, Texas experiences unique health challenges, including a high rate of chronic diseases such as diabetes and hypertension. The State’s hot and humid climate aggravates conditions such as respiratory disorders and heat-related illnesses.
Specific diseases like valley fever are also prevalent in Texas due to the arid regions. Under these circumstances, routine check ups and healthcare facilities become necessary.
Services such as Medicare Advantage plans in the region provide affordable healthcare through bundled coverage plans that combat skyrocketing hospital bills.
Having access to a Medicare Advantage plan also provides seniors with supplemental benefits, unlike Original Medicare. Such plans not only save beneficiaries from high costs but also enhance the quality of life through additional benefits.
Medicare Texas Resources
Numerous organizations across Texas provide free counseling and guidance to senior residents about Medicare plans. Here are some organizations to assist Texans.
| Organization | How you can get help | Website & Contact Info |
| Texas Health and Human Services | The Texas Health and Human Services offers various services to support the well-being, dignity, and choices of older Texans, along with resources for family caregivers. This includes information on state and federal benefits like Medicare and legal rights. | Website | (512) 424-6500 |
| Texas Health Information, Counseling and Advocacy Program | This service assists with Medicare enrollment, offers advice, and provides information on your options. Across the State, trained certified benefits counselors are available to help you identify and apply for suitable programs. | Website | (512) 424-6500 |
| Texas Area Agencies on Aging | Area Agencies on Aging (AAA) provide support for individuals aged 60 and above, along with their families and caregivers, by providing information and help in finding and using community services. These agencies also offer counseling on benefits and legal aid. | Website | (855) 937-2372 |
| Texas Consumer Assistance | This advocacy group serves as a central hub where residents can find information about different types of health insurance coverage and address any related issues or questions. | Website | (800) 252-3439 |
Choose a Medicare Advantage Plan With Silveredge in Texas
Texas, the most populous State in the South Central region of the United States, houses a large number of senior residents.
The inevitable health problems associated with old age deem services such as Medicare necessary as they can cut down healthcare bills and provide comfort.
Leveraging the right resources to make cost-efficient decisions becomes crucial for you or your loved ones in old age. With more than 300 Medicare Advantage plans it may seem daunting to make the right choice. We suggest that you assess your health status before enrolling yourself into a Medicare Advantage plan in Texas.
If you need help comparing Medicare plans, Silveredge can provide you with comprehensive guidance. Our licensed advisors with industry expertise provide insight into various Medicare plans available in your region.
Contacting Silveredge will not only make it easy to navigate through the complexities of Medicare but also help you make a cost-efficient, informed decision. Contact Silveredge today to equip yourself with vital information before you sign up for Medicare!
