Medicare is the United States’ government-run national health insurance program. It was established in 1965 by the Social Security Administration (SSA) and is now managed by the Centers for Medicare and Medicaid Services.
Medicare is divided into four sections: A, B, C, and D. Part A covers hospitalization, skilled nursing care, and hospice care. Outpatient services are covered by Part B. At the same time, part D includes prescribed medications that are self-administered.
You can enroll for Medicare in any state. As a Texas resident, for instance, you can enroll on the official website or have a Medicare Texas company guide you. Also, you can get other alternatives like Medicare Advantage plans in Texas.
However, whether you want to enroll for the original Medicare in Texas or Texas Medicare Advantage plans, there are some factors to consider. You need to know various plans so you can pick what suits you.
What Is Medicare Advantage Plan
Medicare Advantage Plans are an additional option for getting Medicare Part A and Part B coverage. They are often known as “Part C” and are provided by Medicare-approved private organizations. These organizations must adhere to Medicare requirements.
Private insurance companies that offer Medicare Advantage plans, enter into contracts with the federal government to provide health insurance benefits to Medicare beneficiaries.
The majority of Medicare Advantage Plans also provide medication coverage (Part D). In most circumstances, you must use health care providers who are part of the plan’s network. Here are some benefits of buying the Medicare Advantage plans
- Doctors visits
- Dental care
- Vision care
- Hospice care
- Preventive care
- Hospitalization
Best Medicare Advantage Plans
There are different types of Medicare Advantage plans. But then, three out of the six are more popular. Here are some of them:
- Health Maintenance Organization (HMO) Plans
- Preferred Provider Organization (PPO) Plans
- Private Fee-for-Service (PFFS) Plans.
Health Maintenance Organization (HMO)
The HMO plan is not just among the best Medicare Advantage plans. It’s also the most popular. In most HMO plans, you must seek care and services from providers inside the plan’s network. The exceptions are emergency care, urgent care, and dialysis which are out-of-area.
Also, certain services may be available outside of the network in some plans. However, getting treatment from a network provider is frequently less expensive.
Because HMO Advantage plans outnumber all other types, you should have several options. However, if you receive it via your workplace, you’ll be limited to what’s accessible. Also, there are local and regional restrictions on what plans are available.
Preferred Provider Organization (PPO)
Also, among the best Medicare Advantage plans, we have the PPO. This plan is used by roughly one-third of Medicare Advantage enrollees. When you use a PPO plan, you pay less to see health care providers inside the plan’s network than you would if you went outside the network.
If you want to maintain seeing some specific doctors, check if they are in your plan’s network before enrolling. Check with them to see which MA plans they are on.
Some PPO plans now have a yearly deductible for medical and drug coverage, but the vast majority do not.
Private Fee-for-service Plans (PFFS)
You can access providers in the network if your private plan has one. If it does not, you may be allowed to see any doctor or hospital that accepts Medicare. However, this depends on the terms and conditions of your plan.
The disadvantage of this plan is that not all Medicare-accepting health care providers will agree to your plan’s terms and conditions.
Also, many health care providers do not take PFFS insurance, and they are free to accept or reject the plans at any time. And the majority of the plans do not offer prescription drug coverage.
How to Apply For Medicare Advantage
Anyone with Original Medicare (Parts A and B) may be eligible to enroll in a Medicare Advantage (Part C) plan. Also, if you are under the age of 65 and qualify for Medicare due to a disability, you are included.
However, there is no single way to sign up for Medicare Advantage. This is because each Medicare Advantage Plan has its own set of requirements and processes.
The first step is to research the coverage plans available in your area. Next is to compare the benefits of the plans to those provided by Original Medicare.
You can use the Medicare website to complete the enrollment process for many plans. Also, you may need to contact the company that provides the service to obtain an enrollment form.
Positives of Medicare Advantage Plans
When compared to the original Medicare plan, Medicare has some added advantages. If you buy a Medicare Advantage plan, here are some positives you can enjoy.
Customized Plan Structures
Medicare Advantage has different plan options, and you can find one that fits your needs. If you have a chronic health condition, for example, an SNP Advantage plan can help you with your medical bills.
If you prefer provider independence, a PPO or PFFS plan may be more suitable. Many Medicare Advantage plans include extra services like dental, vision, and hearing.
Convenient Coverage Choices
Original Medicare covers only two types of services: hospital insurance and medical insurance. If you want additional coverage for prescription drugs, you’ll need to acquire Medicare Part D.
Also, if you want supplemental coverage, you’ll need to purchase a Medigap plan. However, with a Medicare Advantage plan, you can get all your coverage options in one easy package.
Opportunities to Save Costs
Many Advantage plans feature no or low deductibles and no premiums. Another benefit of selecting Medicare Advantage is that most plans limit the maximum out-of-pocket payments you can incur during a plan year.
Switching to a Medicare Advantage plan can save you money on laboratory services and medical equipment. If you select a Medicare HMO plan, you may be able to save even more money on healthcare services offered by your HMO network.
Organized Medical Care
Organization of medical care is included in many Medicare Advantage plans. This means that your healthcare providers are actively communicating with one another in order to coordinate your care across various types of healthcare services and medical specialties.
This ensures that you have a healthcare team in place. It helps you avoid extra costs and complications such as medication interactions.
Conclusion
If you’re thinking about enrolling in a Medicare Advantage plan, you should compare both individual plans and different types of coverage. Furthermore, Advantage plan fees and coverage benefits might change annually, so carefully consider your alternatives each year before re-enrolling.