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Texas Medicare Part C – Medicare Advantage

Texas Medicare Part C offers the same coverage as traditional Medicare Part A and Part B, but these insurance programs are administered by private companies. 

Medicare Part C is also called Medicare Advantage. A Medicare Advantage plan can offer additional coverage at no higher cost than original Medicare, so explore your Part C choices.

What is Texas Medicare Part C?

Medicare Part C is Medicare coverage that is delivered by private companies. These insurance companies contract with the federal government to provide the same coverage as you would receive through traditional Medicare. In fact, some Medicare Part C plans offer more benefits than traditional Medicare.

Medicare Part C plans all combine the coverage from Medicare Part A and Medicare Part B. This includes hospital coverage (Medicare Part A) and medical coverage (Medicare Part B). Some Medicare Advantage plans also include prescription drug coverage, which is provided through Medicare Part D. 

If you choose to enroll in a Part C plan, you are still eligible for all other parts of Medicare. You can change from Part C back to Part A and B if you choose.

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Do You Need Medicare Part C (Medicare Advantage) in Texas?

Medicare Advantage plans in Texas may offer additional benefits you won’t receive through traditional Medicare. For example, Texas Medicare Part C plans can include dental or vision coverage, which is not provided through Medicare Part A or B. Traditional Medicare coverage includes hospital and medical care. If you are looking for more than just basic coverage, Medicare Advantage may be the best choice for you. Coverage2Care can help you explore your options.

What do Medicare Advantage plans (Part C) in Texas Cover?

Texas Medicare Part C plans include all the coverage from Medicare Part A and Medicare Part B. You keep the hospital coverage of Part A, which includes treatment at a hospital, skilled nursing facility, or hospice. Some home health services are also covered

Texas Medicare Advantage plans also include the medical coverage provided by Medicare Part B. This coverage includes preventative care as well as medical treatments by a physician. Medicare Advantage plans also provide for durable medical equipment, which is also covered by Medicare Part B.

However, Medicare Part C plans can include many other services. Your Texas Medicare Advantage plan can include dental and vision coverage, housekeeping services, medications, gym memberships, transportation, caregiver support, and more.

Stethoscope in chart

How Much Does Medicare Advantage Cost?

Medicare Advantage plans cost different amounts depending on where you live. However, most patients who live in a major city can find Texas Medicare Part C plans starting at $0 a month. 

In most cases, you will have co-pays for specialist or emergency treatments.

Contact Coverage2Care to explore Medicare Advantage costs for your situation.

Is there a deductible for Medicare Advantage Part C?

Every Medicare Part C plan is different. Some plans do charge a deductible for out-of-network services, while other plans have no deductibles. Coverage2Care can help you find a plan that is best for you.

Who is Eligible for Texas Medicare Part C?

If you are eligible for traditional Medicare Part A and Part B, you are also eligible for Medicare Part C. Most people become eligible when they turn 65. If you or your spouse paid Medicare taxes through a job for at least ten years, you are eligible.

Younger people with End-Stage Renal Disease will become eligible for Medicare Advantage beginning in 2021. 

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Texas Medicare Enrollment Periods for Part C

Initial Enrollment Period for Part C: Your 65th Birthday

Before you can enroll in Medicare Part C, you must first enroll in Medicare Part A and Part B. Your Initial Enrollment Period is the first time most people can enroll in Medicare. This timeframe begins three months before your 65th birthday includes your birthday month, and continues for three months after your birthday month. 

After you enroll in Medicare Part A and B, you can sign up for Medicare Part C directly through the insurance company.

General Enrollment Period for Part C: October 15 to December 7

After your Initial Enrollment Period, you can change to Medicare Advantage during the General Enrollment Period. From October 15 to December 7 of each year, you can select a Medicare Part C plan.

Special Enrollment Period for Part C

If you have private insurance when you turn 65, you can choose to keep this insurance instead of moving to Medicare. 

For example, you may have insurance through your employer. You can delay enrolling in Medicare for as long as you keep this coverage. Once your other insurance ends, you can sign up for Medicare during your Special Enrollment Period. This eight-month period begins as soon as your other insurance ends. 

If you want to enroll in Medicare Part C, you must first enroll in Part A and Part B during your Special Enrollment Period.

Medicare Advantage Disenrollment Period (MADP)

If you want to change from Medicare Advantage back to traditional Medicare, you can make this change from January 1 to February 14 each year.

Old Cople with Dog

10 Important Things to Know About Medicare Part C or Medicare Advantage Plans

1.) You still need to pay your Medicare Part B premium each month

Medicare sends your premium to your Medicare Advantage provider to pay for your extra coverage. Whether you have Medicare Part B or Medicare Advantage, you always need to pay your monthly Part B premium. The only exception is if you receive services such as Medicaid or the low-income subsidy Extra Help.

2.) Joining a Medicare Advantage plan may affect your current coverage

If you’re working past age 65 or have existing insurance coverage, joining a Texas Medicare Advantage plan can impact your current insurance coverage.

3.) Use network providers

Like many insurance plans, your Medicare Advantage may charge you more if you see providers outside your network. Outside of an emergency, use your network providers and pharmacy to save money.

4.) Financial assistance is available

You may qualify for help paying for premiums or Part D medications. A low-income subsidy program called Extra Help is available for seniors who need assistance.

5.) Part D late-enrollment penalty

If you go more than 63 days in a row after your Initial Enrollment Period without Part D prescription drug coverage, Medicare will charge you a higher Plan D premium. Texas Medicare Advantage plans that include Part D coverage avoid these higher premiums. 

6.) A Medicare supplement insurance (Medigap policy) plan is not a Medicare Advantage plan

Medicare supplement plans are health insurance policies that are secondary to traditional Medicare Part A and Part B. Medicare Advantage plans combine Medicare Parts A and B, and sometimes Part D, into a single plan.

7.) Use your member ID card

Medicare Advantage members must use their member ID card, not their Medicare card when receiving services.

8.) Medicare Advantage protections

You keep all the same rights and protections from Original Medicare, even though Medicare Advantage plans are privately administered.

9.) Medicare Advantage has you covered

Texas Medicare Part C plans are required to include all the same services as Original Medicare. Hospice is still covered under both traditional Medicare and Medicare Advantage. Medicare Advantage plans may also offer additional benefits not found in Original Medicare.

10.) Medicare Advantage is a built-in financial safety net

Medicare Advantage plans with annual out-of-pocket maximum cost provide a financial safety net. You’ll never pay more than this amount in one year for covered Medicare expenses.

Stethoscope and Computer


Do Medicare Advantage Plans Replace Medicare?

Medicare Advantage plans do not replace Medicare. Instead, they offer other options to Medicare Part A and Part B.

What are the pros and cons of a Medicare Advantage plan in Texas?

– Pros of Medicare Advantage Plans

Texas Medicare Advantage plans let you pursue personalized treatments with all of your coverage administered by the same program. You may pay lower costs than traditional Medicare Part A and Part B, while also receiving additional services. You still retain all of your Medicare rights and can still qualify for financial assistance.

– Cons of Medicare Advantage Plans

Depending on the Texas Medicare Part C plan you choose, you may face a small network of providers or higher costs on some services. You may also have limited services available if you travel regularly. 

What types of Medicare Advantage plans are available?

Like other types of health insurance, there are many kinds of Medicare Advantage plans available. HMO, PPO, and Private Fee-for-Service plans are all available in Texas. Coverage2Care can help you learn about the different types of plans and what they mean for you.

How do you choose a Medicare Advantage plan in Texas?

Make sure to consider your current coverage and compare your benefits to the various Medicare Advantage plans. Medicare Advantage plans may offer more or less coverage than your existing insurance.

Look into whether your current doctors are part of the Medicare Advantage networks, as well as if your current medications are covered. You should also consider the monthly premium cost and any ongoing fees such as deductibles and co-pays. Coverage2Care can help you compare all your options.

Still Have More Texas Medicare Questions?

Medicare Advantage plans offer a wide range of choices. Contact Coverage2Care to learn more about Texas Medicare Part C and explore which plan is best for you.

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