Medicare Advantage

Texas Medicare Advantage Made Simple

Ashford Insurance is an insurance agency serving North and Central Texas specializing in Medicare health plans. There are way too many prescription drug plans, Medicare Advantage Plans, and Medicare supplement plans and carriers to sort through. We help you sift through this maze of information to find a plan that will provide the benefits you need. If you have questions about Medicare, call Ashford Insurance at 817-952-3153.

Now, more than ever, it is vitally important that you understand your healthcare options. Choosing the right plan is the single most important decision you’ll make for your future health.  As a licensed Medicare supplement insurance agent in the state of Texas, we work with many TX health insurance carriers and will be your advocate in dealing with them. Our broker and consultant services are offered at no cost to you.

Medicare is a federal health insurance program that pays most of the health care costs for people who are 65 or older.  It will also pay for health care for some people under age 65 who have disabilities.

 Medicare Advantage

 
There are many people who are enrolled in some of the best Medicare Advantage plans in Texas. If you have recently enrolled in Medicare Part A and Part B or if you will be eligible in the near future, you might want to join them and look into Medicare Advantage plans in Texas yourself. It’s possible to just stick with Original Medicare (Medicare Part A and Medicare Part B), but opting for a Medicare Advantage plan can help you significantly reduce your out-of-pocket expenses and can provide you with some extra perks.
 

You can get your Medicare benefits through Original Medicare, or you can choose a Medicare Advantage Plan. With Original Medicare, the government pays for your Medicare benefits when you get them. Medicare Advantage Plans, the Part C of Medicare are offered by private companies that have been approved by Medicare. Medicare pays these companies to administer your Medicare benefits.

If you join a Medicare Advantage Plan, the plan will provide all of your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage. They are completely different than a Medicare Supplement Insurance (Medigap) policy.

There are the several types of Medicare Advantage Plans:

Health Maintenance Organization (HMO) plans: In most HMOs, you may only go to doctors, other health care providers, or hospitals that are in the plan’s network, except in an emergency or urgent situation. You probably also need to get a referral from your primary care doctor for diagnostic tests or to see other doctors or specialists.

Preferred Provider Organization (PPO) plans: With a PPO, you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. You generally pay more if you use doctors, hospitals, and providers outside of the network.

Private Fee-for-Service (PFFS) plans: PFFS plans are similar to Original Medicare in that you can generally go to any doctor, other health care provider, or hospital as long as they agree to accept the plan’s payment terms. The plan will determine how much it will pay doctors, other health care providers, and hospitals, and how much you must pay when you get care.

Special Needs Plans (SNPs): SNPs provide specialized and focused health care for specific groups of people, like those who have both Medicare and Medicaid, live in a nursing home, or have certain chronic medical conditions.

HMO Point-of-Service (HMOPOS) plans: These are HMO plans that may allow you to get some services out-of-network for a higher copayment or coinsurance.

Medical Savings Account (MSA) plans: These plans combine a high-deductible health plan with a bank savings account. Medicare will deposit money into the account (usually less than the deductible). You can use the money to pay for your health care services throughout the year. MSA plans do not offer any Medicare drug coverage. If you want drug coverage, you have to join a Medicare Prescription Drug Plan, Part C of Medicare.

To be eligible enroll in a Medicare Advantage plan you must have both Medicare Parts A and B and live in the plan’s service area. People with End-Stage Renal Disease (permanent kidney failure) generally cannot enroll in a Medicare Advantage Plan.

You must continue to pay your Part B premium and generally pay one monthly premium for the services included in a Medicare Advantage Plan. Each Medicare Advantage Plan has different premiums and costs for services, so it’s important to compare plans in your area and understand plan costs and benefits before you join. Some may have a $0 premium.

Medicare Advantage Plans have to cover all of the services that Original Medicare covers except for hospice care. Original Medicare will cover hospice care even if you are in a Medicare Advantage Plan. In all types of Medicare Advantage Plans, you will always be covered for emergency and urgent care. Medicare Advantage Plans must offer emergency coverage outside of the plan’s service area (but not outside the U.S.). Many Medicare Advantage Plans also offer extra benefits such as dental care, eyeglasses, or wellness programs.

Most Medicare Advantage Plans include Medicare prescription drug coverage (Part D). In addition to your Part B premium, you usually pay one monthly premium for both the plan’s medical and prescription drug coverage.

Remember, plan benefits can change from year to year. Make sure you understand how a plan works before you join.

Whether an “all-in-one” Medicare Advantage plan or a standalone Part D plan suits you, Ashford Insurance can help. Get a quote for prescription drug plans online now at now cost to you. Or, let one of our licensed agents review your options and find the best drug insurance plan for your unique needs. Just give us a call today at 817-952-3153.

Need help? Call us for an appointment at (817) 952-3153

Sonia, “The Medicare Insurance Lady”,  has been helping Medicare eligibles in Texas with their Medicare Insurance now since 2005. She has been married to John Ashford since 1982 and they reside in Bedford, Texas. They have six adult children and nine adorable grandchildren that they love to spoil. In Sonia’s limited spare time she enjoys quilting and crafting.