Health

Medicare Advantage Plans: Do You Need Them?

Are you looking for the perfect Medicare plan that is just right for your life, as well as your budget? This decision may seem nerve-wracking, but we’re here to clear all doubts.

Read on ahead.

As you near the age of 65, you will enroll yourself into a Medicare, Texas program. Chances are you will put off your Medicare coverage temporarily, such as when your partner retires, but at the end of the day, you will sign up for it. 

And when it comes to that, you will be brought forward two options:

  • Original Medicare, including Part A (hospital coverage) and Part B (medical coverage)
  • Medicare Advantage

You or someone from your family might be using original medicare plans because they’re quite common. That said, Medical Advantage plans may prove to be more beneficial. That, you can find out in the following lines. 

Growing Popularity of Medicare Advantage Plans 

If you live in Texas, you should check out Medicare Texas plans as they’re growing popular every day –  and for all the right reasons. Medicare Advantage is a private Medicare plan. It is a balanced hybrid of Medicare with Insurance. 

Medicare Advantage Plans (MA Plans) cover benefits from Plans A and B and often stretch out to further benefits. This is why Medicare Advantage plans are also termed as “Part C” . 

Medicare-approved private companies that offer Medicare Advantage Plans are obligated by law to provide the same amount of benefits as the Original Medicare Plan. However, what sets them apart is the wider scope of coverage. 

But what you might want to know is:

  • How Medical Advantage plans work
  • What makes them similar to original plans and what are the differences
  • What benefits they offer, 
  • How you can qualify for these plans

So, let’s get started.

How Do Medicare Advantage Plans work?

Both, Medicare Advantage and Original Medicare Plan include hospital insurance (Part A) and medical insurance (Part B). Both Medical Advantage Plans and Original Medicare Texas will cover your doctor visits, hospital bills and medical services.  

Source: Pexel 

However, there are some apparent differences in the operations of Texas Medicare Advantage Plans and Original Medicare. These include: 

Doctor Visits

  • Original Medicare: Usually, you do not require a referral to visit a specialist. If any hospital accepts Medicare in Texas, you can see the doctor without a referral.  
  • Medicare Advantage: Typically, you have to utilize the plan’s in-network hospitals and doctors, and during non-emergency cases, you would require a referral to go and visit a specialist. 

Cost

  • Original Medicare: Usually, you are required to pay 20% coinsurance once you have reached your deductible (payment limit before your insurance supports). However, it comes with no out-of-pocket spending. 
  • Medicare Advantage: The Medicare Advantage Plan cost varies from service to service based on your Medicare in Texas. However, there will be a yearly limit to how much you spend, unlike the Original Medicare. 

Now that we understand how the costs and doctor visits work, let’s talk about the benefits. 

Medicare Advantage Plan Benefits

Compared to the Original Medicare Plan, the Medicare Advantage Plan comes with its set of added benefits. They will help you find out if you’re eligible for a Texas Medicaid application or not. 

Dental, Hearing and Vision Coverage. 

The elderly need to get regular dental, hearing and vision checkups. With age, these elements deteriorate, but that doesn’t mean you should let go of them. With regular check-ups, you can avoid problems before they even occur. 

However, in Original Medicare, you do not receive coverage for dental, hearing or vision medication, aside from the ones you might receive during your hospital visit. On the other hand, you may receive routine checkups and even cleanings for dental services, or hearing and vision in Medicare Advantage Plans, in Texas.

Over-the-Counter Medication 

With the Original Medicare Plan, you might also be required to get your own supplemental plans per your coverage. However, with Plan C, you get the advantages of Plan D as well. Which means you can get coverage for OTC medication. This is helpful in old age, and you can avoid the extra out-of-pocket costs associated with OTC.

Source: Pexel 

Plan C comes with a myriad of perks. The best part is most offer prescription drug coverage. This means you are not required to enroll in a separate medication coverage program. 

Doctor Transportation 

In old age, where you don’t have much support, a Medicare Advantage Plan gives you just the right kind of support that you need. If you have a doctor’s appointment and no one to take you, then Plan C also covers that problem by providing transportation to the doctor, so all you can care about is your health.

Gym and Discounts

With age, you may become physically inactive. And unlike the Original Medicare Plan, Plan C offers Gym Memberships and discounts on other health and wellness-promoting services. 

Now you can be healthy and fit to live a longer and bountiful life without worrying about gym memberships and the hassle associated with it. Other than that, you can also pick benefits as per your requirement. 

Tailor-Made Plans

You must have heard about “bundled plans”, right? Well, Medicare Advantage Plans are the same. 

With condition-specific treatments, they can can also be customized, offering you with a mix of Original Plan and other benefits. 

For example, Medical Advantage Plans in Texas may cover the following: 

  • Hospice care 
  • Skilled nursing facilities
  • At-home Medicaid in Texas.

This flexibility lets you tailor-make your own plans, which is a significant benefit for chronically-ill patients.

Before enrolling on any plan, you must check if you qualify for your requirements. Also, check Medicaid eligibility in texas to see whether or not it comes with any limitations. 

How to Pick the Right Medicare Advantage Plan for Yourself

As we know, no two people are alike. Similarly, everyone requires extra medical attention. So, why pick a generic plan? Please choose the best Medicare Advantage Plan that suits you most, as it would be one of the most important personal decisions you would have to make. 

With the many benefits and health options, you also have a lot of Medicare Advantage Plan choices to pick from. And that may not be an easy choice to make. But don’t worry, we are here to help you select the best Medicare Advantage Plan in Texas that suits your life budget and medical needs with perfection. 

Wondering how to apply for medicare in Texas? Following are the several types of the best Medicare Plans available, with varied benefits for each. 

Source: Pexel

Health Maintenance Organization (HMO) Plans

These require you to receive care from in-network hospitals and providers. With the exception of emergency cases, temporary out-of-area dialysis and out-of-area urgent care. 

As you enroll in HMO, you may be required to pick a primary care doctor who will further refer you to see specialists if needed. 

Organisation (PPO) Plans

In a PPO plan, you do not have to pay a high price for an in-network care provider. However, if you seek an out-of-network hospital or doctor, you may be required to pay a higher cost. 

You will always be catered to and covered for emergency cases, as well as urgent care. However, a PPO plan does not require you to pick a primary care doctor, nor do you need referrals to seek specialists in most cases.

Private Fee-for-Service (PFFS) plans

In the PFFS, the plan sets the cost of how much you are required to pay health care providers — also how much you pay for hospitals and care. 

Most plans allow you to receive care from any hospital or doctor in Texas, while others may have a specific in-network provider.

No need to worry about those complications, though. Because if you seek urgent care or have an emergency case, you will be treated regardless. You are not required to pick a primary care doctor, not need referrals to reach specialists.

No matter what plan you pick, you should always check if it covers prescription medicines. Most do, but not many. Plan D, a separate Medicare that covers prescription medicines, is not always available to Advantage Medicare Plan enrollees. So it would help if you were careful of that.

Special Needs Plans (SNPs)

As the name suggests, special needs plans are only limited to a specific group of people. 

These include patients with specific disabilities and diseases, such as HIV/AIDS, end-stage renal disease (ESRD), and some autoimmune, neurological or lung disorders. As well as people residing in nursing homes or hospital facilities are also eligible for Medicaid and Medicare. 

Several SNPs may cover out-of-network services, while others might not. Most services require you to have a primary care doctor, and you would need a referral to a specialist often. All SNPs providers are obligated to provide drug coverage.

Conclusion

The decision of your Medicare Advantage Plan coverage is up to you. The plan that may seem perfect for others may not be the right choice for you. However, we hope this guide helped you understand whether or not you need a Medicare Advantage Plan. And if you need it, what is the best way to pick the right one for yourself?  

The guide covered all the benefits and different plans to help you make a well-thought and confident decision so that you can live a healthy and stress-free life ahead. 

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