| Texas Medicare Advantage Plans: Is One Right For Me? |
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| Written by Danielle Kunkle |
| Friday, 15 April 2011 11:40 |
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Understanding the difference between Medicare Advantage plans (MA) and medicare supplements in Texas is often tricky. In essence, Texas Medicare Advantage plans are private Medicare health plans that pay for your medical services instead of original Medicare. Supplements pay some or all of the difference between what Medicare pays and what you owe; conversely, when you enroll in an MA plan, the plan pays for part of your care, and you pay the required coinsurance or copay for each different medical service.
Understanding the difference between Medicare Advantage plans (MA) and medicare supplements in Texas is often tricky. In essence, Texas Medicare Advantage plans are private Medicare health plans that pay for your medical services instead of original Medicare. Supplements pay some or all of the difference between what Medicare pays and what you owe; conversely, when you enroll in an MA plan, the plan pays for part of your care, and you pay the required coinsurance or copay for each different medical service. The Basics of How Medicare Advantage Works By enrolling in a MA plan, you commit to obtain your Part A, B, and sometimes D services/benefits from providers in the plan's network. Since your providers can no longer bill Medicare when you have joined a MA plan, you can store your Medicare card away in a protected place for as long as you remain enrolled the plan. Each time you access a medical service, you will share in the costs of that service as stated in the plan's summary of benefits. For instance, you might pay $5 or $10 for a primary care doctor visit, $30 or $40 for a specialist visit, and $100 for an ambulance ride, and so on. Thoroughly review a plan's summary of benefits before enrolling. Ask yourself these questions to narrow your search: Can I afford the monthly premium, if any, for this plan? Are my preferred doctors and hospitals in the network or accepting this particular plan? Can I afford the cost-sharing required if I develop a chronic illness? Does the plan also cover my Part D drugs? Often, your risk tolerance and your attachment to certain providers can help guide you toward the plan that is right for you. How Do I Know Which Doctors I Can See? HMO or PPO-style plans are common among MA options in texas. To see if your doctors are in the network, you can access an online directory of treatment providers. Some plans require you to get referrals from a primary care doctor before seeking treatment at a specialist or being admitted to the hospital, so be sure you understand the rules of the plan you choose. Some Texans opt for an MA PFFS plan, which allow you to obtain care from any medical provider that agrees to the plans terms and will send the billing to the plan instead of the federal government. Do I Have to Pay a Monthly Premium For Medicare Advantage? The monthly premium for each plan varies, and you pay this amount in addition to the Part B premium that you pay to social security. In Texas, we are lucky to have plans in certain counties that have premiums as low as $0. This doesn't actually mean the plan is free - it just means that the plan is receiving a high enough remibursement from the federal government that it has chosen not to charge you, the member, any additional premium. Determining which plan is right for you can often be overwhelming. Plans are offered based on the county of your residence, and have a wide array of ancillary benefits such as routine vision coverage or hearing exams. A word of caution: the benefits of each plan change from one year to the next. If you opt for an MA plan, be prepared to spend a little time each autumn reviewing what changes are happening from one year to the next in the plan's premiums, copays, network and drug formulary. Since this takes considerable time, you would do well to establish a relationship with an insurance agent who focuses on these senior health insurance products. The price you pay for the benefits you receive is exactly same if you use an agent, but you enjoy the added benefit of having an experienced advisor to help you with changing Medicare needs over the years. DISCLAIMER: This article is provided as information only and is not to be taken as financial advice. Looking to find a great medicare advantage plan in Texas ? Then visit www.texasmedicareplan.com to find information about Texas Medicare Advantage Plans. |