Last Updated on July 26, 2024 by Team Experts

It can be difficult for any country or state to ensure that every single member of the population has adequate Medicare coverage. That said, the state of Texas has shown real progress in this regard. 

In 2022, more than 4.3 million residents have enrolled themselves in Medicare. Even better, Medicare Advantage Plans in Texas have increased considerably as compared to 2021. 

So, you shouldn’t be facing any trouble getting Medicare Texas. However, when it comes to finding the right medicare plan in Texas, you may need to conduct in-depth research. 

Find out whether the original plan you’re entitled to offers all the benefits pertaining to your health. Should you stick to the original plan or opt for Medicare Advantage plans that are flexible and customizable in nature? 

This is why choosing the best Medicare plan isn’t as easy as you think. Several variables must be considered before enrolling in an insurance program.

In this article, we will discuss several important aspects of Medicare Advantage and Original Medicare insurance plans. It will help you determine why the former would be better suited for your needs.

So, let’s start exploring.

Everything You Should Know About Medicare

Medicare is a federal health program in the United States that provides healthcare services for Medicare-eligible and reduces overall costs.

You will have to apply for Medicare in Texas, but you should know that the Centers for Medicare & Medicaid Services, a federal program, regulate this healthcare insurance system. This means that Medicare functions similarly across the country, regardless of whether you’re in Texas.

According to a report, more than 4.3 million people are enrolled in Medicare Texas health program. This accounts for 14% of Texas’s population, which is massive for any healthcare program, national or otherwise.

There has been an ongoing debate on social and mainstream media about switching from Original Medicare to Medicare Advantage. This is mainly because you can switch to open enrollment during specific times of the year.

In fact, according to a report, in 2022, 50% of the people eligible for Original Medicare switched to Medicare Advantage. Moreover, this number is expected to increase by 2032 when 70% of the beneficiaries switch to Medicare Advantage insurance plans.

However, if you are wondering what Medicare Advantage and Original Medicare are, continue reading.

Medicare Advantage & Original Medicare

If you’re signing up for Medicare for the first time or during certain times of the year, such as right before winter, you can choose how to get your Medicare coverage.

There are two ways to buy a Medicare plan. Either you choose Original Medicare or Medicare Advantage.

What is an Original Medicare healthcare insurance plan?

The Original Medicare insurance plan is divided into two parts, which includes

• Part A – Health insurance
• Part B – Hospital Insurance

This fee-for-service health plan involves you paying a deductible and coinsurance. Once you have paid your share of the insurance, Medicare pays the approved cost determined by the insurance plan.

It doesn’t cover drugs or prescriptions. So, you will have to get a separate drug plan, also known as Part D, to cover that part of your treatment.

What is the Medicare Advantage healthcare insurance plan?

The Medicare Advantage healthcare plan is a Type C health insurance plan in which a private company collaborates with Medicare. This type of healthcare plan includes Part A and Part B health insurance and Part D.

A Medicare Advantage health insurance plan offers several other benefits that an Original Medicare plan usually doesn’t cover.

When choosing a Medicare program, it is imperative to make a conscious choice because it will determine how much money you will pay for your health insurance out of your pocket. Not to mention, it will also determine,

• The services you get
• The doctors you can go to
• The quality of health care you’re assisted with

So, you need to learn everything you can about the Medicare programs through online sources and from your friends and family. You should also compare different Texas Medicare Advantage plans to learn more about them and make a wise decision.

Everything You Should Know About Original Medicare Health Insurance Plan

Here is everything you must know about the Original Medicare health insurance program.

Coverage

• The Original Medicare Health Insurance plan includes Part A (Hospital Insurance) and Part B (Medical Insurance) plans.
• You can also sign up for a Part D (Drug Insurance) plan if you want to, but that will have to be purchased separately.
• The Original Medicare health program allows you to go to any doctor in the United States that takes the Medicare health program.
• The Original Medicare allows you to shop for supplemental coverage to pay for the 20% of coinsurance you have to pay out of your pocket.
• Most of the time, you will not need a referral to see a specialist.

Cost

• As far as the cost is concerned, if you’re opting for a Medicare Original health plan that covers Part B, you will have to pay the 20% of your total cost once you have met your deductibles.
• You must also pay a set monthly amount for health insurance. You must pay for the drug plan separately monthly if you buy Part D.
• Medicare Original doesn’t have a limit on how much you have to pay out of pocket every year unless you have purchased Supplemental Medical Coverage.
• You can get a previous employer or union to cover the 20% of medical costs.

Foreign Travel

Medicare usually doesn’t cover health insurance outside of the USA. However, you can purchase Supplemental Medical Insurance in case of an emergency when travelling to foreign countries.

Everything You Should Know About Medicare Advantage Health Insurance Plan

Here is everything you must know about the Medicare Advantage health insurance plan.

Coverage

• In most cases, if you opt for a Medicare Advantage health program, you can only go to doctors that fall under the network’s service area.
• For emergency cases, you can go to doctors that don’t come under the network or service area but at a higher cost.
• You might also have to get a referral to see a specialist.
• The Medicare Advantage also includes Part D; you don’t have to buy a separate drug plan.

Cost

• The cost varies from case to case. Sometimes, it will be less, while others may have to pay a higher out-of-pocket cost.
• You pay the monthly Part B premium and may also have to pay the plan’s premium. However, some plans may have a $0 premium and help pay all or part of your Part B premium. In addition, most plans include Medicare drug coverage (Part D).
• The Medicare Advantage has a set limit for the amount you pay every year out of your pocket. Once you reach that limit, the Part A and Part B insurances will cover your healthcare costs for the rest of the year.
• It also covers the cost of all medically needed supplies that, in some cases, Medicare Original doesn’t cover. In addition, Medicare Advantage also offers additional treatments that Medicare Original doesn’t cover, including dental, hearing, and vision treatment.

Foreign Travel

Medicare Advantage doesn’t cover foreign travel. However, you can get Supplemental Medical Coverage in an emergency when traveling to foreign countries.

How to Get Medicare in Texas?

If you’re wondering how to get Medicare in Texas, you will first have to figure out whether you’re eligible for health insurance.

The eligibility criteria for Medicare, Texas, depends on your age or the eligibility of your disabilities as determined by the Social Security Administration.

Qualifying for Medicare Advantage Plans in Texas

You are eligible for Medicare Advantage plans in Texas and the rest of the United States if you meet even one of the following criteria.

• You are above the age of 65.
• You are younger than 65 but have eligible disabilities as determined by Social Security Administration.
• You have End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS).

Why Choose Medicare Advantage?

There are various reasons why you should choose Medicare Advantage over Original Medicare, including,

• It is very much affordable and offers excellent value for the money.
• It is straightforward and convenient.
• The quality and service are top-notch.

Final Verdict

As you have read, getting Medicare Advantage in Texas is no biggie as long as you are eligible, determined by the criteria set. It is excellent due to the fixed cost and the fact that there is an annual limit for the fees that you have to pay.

Moreover, you get hospital care, medical services, and prescription care all in one insurance plan, making it all worth buying. The plan also covers emergency health issues worldwide, which means you will not have to get separate travel insurance if you get this one.

Medicare offers 24/7 customer care. So, if you have confusion any time of the day, you can always get in touch with the CSR and ask them for answers to all your queries. The quality is also unmatched and offers 100%-member satisfaction.

Health insurance is imperative today if you look at how the cost of living is multiplying daily. The last thing you need is an added burden of medical costs to improve the quality of living. This is why it would be wise to opt for Medicare insurance plans.

They are convenient, easy, and very functional, covering all significant health aspects and improving the quality of life.

Read more: Choosing and Arranging Health Insurance for Employees