Medicare plans in Texas are designed to meet the healthcare needs of those over the age of 65 or who have specific disabilities or chronic illness. Original Medicare is administered directly through the federal government.

In this guide, we’ll walk you through the different types of Medicare plans and how to access your benefits. Alignment Health Plan is committed to providing you with affordable and comprehensive Medicare advantage insurance.

Original Medicare includes two parts, Medicare Part A and Part B.

Part A is hospital coverage. It is free for eligible Medicare beneficiaries. Part A is paid for by the Medicare tax taken out of employment checks.

Part B is doctor and other medical coverage. It requires a monthly premium.

Original Medicare does not cover health services like vision, hearing, dental, or prescription drug benefits. Medicare beneficiaries will have to decide between getting a Medicare Supplemental (Medigap) plan or a Medicare Advantage plan.

Medicare Advantage plans are provided by private insurance companies that work with the government to provide health services to Medicare beneficiaries. They are Part C health plans that include the benefits of Part A and B with additional health service benefits.

Alignment Health Plan offers Medicare Advantage plans in Texas that provide coverage for extra services like vision, dental, hearing, prescription drug coverage, and more.

Compare plans, enroll, or join us for a virtual or in-person seminar for more information. We’ll be happy to answer any of your Medicare Advantage questions. You’ll also have the opportunity to apply on the spot.

 

Types of Medicare Advantage Plans in Texas

There are three different types of Medicare Advantage plans in Texas that you can choose from based on your healthcare needs, budget, and lifestyle:

• HMO,
• PPO, and
• SNP

Health Maintenance Organization (HMO)

HMO plans give you access to hospitals and doctors within a healthcare network. You’ll select a primary care provider(PCP) in-network to provide essential and routine medical services.

On Medicare Advantage HMO plans, seeing a specialist or going to the hospital requires a referral from your PCP beforehand. Referrals ensure the visit is covered by insurance.

HMO plans typically include Part D (drug coverage), as well. For some drug prescriptions, your PCP will need to provide a prior authorization so that insurance covers the cost.

Insurance benefits are limited outside of the provider network. Some exceptions, like emergency care, out-of-area urgent care, and temporary out-of-area dialysis, may apply.

If you have any questions about referrals or seeing a specialist, please reach out to an Alignment Health Plan representative to get the assistance you need.

Preferred Provider Organization (PPO)

PPO plans allow you to choose both in-network and out-of-network providers. You’ll have the opportunity to choose your provider as long as they have not opted out of Medicaid Part A (hospital coverage) and Part B (doctor and other medical coverage). While you have the flexibility to choose out-of-network providers with a PPO plan, you’ll save money by visiting doctors, hospitals, and specialists in-network.

With a PPO Medicare Advantage plan, you may visit a hospital or a specialist without obtaining a referral. Seeing specialists and visiting hospitals out of network may result in a higher copay. Emergency visits are always covered with a PPO plan if you need it.

Special Needs Plans SNP

SNP plans are intended for Medicare beneficiaries with special need

We are happy to assist you in finding the right SNP for you specific needs. Contact an Alignment Health Plan representative today.

There are three types of SNP plans:

• Institutional SNP (I-SNP): For individuals needing long-term care, a nursing facility, intermediate care for those with intellectual disabilities, or an inpatient psychiatric facility.
• Dual eligibility (D-SNP): For individuals who qualify for Medicare and Medicaid.
• Chronic SNP (C-SNP): For individuals with chronic illnesses like end-stage renal disease (ESRD)

SNPs are offered as an HMO or a PPO plan. Learn more about the difference between HMO and PPO plans here.

All SNPs are required to provide Part D drug coverage.

SNP plans typically offer additional benefits like a grocery allowance and unlimited one-way trips to approved locations for qualified Medicare beneficiaries. Find out more about Special Needs Plans at Medicare.gov.

 

Plan Benefits that go Beyond Original Medicare

Medicare Advantage plans like Alignment Health Plan are a great way to fill in the gaps left by Original Medicare.

Coverage may include benefits like:

• Vision
• Dental
• Hearing
• Prescription
• Acupuncture
• Chiropractic services
• Transportation

Private insurance companies offer Medicare Advantage plans. You benefit from the breadth of healthcare providers and additional healthcare services. Medicare Advantage plans are designed to be both affordable and comprehensive in providing the best available health coverage.

 

When to Sign up for Medicare Advantage Plans in Texas

Initial Enrollment Period (IEP): You are first eligible to enroll in Medicare Part A and Part B the three months before you turn 65. You have three months before your birthday month, the month of your birthday, and the three months afterward to enroll in Medicare.

If you are applying for coverage because of a disability, the three months before or after the 25th month of receiving benefits (from Social Security or Railroad Retirement Board) is your election period to enroll.

Annual Enrollment Period (AEP): Every year, from October 15th to December 7th, you may join, switch, or drop plans. Your changes will take effect on January 1st if your request is submitted by December 7th.

Medicare Advantage Open Enrollment Period (OEP): Every year from January 1st - March 31st, you can switch to a different Medicare Advantage. You can also switch back to Original Medicare. You must already be enrolled in Original Medicare. You can only change plans once during this time frame.

It's important to note that you cannot be enrolled in a Medicare supplemental plan (or Medigap plan) and a Medicare Advantage plan.

 

Benefits of Alignment Medicare Advantage Plans

At Alignment Health Plan, we put our patients at the center of everything we do. By combining technology and compassionate care, we offer extensive and quality care over the phone, online, in the doctor’s office, and senior homes.

Medicare Advantage Plans in El Paso and Hudspeth County

We’ve created HMO, PPO, and HMO C-SNP plans to meet the needs of Medicare beneficiaries living in El Paso and Hudspeth County. Our goal is to connect you with the right healthcare services when you need them.

Let us help you find available plans in your area and sign up for benefits. Visit our Benefits Highlights page and fill out a short questionnaire to get started.