What are Medicare Advantage Plans?
Medicare Advantage (MA) plans, also referred to as Medicare Part C, are an alternative way to get your Medicare Part A and Part B coverage. Most Medicare Advantage plans include vision coverage and dental coverage. Some plans also provide enrollees innovative benefits such as wellness and healthcare planning, reduced cost-sharing, and rewards and incentive programs. These are plan benefits that Original Medicare (Parts A & B), alone, do not provide.
Based on your county service area, you could have a few options for Medicare Advantage plans or an overwhelming number of options—like 55 in Harris County. The table below highlights how many options might be available to you—depending on where you live.
Read more about the benefits of Medicare Advantage plans in Texas, how much plans may cost, and when to enroll.
[Table] 2021 Number of Medicare Advantage Plans for Top 20 Texas Counties
|Texas County||Most Populous City||Number of Plans Available|
|Bexar County||San Antonio||46|
|Tarrant County||Fort Worth||45|
|El Paso County||El Paso||38|
|Fort Bend County||Sugar Land||48|
|Williamson County||Round Rock||36|
|Nueces County||Corpus Christi||24|
|Galveston County||League City||39|
Where are Medicare Advantage Plans Most Popular in Texas?
Medicare Advantage plans help you control costs and have extra benefits. No wonder they are a popular choice for older Americans in Texas and across the United States. As of June 2021, 42% of all U.S. Medicare beneficiaries are enrolled in a Medicare Advantage plan.
In Texas, 45% of Medicare beneficiaries chose to enroll in a Medicare Advantage plan in 2021. The average enrollment in Texas is a bit higher than the national average. Wondering what percentage of older Americans are enrolling in a Medicare Advantage plan in your county?
In 2021, the 10 Texas counties with the highest Medicare Advantage enrollment are El Paso County (66%), Hidalgo County (64%), San Patricio County (59%), Starr County (58%), Nueces County (58%), Cameron County (58%), Willacy County (57%), Kleberg County (57%), Zavala County (56%), and Jim Wells County (56%).
These counties are all well above the national and Texas state averages for Medicare Advantage plan enrollment. The table below shows the counties with the most Medicare beneficiaries, along with the population and percentage of Medicare Advantage enrollment. Scroll down to see if your county is listed.
[Table] Top 20 Most Populous Medicare-Eligible Texas Counties & Medicare Advantage Plan Enrollment
|Texas County||Total Number of Medicare Beneficiaries||Medicare Advantage Enrollment (Population)||Medicare Advantage Enrollment (Percentage)|
|Harris County||567,107||299,573||53 percent|
|Dallas County||328,145||150,023||46 percent|
|Bexar County||303,158||155,334||51 percent|
|Tarrant County||282,260||142,398||50 percent|
|Travis County||142,516||52,899||37 percent|
|El Paso County||133,543||88,395||66 percent|
|Collin County||125,973||45,656||36 percent|
|Hidalgo County||107,901||68,517||64 percent|
|Denton County||104,647||40,635||39 percent|
|Fort Bend County||102,485||47,916||47 percent|
|Montgomery County||94,298||42,918||46 percent|
|Williamson County||84,176||32,459||39 percent|
|Cameron County||65,501||37,947||58 percent|
|Nueces County||61,465||35,621||58 percent|
|Galveston County||59,089||25,051||42 percent|
|Bell County||54,382||22,143||41 percent|
|Brazoria County||52,984||24,034||45 percent|
|Lubbock County||47,615||21,303||45 percent|
|Smith County||46,900||18,148||39 percent|
|McLennan County||45,533||19,926||44 percent|
How Much Do Medicare Advantage Plans Cost in Texas?
The lowest monthly premium for a Medicare Advantage plan is $0. In 2021, the average monthly Medicare Advantage premium for those with a premium is $11.42. For Medicare Advantage Prescription Drug (MAPD) plans nationwide, the premiums vary by plan type.
In 2020, the Kaiser Family Foundation noted that premiums average $20 per month for HMOs, $32 per month for a local PPO, and $47 per month for regional PPOs. Nearly 61% of Medicare Advantage beneficiaries enrolled in an HMO, 33% were in local PPOs, while only 5% were enrolled in regional PPO plans.
When you enroll in a Medicare Advantage or MAPD plan, you’ll be responsible for out-of-pocket costs, including premiums, health and prescription drug coverage deductibles, and copays. You’ll continue to pay your Original Medicare Part B premium to Medicare or by a monthly withdrawal from your Social Security Benefit. Medicare Advantage and MAPD premiums are paid directly to the plan provider.
Plan costs vary widely and are subject to the county in which you live. Below you’ll find a table with the top 20 most populous Medicare-eligible Texas counties.
Review the table to see how many Medicare Advantage plans with a $0 premium are available in each county, the plan premium range, the annual Part D deductible range, and the maximum out-of-pocket maximum per year.
Are you not sold on a Medicare Advantage plan? Are you considering keeping Original Medicare Parts A & B but need a plan to cover the unpredictability of out-of-pocket costs? Read more about Medigap plans.
[Table] Average Medicare Advantage Plan Costs in the Top 20 Counties in Texas
|Texas County||Number of Plans With $0 Premium||Plan Premium Range||Annual Part D Drug Deductible Range||In-Network Out-of-Pocket Maximum per Year Range|
|Harris County||36||$10 - $199||$100 - $445||$2,600 - $7,550|
|Dallas County||32||$10 - $200||$150 - $445||$2,500 - $7.550|
|Bexar County||32||$10 - $96||$150 - $445||$2,999 - $7,550|
|Tarrant County||27||$10 - $200||$150 - $445||$2,500 - $7,550|
|Travis County||16||$15 - $93||$175 - $445||$2,999 - $7,550|
|El Paso County||27||$10 - $96||$175 - $445||$2.900 - $7,550|
|Collin County||29||$10 - $200||$175 - $445||$2,500 - $7,550|
|Hidalgo County||18||$10 - $96||$175 - $445||$2,000 - $7,550|
|Denton County||29||$10 - $200||$150 - $445||$2,500 - $7,550|
|Fort Bend County||32||$10 - $96||$100 - $445||$2,999 - $7,550|
|Montgomery County||32||$10 - $93||$100 - $445||$2,999 - $7,550|
|Williamson County||19||$14 - $242||$50 - $445||$2,999 - $7,550|
|Cameron County||16||$10 - $96||$175 - $445||$3,400 - $7,550|
|Nueces County||13||$10 - $96||$175 - $445||$2,999 - $7,550|
|Galveston County||26||$10 - $93||$100 - $445||$3,000 - $7,550|
|Bell County||9||$37 - $242||$50 - $395||$4,500 - $7,550|
|Brazoria County||19||$10 - $93||$100 - $395||$3,000 - $7,550|
|Lubbock County||9||$10 - $96||$175 - $445||$3,450 - $7,550|
|Smith County||9||$20 - $93||$150 - $395||$4,400 - $7,200|
|McLennan County||9||$10 - $242||$50 - $395||$4,500 - $7,550|
What Are Your Medicare Advantage Plan Options in Texas?
In Texas, there are two primary types of Medicare Advantage plans; either a Health Maintenance Organization (HMO) or a Preferred Provider Organization (PPO). HMOs and PPOs use networks of hospitals, doctors, and other healthcare professionals.
Both plan types are available through private insurance companies that contract with Medicare. To be eligible for a Medicare Advantage HMO or PPO, you must have Medicare Part A and Part B and live in the plan’s service area. For both plans, prescription drug coverage is usually included, and plans may have preferred pharmacy networks.
What is the Best Medicare Advantage Plan in Texas?
There isn’t a one-size-fits-all or “best” Medicare Advantage plan in Texas or anywhere in the U.S. If there’s a source telling you there is, they aren’t looking out for what’s best for your health and finances. Your Medicare health plan choice will come down to a mix of cost and benefits—and should be tailored to your needs.
If the lowest premium possible is your primary concern, then a Medicare Advantage HMO plan might be the best health insurance choice for you. Your costs are generally lower than a PPO. However, if having maximum flexibility is most important, you may choose a Medicare Advantage PPO with slightly higher costs.
While determining which is essential, you’ll also want to weigh whether maintaining existing relationships with doctors, hospitals, or other care providers is vital to your health care. You’ll want to check if your preferred healthcare providers are participating in the Medicare Advantage plan’s network before committing.
There is a lot to consider. Do you need help ensuring that you pick a plan that’s the right mix of costs and benefits or ensuring you have access to existing providers and prescriptions? Have a local Medicare agent guide you through the process.
The Medicare Advantage Star Rating System
Did you know that every Medicare Advantage plan is rated annually? The Centers for Medicare & Medicaid Services (CMS) publishes Medicare Advantage (Medicare Part C) Star Ratings every year.
The Star Rating system measures the quality of health and prescription drug services received by Medicare beneficiaries enrolled in the plans. The plans are measured by five categories, on a scale of 1 to 5—with 5 being the best: customer service, preventative care, managing chronic conditions, plan responsiveness, and member complaints, including those when leaving the plan. The Star Rating system can help narrow your Medicare plan choices.
Approximately 49 percent of Medicare Advantage Prescription Drug plans earned four stars or higher for their 2021 overall rating. That means that about 77 percent of MA-PD are currently enrolled in a plan that has four or more stars in 2021.
Make sure you choose a plan with a high Star Rating and the right mix for your budget and health. A local Medicare agent can ensure that you get all that while maintaining relationships with your doctors and the prescription drugs you depend on.