A Medicare Advantage PPO (Preferred Provider Organization) plan is a type of Medicare Advantage plan in Texas that enables greater network coverage and flexibility. These plans are available through private insurance companies and regulated by the Centers for Medicare and Medicaid Services (CMS). Medicare Advantage PPO plans often have a network of preferred providers, but you can choose doctors or hospitals from outside the network at a higher cost.
When you select a Medicare Advantage PPO plan in Texas, you:
Won’t need to choose a Primary Care Physician (PCP) or receive referrals to specialists.
Have greater flexibility in selecting where and from whom you receive care.
Typically have higher premiums and out-of-network costs (copayments and coinsurance) compared to a Medicare Advantage HMO plan.
Need to keep better records and take a more active role in coordinating your care.
Typically have prescription drug coverage included, and you cannot purchase standalone Part D prescription drug plans.
May have a preferred pharmacy network.
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Alternatively, Medicare Advantage HMO plans require that you stay in-network unless there is an emergency and require that you have a Primary Care Physician (PCP) who provides referrals for services.
With PPO plans, you then have the option of choosing between a regional or local PPO provider.
What is a Regional PPO Medicare Advantage Plan?
Once you’ve determined that you’re interested in a Medicare Advantage PPO plan, you need to weigh whether you want a Regional PPO or a Local PPO plan.
A Regional PPO serves a single state or multi-state area, while a Local PPO serves a single county or group of counties within a single state. Both types of PPOs have a maximum out-of-pocket limit for all in-network care and a combined in-network and out-of-network out-of-pocket limit. And both of their monthly premiums start at $0.
The primary difference between Regional PPO and the Local PPO plan is the size of the network. A Regional PPO has a more extensive network of providers and can, typically, better meet the needs of Medicare beneficiaries in rural areas.
As you evaluate Medicare in Texas, a local licensed agent can help. A Connie Health advisor can review your health and budget needs to help uncover the right plan for your unique situation. Call (623) 223-8884 to speak with an agent.
Agent tip:
“Because a plan is popular in your county doesn’t mean it’s the right plan for you. To discover that, you should meet with a local licensed agent who will review your health needs, doctors, specialist, prescriptions, and more to determine the best fit for your health and budget.“
Top 5 Medicare Advantage PPO Insurance Companies in Texas by Enrollment
Not all PPO plans are available in your area. Plan availability is based on the county and zip code that you live in. However, five Medicare Advantage PPO insurance providers are enrolling the most people in Texas.
The five most popular Medicare Advantage PPO providers are:
What is the Best Medicare Advantage PPO Plan in Texas?
Because Medicare Advantage PPO plan availability is based on the county you reside in; every state plan is not available to you. We’ve taken the time to comb through the data to discover the most popular Medicare Advantage PPO plans in counties throughout Texas.
Remember that just because it’s the most popular plan in your county doesn’t mean it’s the right plan for you. To discover that, you should meet with a local licensed agent who will review your health needs, doctors, specialist, prescriptions, and more to determine the best fit for your health and budget.
Continue reading to discover which plans have the highest enrollment in the Greater Houston, San Antonio, Austin, and Dallas-Fort Worth counties.
Top Medicare Advantage PPO Plans in Greater Houston Counties
Most Popular Medicare Advantage Plans in Austin County
In Austin County, Texas, local PPO plans are the most popular Medicare Advantage PPO plan option; however, there is one popular regional PPO plan. These are the top 5 plans by enrollment:
Care Improvement Plus South Central Insurance Co. (UnitedHealthcare) / R6801 Dual Complete Choice (Regional PPO)
Most Popular Medicare Advantage Plans in Chambers County
In Chambers County, Texas, the most popular PPO plans are local; however, if you’re dual-eligible, there is one popular regional PPO plan for you to consider:
Aetna Life Insurance Company / H5521 Medicare Premier Plan (Local PPO)
Most Popular Medicare Advantage Plans in Grimes County
In Grimes County, Texas, local Medicare Advantage PPO plans are the most popular choice unless you’re dual-eligible. If you are, there is one popular regional choice:
Most Popular Medicare Advantage Plans in Montgomery County
Montogomery County, Texas, prefers to enroll in a local Medicare Advantage PPO versus a regional PPO. All five of the county’s popular plans are local PPOs:
Most Popular Medicare Advantage Plans in Walker County
In Walker County, Texas, four out of the five most popular Medicare Advantage PPO plans are local PPOs, except for one regional PPO dual-eligible plan:
Top Medicare Advantage PPO Plans in San Antonio & Austin Counties
Most Popular Medicare Advantage Plans in Atascosa County
In Atascosa County, Texas, the majority of Medicare beneficiaries choose a Medicare Advantage local PPO plan unless they required a special needs plan. One popular dual-eligible plan made the top 5 for enrollment:
Care Improvement Plus South Central Insurance Co. (UnitedHealthcare) / R6801 Dual Complete Choice (Regional PPO)
Aetna Life Insurance Company / H5521 Medicare Premier Plan (Local PPO)
Most Popular Medicare Advantage Plans in Bandera County
In Bandera County, Texas, four of the five most popular plans are Medicare Advantage local PPO plans. One plan is a regional PPO for those that are dual-eligible:
Humana Insurance Company / R4182 HumanaChoice (Regional PPO)
Most Popular Medicare Advantage Plans in Bexar County
The most popular Medicare Advantage plans in Bexar County, Texas, are local PPO plans. Not a single regional PPO plan makes the top 5 list for enrollment:
Most Popular Medicare Advantage Plans in Frio County
Frio County, Texas, Medicare beneficiaries choose to enroll in a mix of local and regional PPO plans. Three plans are local PPOs, one is a regional PPO, and another is a regional PPO for dual eligibles:
Humana Insurance Company / R4182 HumanaChoice (Regional PPO)
Aetna Life Insurance Company / H5521 Medicare Premier Plan (Local PPO)
Most Popular Medicare Advantage Plans in Guadalupe County
In Guadalupe County, Texas, most people who enroll in a Medicare Advantage PPO plan choose a local PPO plan, with one exception. Those who need a dual eligible plan are selecting a regional PPO plan:
Aetna Life Insurance Company / H5521 Medicare Premier Plan (Local PPO)
Most Popular Medicare Advantage Plans in Wilson County
In Wilson County, Texas, when enrollees are weighing their options between a local and regional PPO plan, they’re likely to choose a local Medicare Advantage PPO plan:
Most Popular Medicare Advantage Plans in Dallas County
In Dallas County, Texas, most Medicare Advantage PPO plan enrollees choose a local PPO versus a regional PPO plan. The one exception is if you are dual eligible:
Most Popular Medicare Advantage Plans in Denton County
When Denton County, Texas, Medicare beneficiaries are choosing a Medicare Advantage PPO plan, they are most likely going to select a local PPO plan versus a regional PPO plan:
Most Popular Medicare Advantage Plans in Ellis County
Four out of five of the most popular Medicare Advantage PPO plans in Ellis County, Texas, are local PPOs, not regional. One exception is those needing a dual eligible PPO plan:
Aetna Life Insurance Company / H5521 Medicare Premier Plan (Local PPO)
Care Improvement Plus South Central Insurance Co. (UnitedHealthcare) / R6801 Dual Complete Choice (Regional PPO)
Most Popular Medicare Advantage Plans in Hunt County
In Hunt County, Texas, beneficiaries choose a mix of Medicare Advantage PPO plans that are local and regional. Two of the five most popular plans are regional, one for dual eligible needs and the other is a regional PPO option:
Most Popular Medicare Advantage Plans in Jack County
In Jack County, Texas, there are fewer Medicare Advantage plan options than in other counties. Of the top four Medicare Advantage PPO plans, the top plan is for dual eligible coverage, while the remaining three are a mix of local and regional PPO plan options:
Care Improvement Plus South Central Insurance Co. (UnitedHealthcare) / R6801 Dual Complete Choice (Regional PPO)
Aetna Life Insurance Company / H5521 Medicare Premier Plan (Local PPO)
Care N’ Care Insurance Company, Inc. / H6328 Care N’ Care Choice (Local PPO)
Most Popular Medicare Advantage Plans in Kaufman County
In Kaufman County, Texas, Medicare Advantage PPO enrollees choose both local and regional PPO plans. The top 5 plans also include a plan for those who are dual-eligible:
Most Popular Medicare Advantage Plans in Palo Pinto County
In Palo Pinto County, Texas, the top five Medicare Advantage PPO plans are a mix of local and regional PPO plans. These include local PPO, regional PPO, and one dual eligible regional PPO plan:
Aetna Life Insurance Company / H5521 Medicare Premier Plan (Local PPO)
Most Popular Medicare Advantage Plans in Wise County
In Wise County, Texas, most Medicare beneficiaries choose a Medicare Advantage local PPO plan versus a regional PPO plan. However, if you are dual eligible, you might select the regional PPO plan:
Not sure what the right plan for your health needs and budget is? Connie Health is here to help throughout your Medicare journey. Together, we can sift through all of your plan options and ensure you’re enrolled in a plan that has the doctors, specialists, and medications you need, at a cost that you can afford.
A Connie Health advisor can review your health and budget needs to help uncover the right plan for your unique situation. Call (623) 223-8884 to speak with an agent.
I am a Spanish-speaking Texas Life and Health Insurance Licensed Agent and have been helping people with Medicare since 2011. When not working, you can find me exploring new places in the Lone Star State, or watching movies and TV shows.