Texas Medicare Advantage Programs

Medicare is a federal health insurance program targeted at senior citizens. Medicare is designed for people who are 65 years or older, although those younger than 65 may be eligible if they have certain disabilities or health problems. Medicare Parts A and B cover hospice care, home health and hospital services. However, they don't offer other health services such as vision, dental and prescription drugs. For those, citizens need to purchase a Medicare supplement or Medicare Advantage plans through private companies. Texas allows a variety of Medicare Advantage policies offered in different ways.

Medicare Advantage HMO Plans

• Health maintenance organization, or HMO, plans generally require customers to use health-care providers who are part of their network or under contract to the HMO. People who use HMOs must choose a primary care physician who is part of the network, and this doctor must provide all referrals to other providers such as cardiac specialists or surgeons. Medicare Advantage plans in Texas are offered according to county. Texas HMO Medicare Advantage plans are usually offered around major cities and urban areas, as Texas is a big state, and laws require that an HMO network must be within a certain traveling distance from members. HMO plans usually have lower monthly premiums than other kinds of Medicare Advantage, but you may have to give up your current doctor if he's not part of the network.

Medicare Advantage PPO Plans

• Preferred provider organization, or PPO, plans also use a network, but usually don't require that all referrals go though your primary care physician. Customers can usually go outside the network for services if they agree to pay higher costs. PPOs are also usually offered around the major cities in Texas. Be certain you want the services of a PPO before enrolling, as membership in a PPO in Texas is usually binding for a full year.

Medicare Advantage Private Fee-for-Service Plans

• Private fee-for-service, or PFFS, plans allow you to go to any doctor or health-care provider who agrees to take the plan's terms of payment. You don't need to choose a primary care physician or get a referral for any service. You must live in the plan's Texas service area to initially qualify, but you can then get treatment using it anywhere in the country. There are extra charges with a PFFS plan, such as copayments or coinsurance. PFFS plans may also allow service providers to tack on an extra 15 percent over what the plan pays --- this charge will be your responsibility.

Medical Savings Account Plans

• Texas health insurance companies may offer plans that work with medical savings accounts. A medical savings account is a bank account set aside for health-care costs and combined with a high-deductible health policy. Medical savings account plans deposit money from Medicare into your account, which you can then use for health-care bills after you meet your yearly deductible. These funds can stay in your account from year to year. Texas Medicare Advantage medical savings account plans don't cover prescription drugs, but they also don't require a monthly premium.

Medicare Advantage Special-Needs Plans

• Special-needs plans are those that offer services for specific diseases and conditions, such as diabetes. You must already have the condition to enroll in a special-needs plan; certain special-needs plans are available for people in long-term-care facilities. Medicare Advantage must include coverage for prescription drugs. Special-needs plans in Texas are offered all over the state.