Assisted living facilities primarily help residents with non-medical needs. Although minor and infrequent medical services, such as first-aid for a wound, can sometimes be met on-site by nurses. These communities may sometimes also be called ALFs, residential care facilities, retirement homes, or long-term care facilities.
The financial options available to help pay for senior care is dependent on, among other things, the type of care that is required. If you are just beginning the research process on how to pay for long-term care, it is helpful to have an idea about the type of care you or your loved one currently requires, as well as to anticipate future needs. In addition, it is important to be familiar with the associated eldercare terminology.
Can using home care technology help your family save money caring for an aging loved one? The answer is most certainly “Yes”. Our goal is not to provide a comprehensive list, but rather to make sense of those that are available on the market today and can reduce the care hours required by elderly persons. As such, they can reduce a family’s out-of-pocket care costs or reduce the hours they spend providing care themselves.
Medicare Advantage (Part C), a privately offered alternative to Original Medicare (Parts A and B), has grown in popularity over the years. Despite the growing popularity of Medicare Advantage, some seniors face obstacles that prevent them from truly understanding how it works and who it benefits. Common mistakes about Medicare Advantage include misunderstanding its differences from Original Medicare, getting it confused with other forms of private Medicare insurance (like Medigap or Part D), or not understanding how to look up or evaluate plans.
Medicare Advantage is a popular way for many Texas seniors and other eligible individuals to get their Medicare benefits. With the exception of hospice care, Medicare Advantage plans, sometimes called Part C, combine all of the coverage Original Medicare offers under Parts A and B under a single monthly premium. Medicare Advantage plans also commonly include a few extra benefits not offered by Original Medicare, such as vision, hearing and dental plans. Unlike Original Medicare, which is a benefit delivered directly from the federal government, Part C plans are issued by private insurance companies on a state-by-state basis. Medicare Advantage plans usually bill the Social Security Administration on behalf of its participants, who are charged group rates. This sometimes results in Part C beneficiaries getting their coverage with a $0 monthly premium and helpful out-of-pocket limits.
Most Medicare Advantage plans include at least some prescription drug benefits, which largely eliminates the need to get supplemental prescription coverage. Part C providers have the freedom to set their own out-of-pocket limits and organize their own referral and specialist services. In Texas, 1.7 million of the 2.5 million Medicare-eligible individuals choose one of the available Part C plans available in the state in 2020. This puts Medicare Advantage participation in Texas at 68%, which is significantly higher than the national average of 42%.
This guide covers some of the most popular Medicare Advantage plans in Texas. It goes over what these plans cover, who is eligible for coverage and how to apply for a plan.
The Top 10 Medicare Advantage Plans in Texas
Multiple companies participate in Medicare Advantage in Texas, and the plans they offer provide a wide range of coverage options for seniors in Texas. The table below lists the 10 most popular Part C providers in Texas, as determined by their current enrollment figures. Most of the companies listed offer multiple plans, each with a range of costs rather than a single average price. To develop an accurate picture of how popular each provider is, relative to the others, we added up the total enrollment of all plans for each company. Numbers for each are current as of April 2022, but you can find the latest numbers online at Medicare.gov.
Name
Total Enrollment
Star Rating
Min Cost
Max Cost
Plan Types
UnitedHealthcare
1,050,293
3.5
$0
$199
HMO, PPO
Humana
371,014
4
$0
$97
HMO, PPO, PFFS
Aetna Medicare
196,996
3
$0
$19
HMO, PPO
Wellcare
125,429
3.5
$0
$21
HMO, PPO
Cigna
119,400
3.5
$0
$19
HMO, PPO
Amerigroup
81,295
3.5
$0
$0
HMO
KelseyCare Advantage
41,299
5
$15
$15
HMO
Wellcare by Allwell
29,184
3.5
$0
$15
HMO
Baylor Scott & White Health Plan
28,669
4.5
$37
$255
HMO, PPO
Devoted Health
25,619
4.5
$25
$25
HMO
How Medicare Advantage Plans Work in Texas
Medicare Advantage providers in Texas organize their plans in various ways to deliver adequate care. Seniors signing up for a plan need to know the differences between their options. Most insurers offer different structures that include: health maintenance organizations (HMOs) and preferred provider organizations (PPOs). These plans each have unique requirements and rules for referrals, network coverage, prescription drugs and whether you need a primary care physician. The four most popular plan structures are described below.
What Medicare Advantage Plans Cover in Texas
Medicare Advantage plans are required by law to provide all the same benefits as Original Medicare Parts A and B as a minimum. These services include X-ray imaging, hospital inpatient services and preventive screenings. The exception to the rule is hospice care, which is always covered under Medicare Part A. Medicare Advantage plans are allowed to go beyond the minimum benefits, which many of them do to cover dental, vision care, hearing aids and some prescription drugs.
Coverage Available With Medicare Parts A & B?
Coverage Available With Medicare Advantage?
Preventive Screenings
Yes
Yes
Hospital Care
Yes
Yes
Durable Medical Equipment
Yes
Yes
Prescription Drugs
No
Yes**
Vision Care
No
Yes*
Dental Care
No
Yes*
Hearing Aids
No
Yes*
*Select plans offer this coverage
** Most plans offer this coverage
Eligibility for Medicare Advantage in Texas
To sign up for Medicare Advantage, a senior in Texas must be eligible for Original Medicare and choose to receive benefits under Part C instead. They must sign up for a Medicare Advantage plan that’s available in the area, but there are no restrictions on which of the offered plans they can choose. Like Original Medicare, Medicare Advantage plans are not allowed to refuse coverage or charge extra for pre-existing conditions, provided the application was submitted within a plan enrollment window. Enrollments outside the open enrollment window may be subject to more limited coverage and a penalty fee, so it’s important to understand when new applications can be submitted. Have a look at the list of enrollment periods below to learn when you can apply for Medicare Advantage.
Initial Coverage Election Period: This is the initial 7-month period, coinciding with one’s 65th birthday, during which everyone is eligible to enroll in a Medicare Advantage plan.
Annual Election Period (AEP): Also referred to as the Open Enrollment Period, this the time of year when anyone over 65 can enroll in Medicare Advantage for the first time or change to a new plan.
Medicare Advantage Open Enrollment Period: During this period, those who are already enrolled in Medicare Advantage can switch to a different plan or switch back to Original Medicare.
Start Date
End Date
Initial Coverage Election Period
3 Months Before One’s 65th Birth Month
3 Months After One’s 65th Birth Month
Annual Election Period (AEP)
October 15th
December 7th
Medicare Advantage Open Enrollment Period
January 1st
March 31st
Additionally, Medicare Advantage plan participants can change their plan outside of these enrollment periods under certain qualifying circumstances, such as moving to a new state.
How to Find & Choose a Medicare Advantage Plan in Texas
Navigating the many intricacies of Medicare Advantage plan types, insurers, and the specific plan options available by region can be a difficult and time-consuming task. Below are several resources we’ve created to help you through the process.
First is a downloadable PDF that you can use as a guide to help you compare plans as you research. Finally, we have listed a number of organizations that you can contact with experts that will help you determine whether Medicare Advantage is right for you and what plans you should consider.
Texas Health Information Counseling and Advocacy Program (HICAP)
The Texas Health Insurance Counseling and Advocacy Program (HICAP) provides Medicare counseling for seniors and individuals with disabilities. The program provides benefit counselors who help seniors understand the difference between the different Medicare plans and determine the plan that’s best suited to their needs and budget. This service is free of charge and available to Medicare beneficiaries aged 60 and older and adults with disabilities.
To contact HICAP for assistance with Medicare Advantage plans, seniors can call (800) 252-9240 or search for a local office online at the Texas Medicare website.
Texas Department of Insurance – Managed Care Quality Assurance Office
Texas’ Managed Care Quality Assurance Office helps members of the public who are enrolled in managed care plans, including Medicare Advantage HMOs. The organization is responsible for licensing HMO providers and assuring that program participants have access to the care they’re promised by their insurance provider. This organization can provide answers to general questions that seniors may have about Medicare Advantage HMOs.
Seniors who have questions about their HMO or their Medicare Advantage provider can contact the Managed Care Quality Assurance Office by calling (866) 554-4926 and selecting option 8.
Texas Area Agencies on Aging
Area Agencies on Aging provide a broad range of services to seniors throughout the state, including benefits counseling. Its staff work with seniors to determine which Medicare, Medicaid or Medicare Advantage programs are best suited to their income and health care needs and can provide further assistance in coordinating care services with their insurance providers and helping with claims or appeals whenever necessary. Other Area Agency on Aging services include long-term care ombudsman access, nutrition services, and in-home support services.
Contact Info
There are 28 Area Agencies on Aging located throughout Texas. To find a location nearest them or to receive clarification on available programs, seniors can email [email protected].
The Texas Aging and Disability Resource Centers are available to seniors and disabled persons of all ages. These centers offer one-on-one options for counseling, which helps seniors and their loved ones to determine their long-term care needs, as well as how to navigate the benefit plans that are available to help them pay for it, such as Medicare and Medicare Advantage. Other services that are available at Texas’ Aging and Disability Resource Centers include caregiver training and advocacy for seniors in long-term care facilities.
Contact Info
Aging and Disability Centers are available in each county throughout Texas. Seniors can log onto the Texas Health and Human Services website to find the location nearest them.
Houston-Galveston Area Council Medicare Benefits Counseling
Houston-Galveston Area Medicare Benefits Counseling services help older Texans to navigate the state’s Medicare system, providing detailed information about Medicare and Medicare Advantage plans that are available to them and helping them choose one that suits their needs. The program also provides assistance with seniors who need help with meals, transportation, or in-home care. Benefits counselors are available monthly at various locations in the Houston-Galveston area to provide in-person assistance.
Seniors can call (713) 627-3200 to speak with a benefits counselor or walk-in to any of the monthly clinics to meet with one in-person.
North Dallas Shared Ministry
Low-income seniors who are Medicare beneficiaries can receive financial assistance with their premiums and assistance in navigating their benefits from the North Dallas Shared Ministry. This nonprofit organization also provides a broad range of other services specifically for low-income residents of the Dallas metropolitan area, including energy assistance, rent assistance, and Medicaid and SNAP assistance and counseling.
