J.J. Starr is a health and finance writer with a background in banking, lending, and financial advising. She holds a Series 6, FINRA, and life insurance licensure and a master's degree from New York University. Through her writing, she strives to use her decade of experience to help consumers make sound financial choices. Connect with J.J. on LinkedIn.
John Leach is an insurance content editor who has worked in print and online. He has years of experience in car and home insurance and strives to make these topics easy to understand for everyone. He has a linguistics degree from UC Santa Barbara.
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You’ve got a lot of Medicare Advantage Plans to choose from in Texas, here’s how.
Though Florida gets a lot of attention as a popular retirement state, Texas has a flourishing community of seniors. Where seniors gather, so gather plenty of Medicare plans. But how do you sort through your options? How do you know which healthcare services are best?
This article will cover the top-rated Medicare Advantage plans in Texas. Plus, you’ll get valuable information about your options so you can make an informed choice. Let’s hop in.
Ready to shop Texas plans now? Use the Insurify Medicare comparison tool to find the right Medicare plan for you. Start with your ZIP code to compare Medicare Advantage plans in your area. Try it today!
What Are the Best Medicare Advantage Plans in Texas?
The best Medicare Advantage plans in Texas share a few traits:
Favorable co-pay rates
Low annual deductibles
High customer satisfaction
The Best Medicare Advantage Plans In Texas
1. KelseyCare Advantage Rx - Score: 81.71
2. KelseyCare Advantage Essential+Choice (No Rx) - Score: 79.63
3. KelseyCare Advantage Essential (No Rx) - Score: 79.63
Our Insurify Composit Score takes into account the overall cost of the plan, the CMS rating, and other important factors. You can learn more about how we scored the plans by visiting our methodology page.
#1. KelseyCare Advantage Rx
Insurify Composite Score: 81.71
Monthly Premium: $0
Annual Health Deductible: $0
Annual Prescription Deductible: $100
Out-of-pocket Spending Limit: $3,450
CMS Rating: 5 Stars
Counties: Brazoria, Fort Bend, Galveston, Harris, Montgomery, Harris
There are a lot of low price tags all over the plan that received our highest marks. That includes $0 for a primary care or preventive care visit. And $0 for hearing aids is a big win. Basic dental, hearing, and vision care is also covered.
While many services or equipment do come with higher copays or coinsurance rates, the low threshold for out-of-pocket expenses helps reign in costs. Not to mention, this plan comes with great customer reviews for service.
#2. KelseyCare Advantage Essential+Choice (No Rx)
Insurify Composite Score: 79.63
Monthly Premium: $0
Annual Health Deductible: $0
Annual Prescription Deductible: $0
Out-of-pocket Spending Limit: $3,450
CMS Rating: 5 Stars
Counties: Brazoria, Fort Bend, Galveston, Harris, Harris, Montgomery
So long as you don’t mind buying your prescription coverage a la carte, this plan offers you a ton of low-cost benefits. That includes $0 copays for in-network visits for primary care and preventive services. And just $20 to see a specialist. That’s in addition to routine dental, vision, and hearing care.
The main benefit of this plan is that it allows you to access out-of-network care if you need it. Though out-of-network care is more expensive, the flexibility is useful for seniors with special healthcare needs.
#3. KelseyCare Advantage Essential (No Rx)
Insurify Composite Score: 79.63
Monthly Premium: $0
Annual Health Deductible: $0
Annual Prescription Deductible: $0
Out-of-pocket Spending Limit: $3,450
CMS Rating: 5 Stars
Counties: Brazoria, Fort Bend, Galveston, Harris, Harris, Montgomery
Again, this is a plan that does not provide prescription drug coverage. Even so, you’ll find a lot of low-cost benefits. That means $0 copays for primary care, preventive, and vision visits. Plus $20 copays for specialist, hearing, and mental health visits.
Routine dental clocks in at $25 for routine care. But there is no coverage for comprehensive dental. All-in-all, this is a solid plan for seniors with basic needs.
#4. KelseyCare Advantage Rx+Choice
Insurify Composite Score: 78.01
Monthly Premium: $77
Annual Health Deductible: $0
Annual Prescription Deductible: $100
Out-of-pocket Spending Limit: $3,450
CMS Rating: 5 Stars
Counties: Brazoria, Fort Bend, Galveston, Harris, Harris, Montgomery
Though you’ll pay a monthly premium, this plan makes up for it through low-cost copays for many services, including:
Prescriptions
Prevneting doctor visits
Primary care doctor visits
Lab services
Outpatient x-rays
Routine eye exams
Beyond that, you’ll find low-cost copays (between $20 and $30) for mental health care, specialist care, hearing, and routine dental services.
#5. AARP Medicare Advantage SecureHorizons
Insurify Composite Score: 76.76
Monthly Premium: $0
Annual Health Deductible: $0
Annual Prescription Deductible: $0
Out-of-pocket Spending Limit: $3,900
CMS Rating: 4.5 Stars
Counties: Kendall, Medina, Wilson, Bandera, Guadalupe, Bexar, Comal, Atascosa, Victoria, San Patricio, Bee, Nueces, Jim Wells
Here’s a plan with a lot of $0 dollar copays. That includes your preventive care and primary care visits. It also includes visits for routine vision, hearing, and preventive dental. You’ll find additional lower cost coverage for comprehensive dental.
With a fairly low threshold for out-of-pocket costs, this plan more than makes up for some of it’s higher coinsurance rates for less-used services.
#6. KelseyCare Advantage Rx Select
Insurify Composite Score: 75.93
Monthly Premium: $15
Annual Health Deductible: $0
Annual Prescription Deductible: $100
Out-of-pocket Spending Limit: $3,450
CMS Rating: 5 Stars
Counties: Austin, Chambers, Grimes, Liberty, San Jacinto, Walker, Waller, Wharton
This plan didn’t join the other KelseyCare plans at the top of our list because the Rx Select generally costs more. However, the reason it costs more is because it allows you to access out-of-network care if you want to. This flexibility can be worth the price tag for some.
And don’t forget that you do get a generous limit for out-of-pocket costs for in-network care. You’ll have a higher limit — $10,000— for out-of-network care. But again, this plan is all about flexibility.
#7. Humana Gold Plus
Insurify Composite Score: 75.05
Monthly Premium: $0
Annual Health Deductible: $0
Annual Prescription Deductible: $200
Out-of-pocket Spending Limit: $3,400
CMS Rating: 4 Stars
Counties: Bee, Aransas, Nueces, Kleberg, Jim Wells, San Patricio, Bandera, Atascosa, Kendall, Bexar, Medina, Guadalupe, Comal, Wilson, El Paso, Hays, Bastrop, Travis, Williamson, Van Zandt, Upshur, Smith, Rusk, Gregg, Henderson, Harrison Montgomery, Orange, Liberty, Jefferson, Fort Bend, Brazoria, Harris, Harris, San Jacinto, Denton, Dallas, Collin, Collin, Johnson, Ellis, Wise, Kaufman, Tarrant, Rockwall, Willacy, Hidalgo, Cameron
Here’s a plan with a big network. Humana is one of the largest Medicare providers nationwide, in fact. And the large network offers advantages that, for some, will outweigh the somewhat higher costs of the plan. Do keep in mind that costs may be different depending on your county.
With that said, you can expect $0 copays for primary care and preventive services. Plus $0 copays for many hearing, dental, and vision benefits. Rounding out the plan are low-cost copays for mental health, specialist visits, podiatry, and diagnostic services.
The final plan on our list is also the final plan without prescription coverage. On the plus side, it has one of the larges networks available. You’ll also get $0 copays for preventive and primary care visits. Plus, specialists are just $25.
Though prescriptions aren’t covered, you will find low-cost dental, vision and hearing benefits. That includes comprehensive dental plans. Plus, $25 copays for mental health visits.
Ready to look at more plans like these? Make use of Insurify’s plan-comparison tool! With the ability to make side-by-side comparisons and access detailed plan information, you’ll find the right plan for you in no time.
How Much Does Medicare Advantage Cost in Texas?
Medicare Advantage in Texas, on average, costs about the same as the national average. That’s when you take into account the monthly premiums and the annual drug deductible. Importantly, those averages disclude operating costs like copays and coinsurance. It also leaves out the out-of-pocket limits a plan might set.
However, Texas has one of the largest Medicare markets available. That means that you can find plans along the full spectrum of affordability. Just remember that affordability is more than a monthly premium.
Those operating costs ultimately determine how expensive or inexpensive your health care truly is. And having the added protection of a low out-of-pocket limit protects you from bankruptcy.
What Is Medicare Advantage?
Medicare Advantage, also called Medicare Part C, is an alternative to Original Medicare —Medicare Parts A and B. MA plans are regulated by the Centers for Medicare & Medicaid Services (CMS), just like Original Medicare. Unlike Original Medicare, MA plans are administered by a private health insurance company.
Even though these plans are an alternative to Original Medicare, you will still be required to cover Medicare Part B premiums. You will also have to pay for Part A premiums if you don’t qualify for premium-free. However, your primary Medicare coverage begins with your Medicare Advantage plan.
Private health insurance companies essentially win contracts with the CMS in order to provide plans to Medicare beneficiaries. These plans must follow strict guidelines for minimum coverage and apply for contract renewals every year. Beyond minimum coverage, Medicare Advantage can offer additional plan benefits, including Medicare prescription drug coverage.
If you want to bundle Medicare Advantage and prescription coverage, be sure to review the plan’s formulary. The formulary is a schedule of costs for medications. The schedule is broken down into four tiers, with Tier 1 being the least expensive. Ideally, your prescriptions should be covered in Tier 1 or Tier 2.
What Are the 4 Types of Medicare Advantage Plans?
Medicare Advantage insurance plans come in four types. These are:
- Health Maintenance Organization (HMO): With an HMO plan, you’ll be required to work within a provider network. These providers have agreed to work with your insurance company within specific pricing structures. HMOs are typically less expensive than other types of plans.
- Preferred Provider Organization (PPO): With a PPO plan, you may work with a primary care physician (PCP) for most of your care. However, you’ll also receive out-of-network coverage. Out-of-network care will be more expensive than in-network, but this advantage gives you additional options.
- Private Fee-for-Service (PFFS): With a PFFS plan, you don’t need to worry about networks. Any healthcare provider can treat you so long as they agree to the terms of your healthcare plan—i.e., agreeing to be paid what the plan outlines for service.
- Special Needs Plan (SNP): SNPs are designed for people with certain health conditions like end-stage renal disease ( ESRD ). SNPs are also suitable for people dual-eligible for Medicare and Medicaid. And SNPs are best for people living in an institution, like a skilled nursing facility. SNPs always come with prescription drug coverage.
What Are the Advantages and Disadvantages of Medicare Advantage Plans?
There are trade-offs when you choose a Medicare Advantage plan over Original Medicare. You get some benefits, but you also take on different risks. Let’s take a closer look.
Advantages of Medicare Advantage Plans
Medicare Advantage plans often come with additional benefits not included in Original Medicare, such as:
Hearing
Dental
Vision
Plus, prescription drug coverage is also included in the same plan. This creates a “one-stop-shop” experience that many beneficiaries will find convenient. It can also keep costs low if the plan is comprehensive and generous.
Comprehensive MA plans can often be less expensive than Original Medicare. Some MA plans may even be less expensive than an Original Medicare plan with prescription drug coverage. Costs are tricky. There are many variables at play when comparing private and public plan options. Always be sure to consider the total cost of plans, not just the monthly premium.
Speaking of total costs, MA plans often include out-of-pocket maximum spending limits. This is very useful, as it can protect you from bankruptcy. Of course, different plans will have different limits. Be sure to keep those limits in mind when comparing Medicare Advantage plans.
Disadvantages of Medicare Advantage Plans
A “one-stop-shop” experience can be beneficial, but it could also mean that if you don’t like one thing about your plan, you need to change your entire plan. Consider that an Original Medicare plan with stand-alone additional coverage means that you can easily swap out one part of your plan independently. Is that hearing coverage not working out? Simply swap it for another option without disrupting everything else.
MA plans are not universally cheaper. Many MA plans cost the same as an Original Medicare plan. Many can cost much more than an Original Medicare plan used with Medigap and a prescription drug plan.
The network for a Medicare Advantage plan will always be smaller than the network for Original Medicare. Any provider who accepts Medicare—anywhere in the country—can treat you when you’re enrolled in the public plan. People who travel out of state a lot (think RV adventurers and snowbirds) are better off with the public plan.
FAQ: Texas Medicare Advantage Plans
Many Medicare Advantage plans do include prescription drug coverage. These are often called MA-PDPs. However, you can also purchase a Medicare Advantage without drug coverage. In this case, you would need to purchase a stand-alone prescription drug plan.
Bundling coverage offers you the advantage of a “one-stop-shop” experience. All your billing information will be in the same place. However, separate plans may be better for people with special prescription needs. Having separate plans also means that you can change coverage options independently of one another. In other words, if you love your prescription coverage but hate your Medicare Advantage plan, you can change the Medicare Advantage plan and keep the drug plan.
You can enroll in Medicare Advantage during your Initial Enrollment Period (IEP). You’ll need to first enroll in Original Medicare to get your Medicare number. You can do this in 10 minutes by logging into your Social Security account at SSA.gov. If you’re past your IEP, you can enroll in a Medicare Advantage plan during the fall Open Enrollment period (OEP). That runs from October 15 to December 7 every year.
If you don’t want to use Medicare Advantage, you should enroll in Original Medicare with Medicare Supplement Insurance, also known as Medigap. Medigap helps you cover coinsurance, co-payments, and deductible costs with Original Medicare. Generally, Medigap plans do not offer additional Medicare benefits. You will need to purchase stand-alone prescription coverage. You’ll also need stand-alone dental, hearing, and vision coverage.
Yes. All Medicare Advantage plans must include free annual wellness visits. These visits are designed to help you treat and prevent adverse health conditions.
If you require additional guidance, you can call our team of licensed Medicare insurance agents. They can help you sort through your health plan options, answer your questions, and ensure you get the perfect plan.
Bottom Line: Comparing Your Options Is the Best Way to Get the Best Plan
Wherever you live, whatever your healthcare needs, comparison shopping is your best friend. Remember, plans are not one-size-fits-all. The most important factor in getting a great plan is you:
Your needs
Your preferences
Your budget
Starting with yourself allows you to easily sort through your options. To make this even easier, Insurify offers you a free and confidential Medicare plan comparison tool. Compare options with just your ZIP code. Share your information only with the provider you choose. Try it now!
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Written by
JJ Starr
Insurance Writer
J.J. Starr is a health and finance writer with a background in banking, lending, and financial advising. She holds a Series 6, FINRA, and life insurance licensure and a master's degree from New York University. Through her writing, she strives to use her decade of experience to help consumers make sound financial choices. Connect with J.J. on LinkedIn.
John Leach is an insurance content editor who has worked in print and online. He has years of experience in car and home insurance and strives to make these topics easy to understand for everyone. He has a linguistics degree from UC Santa Barbara.
