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Medicare Advantage (also known as Medicare Part C) plans cover all the same services that Original Medicare (Part A and Part B) plans do, but they also often include prescription drug coverage and other extra benefits. For this reason, Medicare Advantage plans are a popular selection for Medicare coverage.
In Texas, residents have many options when it comes to Medicare Advantage plans. With numerous insurance giants in the mix, cutting through the clutter and pinpointing the providers and plans that align best with individual needs is essential.
Texas hosts a diverse selection of Medicare Advantage plans from well-known insurance companies. To assist you in this decision-making journey, we’ll focus on streamlining comparisons in key areas such as drug coverage, member experience, and the availability of cost-effective plans. We will also present key plan data for select providers, including monthly premium and out-of-pocket cost information.
Compare Medicare Advantage Providers in Texas
Before viewing the important statistics of key Medicare Advantage plan providers in Texas, let’s learn more about some key metrics to consider when selecting a Medicare plan:
CMS Star Rating: Published every year by the Centers for Medicare & Medicaid Services (CMS) to measure the quality of health and drug services received by customers. The overall star rating, between 1 (low) and 5 (high) stars, considers up to 40 quality and performance measures and is a strong point of comparison for plan selection.
Monthly Premium: The amount you would pay to a provider for health insurance plan coverage each month.
In-Network Max Out-of-Pocket Amount: The maximum amount of money you would pay to a provider for in-network services you received during a coverage period (usually one year).
Note: All statistics in the charts below were calculated using plan data specific to Texas.
National Providers
| Provider Name | Average CMS Star Rating | Median Monthly Premium | Median In-Network Max Out-of-Pocket $ |
| UnitedHealthcare | 3.9★ | $0.00 | $6,400 |
| Humana | 4.0★ | $0.00 | $6,900 |
| Aetna | 3.5★ | $0.00 | $6,000 |
| Cigna Healthcare | 3.5★ | $0.00 | $5,700 |
| Wellcare | 2.8★ | $0.00 | $5,900 |
Regional Providers
| Provider Name | Average CMS Star Rating | Median Monthly Premium | Median In-Network Max Out-of-Pocket $ |
| KelseyCare Advantage | 5.0★ | $0.00 | $3,850 |
| Devoted Health | 4.5★ | $0.00 | $3,900 |
| Prominence Health Plan | 4.0★ | $0.00 | $3,775 |
| Baylor Scott & White | 3.9★ | $28.40 | $5,000 |
Please also note that while some smaller providers may offer 5-star or other highly rated CMS rated plans, they will likely have a limited, much smaller network of physicians than the much larger national health insurance providers.
Top-Rated Medicare Advantage Providers in Texas
Humana
Humana is a massive health insurance company in the United States which offers a diverse range of healthcare insurance and related products, one of which is Medicare.
They service 1.8 million members statewide in Texas across two partner communities (Houston and San Antonio). By market share, they are the second largest provider of Medicare Advantage plans in the United States (17.8%).
KelseyCare Advantage
KelseyCare is the provider of the only CMS 5-star rated Medicare Advantage plan in Texas. They have received Medicare’s highest star rating every year since 2017 and boast one of the largest provider networks for a regional provider in Texas (providing access to more than 7,500 doctors).
KelseyCare Advantage has over 50,000 members and provides Medicare service to 13 counties throughout Texas.
Cigna Healthcare
Cigna Healthcare is a global health services organization that provides a wide range of health insurance products and related services. For 2024, Cigna will be offering Medicare Advantage plans to eligible members across 29 states. Additionally, they will also be offering three standalone PDPs to eligible members in all 50 states (plus Washington D.C. and Puerto Rico).
United Healthcare
UnitedHealthcare is a national provider of health insurance and related products. Additionally, they are the market share leader (28.5%) in the competitive Medicare Advantage segment, providing service to over 9 million enrollees across the country. Similarly, they are also the Medicare Advantage market share leader in Texas (50%) as well.
Additionally, they are also the fastest growing MA plan provider, having grown 12.7% YoY in 2023 from 2022 (second fastest growing MA provider was Humana at 10.1%).
Aetna
Aetna is a national provider of health insurance and related products. They operate as a subsidiary of CVS Health Corporation.
As of March 2023, they were the third-largest provider of Medicare plans (10.6% market share) and the largest provider of Medicare prescription drug plans (27.2% market share).
Devoted Health
Devoted Health is an all-in-one healthcare company for Medicare beneficiaries. Not only do they deliver health insurance, but they also strive to provide access to high-quality medical care.
Additionally, despite being smaller than national providers, they nevertheless have a strong presence in Texas.
Prominence Health Plan
Prominence Health Plan started in 1993 as an HMO in Reno, Nevada before expanding to provide Medicare Advantage plans to eligible residents in Nevada, Florida, and Texas.
The Company has locations across Texas in Amarillo, Laredo, McAllen, and Denison.
Baylor Scott & White
Baylor Scott & White is the largest not-for-profit health system in Texas. They offer “BSW SeniorCare Advantage” plans to Medicare eligible persons in North and Central Texas, and “Covenant Health Advantage” to the Medicare-eligible population of West Texas.
BSW provides access to 4,900 primary care physicians and 24,500 specialists, whereas Covenant provides access to 385 primary care physicians and 1,130 specialists.
Wellcare
Wellcare is a large Healthcare enterprise which provides health insurance and related products to Americans nationwide. Medicare Advantage is a key product offering of Wellcare’s – they have a market share of 4.3%.
Additionally, as of 2023, they are the second-largest provider of prescription drug plans (PDPs) (19.9% market share). As with the other large health insurance providers, they have a strong presence in Texas with deep connections to hospitals, services, and physicians statewide.
How to Choose the Best Medicare Advantage Plan
Choosing the right Medicare Advantage plan, tailored to fit your unique needs, is a critical component in maintaining a healthy lifestyle. Let’s review the key steps to simplify the decision-making process of choosing a plan.
From understanding your healthcare needs to exploring plan specifics, our goal is to empower you with the knowledge necessary to navigate the array of options.
- Assess Your Healthcare Needs: Determine your specific medical needs, including prescription medications, anticipated doctor visits, and any specialized care requirements.
- Review Plan Options: Explore available Medicare Advantage plans in your area, considering coverage, costs, and additional benefits. Check for plans offered by reputable insurance companies.
- Check Network Providers: Confirm that your preferred doctors, hospitals, and healthcare providers are included in the plan’s network to ensure convenient and cost-effective access to care.
- Evaluate Drug Coverage: If you take prescription medications, assess each plan’s formulary to ensure your drugs are covered. Consider copayments, coinsurance, deductibles, and any restrictions.
- Consider Additional Benefits: Medicare Advantage plans often include extra benefits like dental, vision, or wellness programs. Evaluate these perks based on your individual needs.
- Examine Cost Structures: Compare premiums, deductibles, copayments, and coinsurance for each plan. Consider your budget and how these costs align with your expected healthcare usage.
- Check Star Ratings: Refer to Medicare’s Star Ratings for plans. Higher-star-rated plans typically offer better overall quality, customer satisfaction, and healthcare outcomes.
- Understand Plan Rules and Restrictions: Familiarize yourself with the plan’s rules, including any prior authorization requirements or referrals for specialists. Ensure you understand how the plan operates.
- Review Out-of-Pocket Maximums: Identify the plan’s annual out-of-pocket maximum, which limits your spending on covered services. This can provide financial predictability in case of unexpected healthcare expenses.
- Get Personalized Assistance: Reach out to CoverRight for personalized assistance. We can help clarify any doubts and guide you through the enrollment process.
Remember that individual preferences and healthcare needs vary, so the best Medicare Advantage plan for you depends on your own unique circumstances. If you have questions unique to your situation that you would like answered, we recommend scheduling a call to speak with a licensed insurance agent.
Additionally, if you are in the process of evaluating your drug coverage, we recommend looking into switching to the generic version of your drugs. If available, the generic version will be much cheaper than the brand-name version.
What Medicare Advantage Plans Cover
Medicare Advantage plans (a.k.a. Medicare Part C plans) are offered by Medicare-approved private insurance companies.
These plans provide all the coverage of Original Medicare (Part A and Part B) and often include additional benefits. Here’s an overview of what Medicare Advantage plans typically cover:
- Hospital Coverage (Part A): This includes inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.
- Medical Coverage (Part B): This covers outpatient care, doctor visits, preventive services, and some home health care.
- Prescription Drug Coverage (Part D): Many Medicare Advantage plans include prescription drug coverage. If not, beneficiaries can usually purchase a standalone Medicare Part D prescription drug plan.
- Additional Benefits: Depending on the exact plan, Medicare Advantage plans can often offer extra benefits not covered by Original Medicare, such as dental care, vision care, hearing aids, fitness programs, and wellness services.
- Out-of-Pocket Maximums: These plans have yearly limits on out-of-pocket costs for medical services, providing financial protection for beneficiaries.
It’s important to note that coverage can vary between different Medicare Advantage plans, so individuals should carefully review plan documents, including the Summary of Benefits, and consider their specific healthcare needs when choosing a plan.
Additionally, beneficiaries must continue to pay their Medicare Part B premium in addition to any premium charged by the Medicare Advantage plan.
When to Enroll for Medicare Advantage Plans in Texas
Enrollment for Medicare Advantage Plans in Texas takes place during specific timeframes.
Initial Enrollment occurs when you’re first eligible for Medicare, usually around age 65. The Annual Enrollment Period (AEP) runs from October 15 to December 7 each year, allowing you to switch, drop, or add Medicare Advantage plans.
The Medicare Advantage Open Enrollment Period from January 1 to March 31 permits plan changes or a return to Original Medicare.
Special Enrollment Periods may apply in certain circumstances, such as moving, losing employer coverage, or qualifying for Medicaid. It’s crucial to be aware of these periods to make informed decisions about your Medicare Advantage coverage in Texas.
Medicare Advantage vs. Medigap
Choosing between Medicare Advantage (Part C) and Medigap (Medicare Supplement) involves being aware of key distinctions between the two categories of plans. Medicare Advantage combines Part A and B benefits, often incorporating extras like prescription drug coverage.
These bundled plans are typically more affordable and administratively convenient, despite potentially having some network restrictions.
Overall, Medicare Advantage plans are very popular in Texas. As of May 2023, nearly 52% of Texas residents with Medicare were enrolled in private Medicare Advantage plans. This figure is a bit higher than the 2023 national average of 51%.
On the other hand, Medigap plans work in tandem with Original Medicare, covering out-of-pocket costs. While offering greater flexibility in healthcare provider choice, Medigap plans generally come with higher premiums.
Here’s a breakdown of the two types of plans:
| Medigap (Medicare Supplement) | Medicare Advantage (Part C) | |
| Coverage | – Comprehensive coverage of out-of-pocket costs. | – Bundled coverage, often includes prescription drugs and extras. |
| – Greater flexibility in choosing healthcare providers. | – Limited to network providers; may require referrals. | |
| Costs | – Higher premiums but lower out-of-pocket costs. | – Lower premiums, but potential for higher out-of-pocket costs. |
| Prescription Drugs | – Doesn’t typically include prescription drug coverage. | – Often includes prescription drug coverage. |
| Network Restrictions | – No network restrictions; can see any doctor accepting Medicare. | – Limited to network providers; may require referrals. |
| Administration | – Simplifies administrative processes with a single plan. | – Requires managing multiple aspects (Part A, B, and sometimes D). |
| Flexibility | – Freedom to use healthcare services nationwide. | – May be limited to specific geographic regions or networks. |
| Additional Benefits | – Focuses solely on medical costs; no additional benefits. | – May include extra benefits like dental, vision, and wellness programs. |
| Decision Criteria | – Suited for those who prioritize flexibility and are willing to pay higher premiums. | – Attractive for those seeking bundled coverage with potentially lower costs. |
The decision here hinges on your own personal priorities: Medicare Advantage for cost-effective bundled benefits with some network constraints, or Medigap for more flexibility in provider selection, albeit at a potentially higher cost.
All Medicare Advantage Providers in Texas for 2024
- Aetna Medicare
- Alignment Health Plan
- Amerigroup (called Wellpoint in 2024)
- Baylor Scott & White Health Plan
- Blue Cross Blue Shield of New Mexico.
- Blue Cross Blue Shield of Oklahoma
- Blue Cross and Blue Shield of Texas
- Care N’ Care Insurance Company
- CHRISTUS Health Advantage
- Cigna
- Clover Health
- Community First Health Plans
- Devoted Health
- Humana
- KelseyCare Advantage
- Memorial Hermann Health Plan
- Molina Healthcare of Texas
- Prominence Health Plan
- SCAN Health Plan
- UnitedHealthcare
- Verda Health Plan of Texas
- Wellcare
- Wellcare by Allwell
