The Medicare Annual Enrollment Period (AEP) begins October 15 and runs through December 7 each year. If you or someone in your family is either already a Medicare beneficiary or turning 65 soon, it is time to make crucial decisions about your health coverage, specific to Medicare in San Antonio. This may include choosing whether you want to get your Medicare coverage through a Medicare Advantage plan or switch to a different plan.
Understanding Medicare Advantage
Also called Medicare Part C, Medicare Advantage is one of the four parts of Original Medicare:
• Medicare Part A is your Hospital Insurance
• Medicare Part B is your Medical Insurance
• Medicare Part C is known as Medicare Advantage (an alternative way to get Medicare Parts A and B benefits)
• Medicare Part D offers Prescription Drug Coverage
Medicare Advantage plans in San Antonio, TX are sold by Medicare-approved private health insurance companies. If you choose to enroll in a Medicare Advantage (MA) plan, your plan will then cover all your Medicare-covered services.
To enroll in a Medicare Advantage plan, you must first enroll in Original Medicare Parts A and Part B. You have to fulfill the same condition for enrolling in a Medicare Part D plan too.
Medicare Advantage Coverage & Why You Need It
Original Medicare covers some of the expenses of health care services:
• Medicare Part A: Covers inpatient services in hospitals, hospice care, skilled nursing facility care, and home health care.
• Medicare Part B: Outpatient care, services from physicians and other health providers, home health care, durable medical equipment, and some preventive services.
Interestingly, Original Medicare doesn’t pay for every service. Medicare Advantage does offer the same level of coverage as Original Medicare, but many MA plans offer additional benefits too that can help you keep up with your health goals. These may include:
• Vision care, routine dental exam, and hearing aids
• Health club memberships
• Prescription drug coverage
Some Medicare Advantage plans also offer a few extra non-medical benefits, such as meal delivery services and nutritional counseling. These are designed to facilitate an active lifestyle, allowing you to stay socially connected in your community.
Choosing the best Medicare Advantage Plan in San Antonio, Texas
Medicare Advantage plans are not a “one-size-fits-all” policy. Therefore, it is sensible to do your homework beforehand. Here is a checklist you can refer to, that can help you understand your options and make a well-informed decision about your health coverage.
1. Are your preferred hospitals, pharmacies, and doctors in your plan’s network?
Medicare Advantage plans have their own lists of in-network doctors and medical facilities, hence it is crucial to check that doctors and facilities you usually prefer to use are on that list.
2. Does your MA plan let you see a non-network provider?
Some Medicare Advantage plans allow you to visit doctors that don’t fall in your network, but in general, you would pay more out of pocket for seeing them.
3. Does your plan cover prescription drugs you take regularly?
MA plans include all the covered benefits under Original Medicare, and some plans offer Medicare Part D prescription drug coverage too. Check if the prescription drugs you take are covered under the MA plan you are considering, and how much you will pay on your own for them. For instance, some MA plans with prescription drug coverage provide some specific medicines with $0 copays (based on the plan’s list of drugs and the level of drug tier). Drug lists may modify each year, so it is prudent to review your plan every year before renewal, to see if your regular medications are still covered under your ongoing plan, and how much you will pay out of pocket for them.
4. Do you want to receive fitness benefits, and live an active lifestyle?
Apart from additional benefits like vision, hearing, and dental care, a number of Medicare Advantage plans provide fitness benefits for elderly beneficiaries. These programs aid you in making physical activity part of your day-to-day life.
5. Does your plan’s cost fit your budget?
A number of factors decide the out-of-pocket costs of having Medicare Advantage. These include monthly premiums, copayments, coinsurance, and deductibles. These expenses may vary from plan to plan. Other factors – like how frequently you require medical care services, and whether or not you need to visit any specialists, besides your primary care physician – will also determine your costs of keeping an MA plan. MA plans come with an annual cap on how much you will pay out of pocket. In 2023, this figure is $8,300 (but some plans may have lower limits too).
6. Are there any programs to aid you in lowering Medicare out-of-pocket expenses?
Medicare can help cover some health care costs, but it's not completely free. If you need help to pay your Medicare out-of-pocket costs, you should go through income guidelines for assistance programs available to you, and consider applying if you believe that you might be eligible.
If you have special health needs, you may consider enrolling in a Medicare Special Needs Plan (SNP) – a kind of Medicare Advantage plan in San Antonio, TX. A few individuals qualify for both Medicaid and Medicare, and may consider enrolling in a Dual-Eligible SNP (D-SNP). People qualifying for the same are either individuals suffering from end-stage renal disease or a disability, or elderly people with low income.
7. Are you interested in non-conventional services like transportation and food delivery?
Some Medicare Advantage plans feature non-medical benefits, like:
• Access to as well as assistance for purchasing healthy foods
• Fall prevention aids
• Help with utility expenses
• An allowance on over-the-counter products
• Companionship
If you think such services could make your life smoother, find an MA plan that includes these benefits.
Best Medicare Advantage Plans
The best Medicare Advantage plan will be one that showcases the right mix of affordable monthly expenses, high ratings, and fair coverage for health services.
• Best Overall: Humana
Pros
• Free plans for most individuals
• Almost 50% of plans features zero prescription drug deductible
• A wide range of options allows you to customize your coverage
Cons
• Offers less number of 5-star rated plans, compared to other insurers
• Humana PPO plans are relatively costly
• Most Popular: AARP/UnitedHealthcare
Pros
• Wide range of options with most plans having low or zero monthly expenses
• Balanced coverage and a fairly large network of health providers
• Often comes with vision, hearing, and dental care benefits
Cons
• Policyholders’ satisfaction levels are below average
• Positioned after other insurers with respect to customer support
• Some plans feature a high out-of-pocket maximum that must be avoided by individuals, requiring costly or continuing medical care
• Best Customer Service: Kaiser Permanente
Pros
• Extremely satisfied customers
• Quite popular in the areas it is available
• Plans usually have low-price medical care due to inexpensive copayments and no deductibles
Cons
• May have higher monthly expenses
• Only available in eight states, plus Washington, D.C.
• Less flexibility when it comes to choosing your physician, as plans are clubbed with Kaiser health facilities
• Cheapest: Cigna
Pros
• Affordable health coverage, including an array of options with no monthly expenses
• Very affordable PPO plans that offer great value to individuals with moderate needs and who want flexibility
• A handful of no-deductible plans that provide low-cost care from day one of enrollment
Cons
• substandard customer support
• Plans featuring a high-spending cap could result in high expenses for individuals needing ongoing medical care or surgery
• Largest Network: Blue Cross Blue Shield
Pros
• Can maximize flexibility with respect to selecting your doctor, based on your chosen plan
• Monthly costs may be as low as $0, but prices may vary from location to location
• Less complaints than national average
Cons
• Inconsistent customer satisfaction ratings and benefits since every BCBS subsidiary runs independently
Final Words
If you still find it difficult to find the right Medicare Advantage plans in San Antonio, Texas, talking to an independent Medicare agent in San Antonio, TX may come in handy.