Medicare Advantage Plans in Texas: A Simple Guide

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Original Medicare provides a solid foundation for your health coverage, but it doesn’t cover everything. You might be surprised to learn that routine dental check-ups, new eyeglasses, and hearing aids are not included. This is where Medicare Advantage plans come in. Offered by private insurance companies, these all-in-one plans are designed to fill those gaps by including extra benefits that Original Medicare misses. We’ll explore how these perks work, what they cost, and what you need to consider when looking at Medicare Advantage plans in Texas, helping you find coverage that supports your total well-being.

Key Takeaways

Look beyond the $0 premium to understand the full cost: A plan’s monthly premium is just one piece of the puzzle. To find the most budget-friendly option, consider the deductibles, copays, and out-of-pocket maximum for the care and prescriptions you actually use.
Match the plan to your specific health needs: The right plan for you is one that includes your trusted doctors and covers your specific prescriptions. Start by making a list of your providers and medications to use as a checklist when comparing your options.
Always verify your network and drug coverage: Don’t just rely on a plan’s marketing materials. The most reliable way to avoid surprises is to use the Medicare Plan Finder tool for drug costs and call your doctor’s office directly to confirm they accept the plan.

Medicare Advantage vs. Original Medicare: What’s the Difference?

When you first become eligible for Medicare, one of the biggest choices you’ll face is whether to stick with Original Medicare or choose a Medicare Advantage plan. It can feel like a complicated decision, but it really comes down to how you prefer to get your health coverage. Think of it this way: Original Medicare is the traditional, government-run program, while Medicare Advantage is an all-in-one alternative offered by private insurance companies.

Both paths are designed to provide your health benefits, but they work very differently in terms of costs, doctor choices, and extra perks. Understanding these key differences is the first step to figuring out which option is the right fit for your health needs and budget. Let’s break down what each one offers so you can feel more confident about your decision.

The Basics of Medicare Advantage

Medicare Advantage, sometimes called “Part C,” is an all-in-one plan offered by private companies that contract with Medicare. These plans bundle all your benefits together, providing a single card to use for your healthcare needs. A key rule is that all Medicare Advantage plans must cover everything that Original Medicare (Part A and Part B) covers. So, you’ll still have the same fundamental hospital and medical insurance.

The main idea behind these plans is to offer a more streamlined way to get your coverage. Instead of dealing with different parts of Medicare separately, you work with one private insurance company for nearly all your health services. These are some of the most common types of Medicare health plans available.

How It Compares to Original Medicare

The biggest difference is how the plans are structured. With Original Medicare, you get your hospital insurance (Part A) and medical insurance (Part B) from the government. If you want prescription drug coverage, you have to sign up for a separate Part D plan. Many people also buy a Medicare Supplement (Medigap) policy to help with out-of-pocket costs.

Medicare Advantage plans work differently. They bundle these benefits—Part A, Part B, and usually Part D—into a single plan. Most also include extra perks that Original Medicare doesn’t cover, like routine dental, vision, and hearing care. Instead of having multiple cards and paying several premiums, you have one plan, one card, and often one monthly premium.

Who Is Eligible for a Medicare Advantage Plan?

Getting a Medicare Advantage plan is pretty straightforward, but you have to meet a few key requirements first. To be eligible, you must already be enrolled in both Medicare Part A and Part B. You also need to live in the service area of the Medicare Advantage plan you want to join, as these plans are typically local or regional.

Most people first enroll in Medicare through Social Security when they are about to turn 65. Once you have your Original Medicare coverage in place, you have the option to join a Medicare Advantage plan. You can’t be denied coverage for a pre-existing condition, except for End-Stage Renal Disease (ESRD), though there are some exceptions to that rule.

What Are Your Medicare Advantage Plan Options in Texas?

When you start looking at Medicare Advantage plans in Texas, you’ll notice they aren’t all the same. They come in a few different types, each with its own rules about which doctors you can see and how much you’ll pay. Understanding these differences is the first step to finding a plan that fits your life and health needs. The three most common types you’ll find are HMOs, PPOs, and SNPs. Let’s break down what each one means for you.

Health Maintenance Organizations (HMOs)

Think of a Health Maintenance Organization (HMO) as a plan with a dedicated team. You’ll choose a primary care physician (PCP) from the plan’s network who becomes your main point of contact. For most services, you must use doctors and hospitals within that network. A policy primer on Medicare Advantage notes that HMOs “generally cover only care provided by in-network doctors, hospitals, and other health providers.” The trade-off for this structure is often lower monthly premiums and out-of-pocket costs. If you’re comfortable using a set network and want to keep costs predictable, an HMO can be a very cost-effective option.

Preferred Provider Organizations (PPOs)

If you value flexibility, a Preferred Provider Organization (PPO) might be a better fit. With a PPO, you still have a network of “preferred” doctors, and you’ll pay less if you use them. However, you have the freedom to go outside the network for care. PPOs offer access to out-of-network providers, but it will be “at a higher cost than in-network providers.” You also typically don’t need a referral to see a specialist. This is a great benefit if you have doctors you want to keep seeing or if you travel often and want coverage wherever you go.

Special Needs Plans (SNPs)

Special Needs Plans (SNPs) are a unique type of Medicare Advantage plan for people with specific circumstances. These plans are not for everyone; they are designed to provide focused, specialized care. SNPs are for “people with high health care needs, including those who are dually eligible for Medicare and Medicaid, have specific chronic conditions, or require an institutional level of care.” For example, there are SNPs for people with diabetes or chronic heart failure. If you qualify, an SNP can be an incredible resource, as it bundles your benefits and coordinates care around your specific condition.

Breaking Down the Costs of a Texas Medicare Advantage Plan

When you start looking at Medicare Advantage plans, it’s easy to focus on one number: the monthly premium. You’ll see plans with low monthly costs, and some with no premium at all. But that monthly bill is just one part of the story. To truly understand what a plan will cost you over the year, you need to look at the complete picture, which includes what you pay when you actually use your insurance.

Think of it like buying a car. The sticker price is important, but you also have to account for gas, insurance, and maintenance. With a Medicare Advantage plan, the premium is the sticker price, while deductibles, copayments, and your out-of-pocket maximum are the running costs. Understanding how these pieces fit together is the key to finding a plan that protects both your health and your budget. We’ll walk through each of these costs so you can feel confident in what you’re signing up for.

Understanding Monthly Premiums (Including $0 Options)

The monthly premium is the fixed amount you pay each month to the insurance company to keep your plan active. In Texas, you’ll find a wide range of options. The average monthly premium for a Texas Medicare Advantage plan is quite low, and what’s even better is that every single person eligible for Medicare in Texas has access to at least one plan with a $0 monthly premium.

It’s important to remember that even if you choose a $0-premium plan, you must continue to pay your monthly Medicare Part B premium to the government. The $0 premium simply means you don’t owe an additional monthly payment to the private insurance company that provides your Advantage plan.

Deductibles and Out-of-Pocket Maximums

A deductible is the amount you have to pay for your medical care before your plan starts to share the costs. For example, if your plan has a $500 deductible, you’ll pay the first $500 of your medical bills yourself. After that, you’ll typically just pay a copayment or coinsurance for services. Some plans have no medical deductible, but they might have a higher premium or different cost-sharing.

The out-of-pocket maximum is your financial safety net. It’s the absolute most you will have to pay for covered medical services in a calendar year. Once you hit this limit, your plan pays 100% for your covered care for the rest of the year. This is a critical feature that helps protect you from overwhelming medical bills if you have a serious health issue.

How to Estimate Your Total Annual Cost

To get a realistic idea of what you’ll spend, you need to look beyond the premium. A plan with a $0 premium might seem like the best deal, but if it has high copayments for your specific medications or frequent doctor visits, it could end up costing you more.

When comparing plans, add up the following: the annual cost of the premium (monthly premium x 12), the plan’s deductible, and your estimated copayments for doctor visits, specialists, and prescriptions. Also, always check that your doctors are in the network and your prescriptions are on the plan’s list of covered drugs. Considering these factors will give you a much clearer estimate of your total costs and help you choose a plan that truly fits your needs.

What Extra Perks Come with Medicare Advantage Plans?

One of the biggest draws of Medicare Advantage plans is that they often include benefits that go beyond what Original Medicare (Part A and Part B) covers. Think of them as all-in-one packages designed to care for your total health, not just hospital stays or doctor visits. While Original Medicare is a solid foundation, it leaves gaps in coverage for some everyday health needs, like routine dental check-ups or a new pair of glasses. This is where Medicare Advantage plans step in.

Private insurance companies that offer these plans compete for your business, and one way they do that is by adding attractive extra perks. These benefits can make a real difference in your daily life and your budget. Most plans bundle medical and prescription drug coverage together and then add on a variety of other benefits. You’ll find that the specific extras can vary quite a bit from one plan to another, so it’s always a good idea to look closely at the details. These perks aren’t just minor add-ons; they are valuable benefits that can help you stay healthy and save money on out-of-pocket costs.

Coverage for Dental, Vision, and Hearing

If you’ve ever been surprised by the cost of a dental crown or a new pair of prescription lenses, you know how quickly those expenses can add up. Original Medicare doesn’t cover routine dental, vision, or hearing services, which is a major reason why many people turn to Medicare Advantage. The vast majority of Medicare Advantage plans offer some level of coverage for these essential services. This can include preventive care like dental cleanings and eye exams, as well as coverage for fillings, dentures, eyeglasses, and hearing aids. The specifics will differ between plans, so be sure to check the details of the supplemental benefits before you enroll.

Built-In Prescription Drug Plans

Remembering to take your medications is one thing; managing a separate insurance plan for them is another. Most Medicare Advantage plans simplify this by including prescription drug coverage (known as MA-PD plans). This means you can have your hospital, medical, and prescription drug benefits all bundled together under one plan, with one monthly premium and one insurance card. It’s a convenient way to streamline your healthcare. Instead of signing up for a standalone Part D plan, your drug coverage is built right in. Just make sure to check the plan’s formulary—its list of covered drugs—to confirm your specific prescriptions are included and see what they’ll cost.

Fitness and Wellness Programs

Staying active is key to good health, and many Medicare Advantage plans are designed to support that goal. A popular perk is a fitness program membership, like SilverSneakers or other similar programs, at no extra cost. These programs can give you access to thousands of gyms, community centers, and online fitness classes across the country. It’s a fantastic way to stay social, maintain your strength, and keep moving. Beyond gym memberships, some plans might also offer benefits like wellness coaching, access to virtual fitness platforms, or even allowances for at-home fitness equipment. These programs are there to help you maintain a healthy and active lifestyle.

Help with Over-the-Counter Items and Transportation

Some of the most practical perks are the ones that help with everyday expenses and challenges. Many plans now offer a quarterly or monthly allowance for over-the-counter (OTC) products. You can use this credit to buy common health items like vitamins, pain relievers, cold medicine, and bandages from participating stores or through a catalog. Another incredibly helpful benefit offered by some plans is transportation to and from medical appointments. If getting to your doctor is a challenge, this service can provide rides for non-emergency visits, ensuring you never have to miss an important check-up. Some plans even offer allowances for groceries or meal delivery after a hospital stay.

How to Check if Your Doctor Is in a Plan’s Network

One of the most important steps in choosing a Medicare Advantage plan is making sure your trusted doctors are included. Unlike Original Medicare, which lets you see almost any doctor in the country, most Medicare Advantage plans have a specific list of doctors and hospitals they work with, called a provider network. If you see a doctor who isn’t on that list, you could end up paying much more, or even the full cost, out of pocket.

Taking a few minutes to check the network now can save you from unexpected bills and the stress of having to switch doctors later. It’s all about ensuring you can continue to see the healthcare professionals you know and trust without any financial surprises. Let’s walk through exactly how to do it.

Finding Your Doctors and Hospitals

Before you even start comparing plans, grab a pen and paper and make a list of every doctor, specialist, and hospital you use and want to keep seeing. Once you have your list, you can start investigating specific plans.

Each insurance company has an online tool, often called a “provider directory” or “find a doctor” search, on its website. You can type in your doctor’s name and location to see if they are in the plan’s network. While these tools are helpful, they aren’t always perfectly up-to-date.

The best way to be 100% sure is to call your doctor’s office directly. Ask the billing staff, “Do you accept XYZ Medicare Advantage plan?” This simple phone call is the most reliable way to confirm that your doctor is in-network.

What to Know About Network Rules and Referrals

The type of plan you choose determines the rules you’ll need to follow. Most Medicare Advantage plans are either HMOs or PPOs, and they handle networks differently.

With a Health Maintenance Organization (HMO), you generally must use doctors and hospitals within the plan’s network for your care to be covered, except in an emergency. HMOs also typically require you to choose a Primary Care Physician (PCP) who coordinates your care and provides referrals if you need to see a specialist.

Preferred Provider Organization (PPO) plans offer more flexibility. You have a network of “preferred” providers, and you’ll pay the lowest costs when you see them. However, you also have the option to see out-of-network doctors, though you’ll pay more. With a PPO, you usually don’t need a referral to see a specialist.

What Happens if You Go Out-of-Network?

Understanding what happens when you see a doctor outside your plan’s network is key to managing your healthcare costs. The consequences depend entirely on the type of plan you have.

If you have an HMO plan and you choose to see an out-of-network doctor for non-emergency care, you will likely be responsible for the entire bill. The plan simply won’t cover it.

If you have a PPO plan, you have the freedom to go out-of-network, but that freedom comes at a price. The plan will still help pay for your care, but your share of the cost will be higher. For example, an in-network specialist visit might have a $40 copay, while an out-of-network visit could require you to pay 50% of the total cost.

Does Your Plan Cover Your Prescriptions? Here’s How to Check

One of the most important parts of choosing a Medicare Advantage plan is making sure it covers your prescription drugs. The costs for medications can vary wildly from one plan to another, so this is a step you definitely don’t want to skip. Most plans in Texas include prescription drug coverage (known as Part D), but the details matter. Here’s a straightforward way to check if your medications are covered and what you can expect to pay.

What Are Drug Tiers?

Every plan has a list of covered drugs, called a “formulary.” Think of it as the plan’s official medication menu. This list is usually broken down into different levels, or “tiers.” Drugs in the lower tiers, like common generics, will have the lowest copay. As you move up the tiers to brand-name and specialty drugs, your out-of-pocket costs will increase. Before you enroll, you’ll want to find the plan’s formulary and see which tier your specific medications fall into. This simple check gives you a much clearer picture of your potential yearly drug expenses and helps you avoid any surprises at the pharmacy counter.

How to Look Up Your Medications

The easiest way to see how different plans cover your specific drugs is by using the official Medicare Plan Finder tool. First, make a complete list of your prescriptions, including the exact spelling and dosage. Then, you can enter this information directly into the tool. It will show you which plans cover your medications and provide an estimate of your annual costs, including premiums, deductibles, and copays. This allows you to compare plans side-by-side based on your personal medication needs. It takes the guesswork out of the process and helps you find a plan that truly fits your health and your budget.

Understanding Coverage Gaps and Special Approvals

When looking at drug costs, you’ll see terms like “deductible” and “out-of-pocket maximum.” A deductible is what you pay before your plan starts covering costs. Some plans have a $0 drug deductible, but often have a higher monthly premium. The great news is that starting in 2025, there’s a new protection in place: a $2,000 annual cap on out-of-pocket prescription costs. This means you won’t pay more than that amount for your drugs all year. Also, be aware that some medications may require “prior authorization,” meaning your doctor needs to get the plan’s approval before you can fill the prescription.

What Do Medicare’s Star Ratings Really Mean?

When you’re shopping for anything new, from a coffee maker to a car, you probably check the reviews. Medicare uses a similar system to help you understand the quality of its plans: the Star Rating System. Think of it as a report card that gives you a quick snapshot of a plan’s performance. These ratings are updated each year, giving you fresh information to help with your decision.

While a high star rating is a good sign, it’s just one piece of the puzzle. A five-star plan might be perfect for your neighbor but could be a poor fit for you if it doesn’t include your doctors or prescriptions. Understanding what these ratings measure—and what they don’t—is key to using them effectively as you compare your options.

How Plans Get Their Star Rating

The star ratings aren’t created by the insurance companies themselves. Instead, they are provided by the Centers for Medicare & Medicaid Services (CMS), the federal agency that runs Medicare. Each year, CMS evaluates Medicare Advantage and Part D prescription drug plans based on dozens of different factors.

This evaluation covers how well the plan performs in several categories, including how it helps members stay healthy, manages chronic conditions, and handles customer service. After collecting all this data, CMS assigns an overall rating to each plan on a simple scale of one to five stars, with five being the highest possible score.

What the Ratings Say About a Plan’s Quality

So, what does a 4-star rating actually mean compared to a 3-star one? The ratings reflect a plan’s overall performance and member experience. Plans are rated on a scale of 1 to 5 stars, with 5 being the best. A plan with a higher star rating has demonstrated strong performance across various quality measures.

These measures include things like member satisfaction surveys, how easy it is to get appointments, and the quality of care provided. For example, the ratings look at whether members received their preventive screenings, like flu shots and mammograms. A 5-star plan is considered excellent, while a plan with fewer than 3 stars is considered to have below-average performance.

How to Use Ratings to Compare Your Options

Star ratings are a fantastic starting point for narrowing down your choices, but they shouldn’t be the only factor you consider. When selecting a Medicare Advantage plan, it’s important to compare options based on your specific needs, not just the number of stars next to a plan’s name. A top-rated plan won’t do you much good if your trusted primary care doctor isn’t in its network.

Before you decide, look at the complete picture. Consider the monthly premium, deductibles, and the plan’s out-of-pocket maximum. Check if your doctors are in the network, if your prescriptions are covered, and what extra benefits like dental or vision care are offered.

How to Choose the Right Medicare Advantage Plan for You

With so many options available in Texas, picking the right Medicare Advantage plan can feel like a huge task. But it doesn’t have to be. The key is to focus on what matters most to you. The plan that works perfectly for your neighbor might not be the best fit for your health needs or budget. Think of it like shopping for a car—you wouldn’t just pick the one with the lowest monthly payment without checking if it has enough seats for your family or gets good gas mileage.

Choosing a plan is a personal decision that comes down to four key areas: your doctors, your prescriptions, your budget, and the extra benefits you’ll actually use. Taking the time to review these details will help you find a plan that truly supports your health and financial well-being. It’s about finding a balance between monthly costs and the coverage you need to stay healthy throughout the year. Let’s walk through a simple, step-by-step process to help you compare your options with confidence and find the plan that’s right for you.

Start with Your Own Health Needs

Before you even start looking at plans, take a moment to think about your personal health situation. The best plan for you is one that’s tailored to your life. Start by making a list of all the doctors, specialists, and hospitals you currently use and want to keep seeing. Next, write down all your prescription medications, including the dosage. This information is critical for ensuring your plan covers what you need. Finally, consider what extra benefits are important to you. Do you need dental, vision, or hearing coverage? Would a fitness membership be valuable? Thinking through these points first will give you a clear checklist to use when you start comparing your options.

Using Online Tools to Compare Plans

Once you have your list of needs, you can start exploring the plans available in your area. The best place to begin is the official Medicare Plan Finder tool. By simply entering your ZIP code, you can see a detailed list of the Medicare Advantage plans offered in your part of Texas. This tool allows you to enter your specific medications and preferred doctors to see how each plan covers them. It’s an invaluable resource for getting a side-by-side comparison of costs and benefits. For additional state-specific information, you can also find resources through the Texas Health and Human Services office, which provides support for residents.

Getting Help from a Licensed Professional

You don’t have to figure this all out on your own. There are free, unbiased resources available to help you. Every state has a State Health Insurance Assistance Program (SHIP) that offers one-on-one counseling to Medicare beneficiaries. These trained volunteers can answer your questions and provide impartial information about your options.

You can also work with a licensed insurance agent who specializes in Medicare. An experienced agent can listen to your needs, explain the fine print of different plans, and help you compare your choices in a way that makes sense. Here at The Big 65, our guidance comes at no cost to you, and we’re here to make the process simpler and less stressful.

When and How to Enroll in a Texas Medicare Advantage Plan

Timing is everything when it comes to choosing your Medicare coverage. You can’t just sign up for a new plan whenever you feel like it; there are specific windows of time when you can enroll or make changes. Understanding these periods is the key to making sure you get the coverage you need, right when you need it. Let’s walk through the most important dates and the steps to get enrolled.

Key Dates: The Annual Enrollment Period

Think of this as Medicare’s open house. The Annual Enrollment Period (AEP) for Medicare Advantage plans runs from October 15 to December 7 each year. This is your main opportunity to make changes to your coverage for the upcoming year. During this time, you can switch from Original Medicare to a Medicare Advantage plan, change from one Medicare Advantage plan to another, or leave a Medicare Advantage plan to return to Original Medicare. It’s the perfect time to review your current plan and see if another one might be a better fit for your health needs and budget.

Can You Enroll at Other Times? (Special Enrollment)

What if you need to make a change outside of the fall AEP? Life happens, and Medicare has rules in place for that. You may qualify for a Special Enrollment Period (SEP) if you experience certain life events. These can include things like moving out of your plan’s service area, losing other health coverage (like from an employer), or qualifying for Medicaid. An SEP gives you a limited window to enroll in a new Medicare Advantage plan outside of the usual dates, ensuring you don’t have a gap in your health coverage.

The Simple Steps to Apply

Once you’ve found a plan that feels right, the application process is pretty straightforward. Here are the simple steps to get enrolled:

Review your options: The best place to start is by using the official Medicare Plan Finder tool to compare the plans available in your specific zip code. This lets you see costs, coverage, and ratings side-by-side.
Gather necessary information: Before you apply, make sure you have your red, white, and blue Medicare card handy. You’ll need your Medicare number and the dates your Part A and Part B coverage started.
Enroll: You have a few ways to submit your application. You can enroll online directly through the insurance carrier’s website, call the plan to enroll over the phone, or contact Medicare for assistance.

Common Mistakes to Avoid When Choosing a Plan

Choosing a Medicare Advantage plan is a significant decision, and with so many options, it’s easy to get tripped up. Many people make a quick choice based on one attractive feature, only to discover later that the plan doesn’t quite fit their needs. But you can avoid that. A little awareness of the most common pitfalls can help you make a selection you feel confident about. It’s all about looking at the whole picture instead of just one piece of the puzzle. The goal is to find a plan that works for you in the real world—when you visit the doctor or pick up a prescription.

Focusing Only on the Monthly Premium

It’s hard to ignore a plan with a $0 monthly premium, and you’ll see plenty of them. While a low or no-cost premium is a great perk, it doesn’t tell the whole financial story. A plan with a $0 premium might have a higher deductible, more expensive copays for doctor visits, or a higher out-of-pocket maximum. It’s important to look at all the costs involved. Sometimes, a plan with a small monthly premium could actually save you money over the year if it offers better coverage for the services you use most. The premium is just the starting point for understanding your total costs.

Not Checking the Doctor Network

One of the most important steps before enrolling in a Medicare Advantage plan is confirming that your doctors are in its network. Many plans have wide networks of trusted doctors and hospitals, but you can’t assume your providers are included. If you enroll in a plan and your long-time physician isn’t in-network, you could face much higher costs or have to switch doctors entirely. Before you commit, take the time to use the plan’s online provider directory or call them directly to verify that your preferred doctors and hospitals are covered. This simple check can save you from a world of frustration and unexpected medical bills.

Comparing Plans Without All the Facts

When you’re looking at different plans, it’s tempting to focus on one or two features, like the premium or a specific extra benefit. But the best way to choose is to compare plans based on your unique needs. Make a list of what’s most important to you. Does the plan cover all your prescriptions? Are your doctors in the network? What will your total out-of-pocket costs look like for the year? How do other members rate the plan’s quality? Looking at all these factors together gives you a much clearer picture of how a plan will work for you day-to-day, helping you find the one that’s truly the right match.

Frequently Asked Questions

Do I still need to pay my Medicare Part B premium if I enroll in a Medicare Advantage plan? Yes, you do. Think of your Part B premium as your entry ticket to the Medicare program. You pay it to the government to maintain your medical coverage. A Medicare Advantage plan is simply a different way to receive those benefits from a private company. Even if you choose an Advantage plan with a $0 monthly premium, you must continue paying your Part B premium to stay enrolled.

Is a $0 premium plan really free? While it’s true you won’t owe an additional monthly payment to the insurance company, a $0 premium plan isn’t completely free. That zero-dollar price tag refers only to the monthly premium. You will still be responsible for other costs when you use your healthcare, such as deductibles, copayments, and coinsurance. It’s important to look at the plan’s total potential costs, not just the premium, to see if it’s the most affordable option for you.

What’s the most important thing to check before choosing a plan? If you have to focus on just one thing, it should be confirming that your trusted doctors and necessary prescriptions are covered. A plan can have a low premium and great perks, but it won’t be the right fit if your primary care physician isn’t in the network or your essential medications aren’t on the formulary. Verifying these two details first will save you from major headaches and unexpected costs down the road.

What’s the difference between an HMO and a PPO in simple terms? The main difference comes down to flexibility and cost. An HMO plan generally requires you to use doctors and hospitals within its network and get a referral from your primary care doctor to see a specialist. In exchange for following these rules, you often get lower out-of-pocket costs. A PPO plan gives you more freedom to see providers both in and out of the network without a referral, but you’ll pay more if you choose to go outside the plan’s preferred network.

Can I switch plans if I make the wrong choice? You aren’t locked into a plan forever. Every year, Medicare has an Annual Enrollment Period from October 15 to December 7. During this time, you can review your coverage and switch to a different Medicare Advantage plan that better suits your needs for the following year. This is your main opportunity to make a change, so it’s a great time to reassess your health needs and budget.