Medicare Advantage Plans Austin 2025

Are you on the hunt for Medicare Advantage plans in Austin? Cut through the complexity with our essential guide that simplifies your search for “Medicare Advantage plans Austin”. We’ll help you compare features, costs, and providers of various plans tailored for Austin residents, ensuring you make an informed and confident decision for your healthcare coverage in 2024.


Key Takeaways


  • Medicare Advantage plans in Austin provide additional benefits that may go beyond basic coverage, and their quality is indicated by CMS star ratings, with top plans receiving 4.5 to 5 stars.


  • Enrollment in Medicare Advantage plans is limited to designated periods such as the Initial Enrollment, Annual Enrollment, and Special Enrollment Periods, and local assistance is available for plan comparison and selection.

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Austin’s Medicare Advantage Landscape in 2024


Medicare Advantage Plans Austin 2025 Austin's Medicare Advantage Landscape in 2024


Austin, the capital city of Texas, prides itself on its vibrant live music scene and cultural landmarks. But beyond the guitar strums and the smell of barbecued meat, Austin holds another treasure – a diverse array of Medicare Advantage plans for its residents.

In 2024, Texas offers 376 Texas Medicare Advantage plans, a slight drop from 385 in 2023. Each of these advantage plans in Texas is uniquely tailored to the healthcare needs of its beneficiaries, underscoring the importance of understanding and selecting the appropriate plan.


Plan Types Available

Austin boasts a diverse mix of Medicare Advantage plan types, ranging from Health Maintenance Organizations (HMOs) to Preferred Provider Organizations (PPOs).

HMO plans, for instance, limit coverage to care from in-network providers and typically don’t cover out-of-network care except in emergencies. PPO plans, on the other hand, offer the flexibility to use both in and out-of-network doctors, albeit with higher out-of-network costs.

There’s also a hybrid of both, the HMO-POS plan, exemplified by the AARP Medicare Advantage (HMO-POS) with a $0.00 monthly premium, a maximum out-of-pocket limit of $5,500 and a 4.5 Medicare star rating.


Top Providers in Austin

Austin’s Medicare Advantage plans are offered by a bevy of reputable Medicare Advantage companies. Key players in the arena include Aetna Medicare, Anthem Blue Cross Blue Shield, Humana, and UnitedHealthcare, among others.

The top five by enrollment are Cha Hmo, Inc., Physicians Health Choice Of Texas, LLC, Care Improvement Plus South Central Insurance Co., and two different Humana Insurance Company entities. Additional major providers include CHRISTUS Health Plan, Community First Health Plans, KelseyCare Advantage, and more.

For quality seekers, Devoted Health, Humana, and UnitedHealthcare boast a 4.5-star CMS rating for the 2024 plan year.


Average Monthly Premiums


 Medicare Advantage Plans Austin 2025 Austin's Medicare Advantage Landscape in 2024


The cost of Medicare Advantage plans in Austin is largely defined by monthly premiums. On average, a Medicare Advantage plan in Texas may have a nominal monthly cost.

In contrast, Austin residents could encounter a slightly higher average monthly premium for their plans. The silver lining? Austin offers Medicare Advantage plans with $0 monthly premiums, making it easier for beneficiaries to secure their healthcare needs.

However, it’s essential to review these plans’ prescription drug coverage, as the low premium may reflect different levels of drug coverage.


Evaluating Medicare Advantage Plans in Austin

Exploring the Medicare Advantage landscape can be as thrilling and challenging as navigating the Colorado River. However, with accurate and current CMS data serving as a reliable compass, this journey becomes significantly less intimidating.

Whether you’re a tech-savvy senior or a caregiver assisting a loved one, these resources can be instrumental in making informed decisions regarding Medicare Advantage plans in Austin.

We will now examine the four primary factors in evaluating these plans: cost, network, prescription drug coverage, and supplemental benefits.


Cost Comparison

When comparing Medicare Advantage plans, cost becomes a pivotal factor. This includes:

  • premiums


  • deductibles


  • copays


  • coinsurance


In Austin, the average out-of-pocket maximum for Austin, Medicare Advantage plans offer a range of out-of-pocket maximums, providing beneficiaries with financial protection by capping annual expenses. Unlike Original Medicare, which doesn’t cap out-of-pocket expenses, Medicare Advantage plans have a CMS-regulated out-of-pocket maximum, offering financial protection for beneficiaries.


Network Considerations

Selecting a plan involves more than just cost considerations; it’s equally vital to verify that your preferred healthcare providers are included in your plan’s network.

Thankfully, the Medicare provider search tool enables beneficiaries to find and compare approved in-network providers in Austin. With this handy tool, you can compare quality ratings for a variety of healthcare providers and make an informed choice.

Indeed, access to quality healthcare is not a privilege, but a fundamental right.


Prescription Drug Coverage

Prescription drug coverage constitutes another crucial element of Medicare Advantage plans. In Austin, plans that include the Part D package have an average of prescription drugs.

In Austin, plans that include the Part D package often have a prescription drug plan deductible. While most Medicare Advantage plans come with prescription drug coverage, it’s crucial to review the prescription drug formularies to ensure necessary medications are covered and assess plan coverage rules for prescription drugs.

Undeniably, appropriate medication can significantly enhance the management of health conditions.


Additional Benefits


Medicare Advantage Plans Austin 2025 Evaluating Medicare Advantage Plans in Austin


Beyond basic coverage, Austin’s Medicare Advantage plans augment healthcare provision with supplemental benefits like fitness memberships, transportation, and meal delivery services. Many plans also provide extra coverage for dental, vision, hearing, and prescriptions, along with other personal wellness services.

However, not all plans include every service, making it essential for beneficiaries to review plan details for specific benefits like routine dental coverage in their Medicare health journey.

With offerings like access to over 16,000 fitness facilities nationwide, and various transportation and meal delivery benefits, it’s important to compare Medicare Advantage plans, including Medicare Advantage HMO plans and Medicare Advantage PPO plans, to find the one that can offer exceptional value and convenience.

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Enrollment Periods and Eligibility

Medicare Advantage plan enrollment is not an all-year-round event; it’s confined to designated periods. These include the Initial Enrollment Period, Annual Enrollment Period, and Special Enrollment Period.

Furthermore, eligibility is based on age, disability, and enrollment in both Medicare Part A and Part B.

Whether you are a new Medicare beneficiary or a long-time participant intending to switch your plan, comprehending these periods can guide you to make prompt decisions and maximize your healthcare coverage benefits.


Initial Enrollment Period (IEP)

The Initial Enrollment Period (IEP) serves as your first opportunity to register, much like the opening act of a concert. The enrollment period begins three months before your 65th birthday and lasts for three months after your birth month.

This six-month window is important for signing up for Medicare. Receiving Social Security Disability Insurance means that the IEP starts on the 25th month of getting SSDI benefits. After this period, individuals become eligible for Medicare.

If you enroll before your birth month, your coverage becomes effective starting the first day of the birth month.

From January 1, 2024, individuals facing unique circumstances are granted a two-month window to join a Medicare Advantage or Medicare drug plan upon enrolling in Medicare Part A and/or Part B.


Annual Enrollment Period (AEP)

Similar to an annual health check-up, the Annual Enrollment Period (AEP) offers existing Medicare beneficiaries the opportunity to evaluate and modify their Medicare Advantage plans. This period occurs annually from October 15 to December 7.

During the AEP, you can make changes to your existing coverage, with new choices becoming effective on January 1 of the upcoming year. Therefore, it’s wise to mark your calendars and utilize this period optimally to identify the plan that aligns best with your healthcare needs.


Special Enrollment Period (SEP)

Life’s unpredictability sometimes necessitates modifications to your Medicare Advantage plan. Enter the Special Enrollment Period (SEP), which allows changes to Medicare Advantage and Medicare drug coverage when certain life events occur, such as moving or losing other insurance coverage.

If you are eligible for both Medicare and Medicaid, you may qualify for a Dual Special Needs Plan (D-SNP) in Austin. This plan can provide additional coverage and benefits tailored to your needs.

D-SNPs help streamline your experience and offer additional coverage by coordinating benefits from both Medicare and Medicaid, which is more than what either program offers alone.


Highly Rated Medicare Advantage Plans in Austin


Medicare Advantage Plans Austin 2025 Highly Rated Medicare Advantage Plans in Austin


In choosing the best Medicare Advantage plan, the service quality and coverage benefits hold significant weight. In Austin, this quality is reflected in the Centers for Medicare & Medicaid Services (CMS) star ratings.

Whether you’re a discerning senior or a caregiver seeking the best for your loved ones, these top-rated Medicare Advantage plans may serve as your ideal choice:

  • Plan A: 5-star rating


  • Plan B: 4.5-star rating


  • Plan C: 4-star rating


  • Plan D: 4-star rating


Let’s explore some of these plans, their ratings, and what they bring to the table.


5-Star Plans

The top-tier Medicare Advantage plans in Austin are:

  • Baylor Scott & White Health Plan


  • UnitedHealthcare’s Erickson Advantage series


  • KelseyCare Advantage plans, such as Silver Community (HMO-POS) and Gold Community (HMO-POS)


These plans, offered by private insurance companies, represent the pinnacle of quality in terms of servicing and coverage benefits.

If you aim for nothing but the best, these 5-star plans certainly merit consideration.


4.5-Star Plans

If a 5-star plan seems out of reach, fret not; Austin offers a multitude of 4.5-star Medicare Advantage plans. While specific plan names aren’t provided, providers like Devoted Health, Humana, and UnitedHealthcare offer 4.5-star plans.

Bear in mind, a higher star rating typically implies superior prescription drug coverage, rendering star ratings an essential factor in assessing and selecting a Medicare Advantage plan in Austin.

Special Needs Plans (SNPs) in Austin

Just as healthcare needs vary, so do the Medicare Advantage plans in Austin. For beneficiaries with unique healthcare needs, Austin offers Medicare Advantage Special Needs Plans (SNPs).

These plans include Chronic Special Needs Plans (C-SNP) and Dual Special Needs Plans (D-SNP), each designed to cater to specific groups.

Let’s examine these plans and their distinctive features more closely.


Chronic Special Needs Plans (C-SNP)

Chronic Special Needs Plans (C-SNPs) are designed for individuals with one or more severe or disabling chronic conditions. These plans provide tailored benefits and provider networks designed specifically to manage severe or disabling chronic conditions effectively.

Therefore, if you or a loved one is dealing with a chronic condition, a C-SNP may provide comprehensive and tailored healthcare solutions.


Dual Special Needs Plans (D-SNP)

Dual Special Needs Plans (D-SNPs), on the other hand, are designed to coordinate Medicare and Medicaid benefits for dual-eligible members. If you’re eligible for both programs, you may qualify for a D-SNP in Austin.

By coordinating benefits from both programs, D-SNPs can provide a streamlined experience and additional coverage, offering more than what either program offers alone.


Local Resources for Medicare Assistance


 Medicare Advantage Plans Austin 2025 Local Resources for Medicare Assistance


While navigating the Medicare Advantage landscape may seem daunting, rest assured that you don’t have to undertake it single-handedly. Several local resources can provide assistance, whether you’re looking for detailed Medicare Advantage plan information, comparing plans, or have questions about Medicare.

Let’s explore these local resources.


Texas Department of Insurance

The Texas Department of Insurance offers resources and assistance for Texans needing help with Medicare choices. This includes:

  • Free volunteer Medicare counseling through the Texas Health Information, Counseling and Advocacy Program


  • Help with enrolling in Medicare


  • Comparing plans


  • And more


Should the multitude of choices appear overwhelming, remember that assistance is merely a phone call away.


Texas Area Agencies on Aging

In addition, Texas Area Agencies on Aging provide a suite of services to individuals aged 60 and older. This includes benefits counseling and legal assistance to help navigate community services.

Aimed at serving those with the greatest economic and social needs, these agencies prioritize services for low-income seniors, minority groups, and those living in rural communities.

By calling the toll-free number 1-833-641-4938, you can tap into these resources and find the assistance you need.


From the vibrant music scene to the rich cultural heritage, Austin, Texas, offers more than meets the eye. The city’s diverse Medicare Advantage landscape offers numerous choices to meet the unique healthcare needs of its beneficiaries.

Whether you’re considering costs, network considerations, prescription drug coverage, or additional benefits, Austin has a plan to fit your needs. With resources like the Texas Department of Insurance and Texas Area Agencies on Aging, you’re not alone on this journey.

After all, your health is your wealth, and finding the right Medicare Advantage plan can be a significant step towards safeguarding it.


Frequently Asked Questions


→ What are 4 types of Medicare Advantage plans?

There are 4 types of Medicare Advantage plans: Health Maintenance Organization (HMO) plans, Preferred Provider Organization (PPO) plans, Special Needs Plans (SNPs), and Private Fee-for-Service (PFFS) plans. Each operates a bit differently, so it’s important to compare and choose the one that best fits your needs.


→ What is the average cost of Medicare Advantage plans in Texas?

The average cost of Medicare Advantage plans in Texas is subject to variation, with premiums that can be quite low to moderately priced in 2024. The specific cost is influenced by a variety of factors, including geographic location and the particular plan chosen.


→ How many Medicare Advantage plans are available in Austin, Texas?

There are 376 Medicare Advantage plans available in Texas, offering numerous options in Austin.


→ What is the average monthly premium for Medicare Advantage plans in Austin?

The average monthly premium for Medicare Advantage plans in Austin tends to be above the state average, reflecting a range of plan options and benefits tailored to the healthcare needs of Austin residents.

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Russell Noga
( Medicare Expert )

Russell Noga is the CEO of ZRN Health & Financial Services, and head content editor of several Medicare insurance online publications. He has over 15 years of experience as a licensed Medicare insurance broker helping Medicare beneficiaries learn about Medicare, Medicare Advantage Plans, Medigap insurance, and Medicare Part D prescription drug plans.