Medicare Advantage Plans in San Jacinto County, TX:
Your Complete 2025 Guide
Explore 37 Medicare Advantage plans available in San Jacinto County, TX for 2025. These plans offer comprehensive coverage beyond Original Medicare, with options for additional benefits such as vision, dental, and/or hearing, and/or fitness programs.Plans change annually, and there may not be a plan in San Jacinto County with all of these benefits in one plan.
Types of Medicare Advantage Plans in San Jacinto County, TX
With 37 Medicare Advantage plans available in San Jacinto County for 2025, you have a range of options to choose from. However, there are no 5-star plans available this year. Here’s a breakdown of your choices:
Summary of Medicare Advantage Plan Types Available in San Jacinto County, Texas
- Preferred Provider Organization (PPO) Plans: These plans (19 available) offer flexibility with out-of-network care at a higher cost. The average monthly premium for these plans is $19.12.
- Health Maintenance Organization (HMO) Plans: These plans (12 available) require in-network care and generally have lower costs. The average monthly premium for these plans is $1.49.
- HMO Point-of-Service (HMO-POS) Plans: These plans (4 available) blend HMO and PPO features, allowing some out-of-network care. The average monthly premium for these plans is $0.00.
- Private Fee-for-Service (PFFS) Plans: These plans (2 available) let you see any Medicare-approved provider who accepts the plan’s terms. The average monthly premium for these plans is $6.50.
- Special Needs Plans (SNP): These highly specialized Medicare Advantage plans cater to individuals with specific healthcare needs. Learn more here: Medicare Special Needs Plans in San Jacinto County, TX .
Medicare Advantage PPO Plans
Preferred Provider Organization (PPO) plans offer flexibility by allowing you to see both in-network and out-of-network providers. These plans often have higher costs for out-of-network care but provide more options for those who want greater freedom in choosing their healthcare providers.
- Out-of-Network Costs: PPO plans allow you to see out-of-network providers, but this flexibility often comes with higher costs. Evaluate additional costs if you prefer providers outside the plan's network.
- Provider Network: Verify your preferred doctors and specialists are in-network to lower costs. If flexibility is important, confirm the network meets your needs.
- Premiums and Out-of-Pocket Maximums: Compare premiums and out-of-pocket maximums across plans. Higher premiums may provide more coverage, but assess if benefits justify additional cost.
- Additional Benefits: Many PPO plans include extras like dental, vision, or fitness programs. Assess which benefits align best with your healthcare priorities, keeping in mind availability varies.
Medicare Advantage HMO Plans
Health Maintenance Organization (HMO) plans typically require you to use in-network providers for your care. These plans often have lower out-of-pocket costs and premiums, making them a cost-effective option for those who don't mind a more limited provider network.
| Plan Name | Rating* | Premium/Mo | MOOP | Rx Ded. |
|---|---|---|---|---|
| Cigna Courage Medicare | $0 | $4,300 | N/A | |
| Cigna Preferred Full Savings Medicare | $0 | $7,500 | $0 | |
| Cigna Preferred Medicare | $0 | $3,500 | $0 | |
| Cigna Preferred Savings Medicare | $0 | $6,900 | $0 | |
| Devoted EXTRA Greater Houston | $0 | $4,900 | $590 | |
| Devoted GIVEBACK Greater Houston | $0 | $7,200 | $590 | |
| KelseyCare Advantage Core | $0 | $4,500 | N/A | |
| Aetna Medicare Premier | $0 | $6,350 | $590 | |
| Humana Gold Plus H0028-042 | $0 | $3,450 | $300 | |
| Wellcare Assist | $18 | $3,450 | $590 | |
| Wellcare Giveback | $0 | $6,900 | $420 | |
| Wellcare Simple | $0 | $3,500 | $420 | |
| * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. | ||||
- In-Network Care: HMO plans generally require you to use in-network providers for all non-emergency care. Verify your preferred doctors, specialists, and hospitals are in-network before enrolling.
- Primary Care Referrals: Many HMO plans require referrals from your primary care doctor to see specialists. Be comfortable with this care coordination requirement.
- Lower Costs: HMO plans typically have lower premiums and out-of-pocket costs compared to other plan types, beneficial if cost savings are your priority.
- Additional Benefits: Some HMO plans offer extras like dental, vision, or fitness programs. Evaluate which benefits are most important, noting availability may vary.
Medicare Advantage HMO-POS Plans
With HMO Point-of-Service (HMO-POS) plans, you can enjoy the cost savings of an HMO while still having the flexibility to see out-of-network providers when necessary. Though out-of-network care typically costs more, this type of plan offers a good middle ground for those who want some freedom in their provider choices.
| Plan Name | Rating* | Premium/Mo | MOOP | Rx Ded. |
|---|---|---|---|---|
| AARP Medicare Advantage from UHC TX-0026 | $0 | $4,900 | $340 | |
| AARP Medicare Advantage Giveback from UHC TX-41 | $0 | $7,900 | $495 | |
| KelseyCare Advantage Freedom | $0 | $6,500 | $200 | |
| Wellpoint Medicare Advantage 2 | $0 | $9,350 | $0 | |
| * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. | ||||
- Out-of-Network Costs: HMO-POS plans allow out-of-network providers, but at higher costs. Evaluate potential extra costs for out-of-network care.
- In-Network vs. Out-of-Network Care: Compare coverage options between in-network and out-of-network care. Decide if flexibility justifies additional expenses.
- Referral Requirements: Many HMO-POS plans require a referral from your primary care doctor for specialist visits. Confirm you're comfortable with this requirement.
- Additional Benefits: Many HMO-POS plans include extras like dental, vision, or fitness programs. Determine which benefits best match your healthcare needs, acknowledging that not all benefits may be available in every plan.
Private Fee-for-Service (PFFS) Medicare Advantage Plans
Private Fee-for-Service (PFFS) plans give you the freedom to visit any Medicare-approved provider who agrees to the plan’s terms. While these plans offer flexibility, it’s important to check that your preferred healthcare providers are willing to accept the plan.
| Plan Name | Rating* | Premium/Mo | MOOP | Rx Ded. |
|---|---|---|---|---|
| Humana Gold Choice H8145-084 | $13 | $6,700 | $250 | |
| Humana Gold Choice H8145-126 | $0 | $6,700 | N/A | |
| * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. | ||||
- Provider Agreement: PFFS plans allow you to see any Medicare-approved provider, provided they accept the plan’s payment terms. Confirm your preferred providers accept the plan before enrolling.
- Flexibility vs. Costs: PFFS plans offer greater flexibility but may come with higher out-of-pocket costs compared to other types. Carefully compare these costs.
- No Network Requirements: While PFFS plans don't have network restrictions, fewer providers may accept them, potentially limiting choices.
- Additional Benefits: Some PFFS plans offer additional benefits like dental, vision, or fitness programs. Determine which of these benefits align most closely with your needs.
Choosing a Medicare Advantage Plan in San Jacinto County requires knowing the right time to enroll. Whether it’s your first time enrolling in Medicare or you’re switching plans, understanding the different enrollment periods will help you get the right coverage for your health needs.
When to Enroll
- Initial Enrollment Period (IEP): Enroll in Medicare during this period, which starts three months before your 65th birthday and ends three months after. This is your first opportunity to select a Medicare Advantage plan. Learn more
- Medicare Advantage Open Enrollment Period (MA OEP): From January 1 to March 31, you can switch your current Medicare Advantage plan to a new one or return to Original Medicare if your current plan no longer suits you. Learn more
- Annual Enrollment Period (AEP): Occurring annually from October 15 to December 7, this period allows you to adjust your Medicare coverage for the upcoming year. Learn more
- Special Enrollment Periods (SEPs): If certain life events, such as moving or losing coverage, apply to you, you may qualify for a Special Enrollment Period to make changes to your plan. Learn more
How to Enroll
- Talk to a Licensed Agent: Speak with a licensed health insurance agent from HealthCompare 1-833-748-3201 (TTY 711) (Mon-Fri 5am-6pm, Sat 6am-5pm PST) for personalized guidance.
- Enroll Directly with the Plan Provider: Contact your chosen plan provider online or by phone to complete your enrollment.
- Visit Medicare.gov: Compare plans and enroll through the official Medicare website at Medicare.gov.
What is the difference between Medicare Advantage and Original Medicare?
Medicare Advantage (Part C) is offered by private insurance companies and combines Medicare Part A and Part B coverage, often with additional benefits like dental and vision. Original Medicare is administered by the federal government and covers Part A and Part B separately, without the extra perks.
How are Medicare Advantage plans rated?
The Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage plans on a 5-star scale, based on quality and performance. These ratings consider factors such as member satisfaction, quality of care, and customer service.
Can I use any doctor with a Medicare Advantage plan?
Whether you can use any doctor depends on the type of Medicare Advantage plan you choose. For example, HMO plans typically require you to stay within a network of providers, while PPO plans allow you to see out-of-network doctors at a higher cost.
What happens if I’m already enrolled in a Medicare Advantage plan and want to switch?
If you want to switch your Medicare Advantage plan, you can do so during the Annual Enrollment Period (AEP) from October 15 to December 7, or during the Medicare Advantage Open Enrollment Period (MA OEP) from January 1 to March 31. Special Enrollment Periods (SEPs) may also apply in certain circumstances.
Can I enroll in a Medicare Advantage plan if I have pre-existing conditions?
Yes, you can enroll in a Medicare Advantage plan even if you have pre-existing conditions. Medicare Advantage plans cannot deny you coverage or charge you more based on your health status.
How do I qualify for a Special Enrollment Period?
You may qualify for a Special Enrollment Period (SEP) if you experience certain life events, such as moving to a new area, losing other health coverage, or becoming eligible for Medicaid. SEPs allow you to make changes to your Medicare Advantage plan outside of the standard enrollment periods.
The MA and MAPD plans on this page are available to people on Medicare enrolled in both Medicare Part A and Part B living in Coldspring, Pointblank, Shepherd, and all other areas of San Jacinto County, Texas.
Plans Offered for Enrollment through Medicare.org
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Baylor Scott & White Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, GlobalHealth, Health Care Service Corporation, Healthy Blue, HealthSun, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
CMS Plan IDs Presented
The Medicare Advantage plan pages listed in the tables above include localization to assist beneficiaries with plans available in their service area. However, most Part C plans are available in more than one service area, which can lead to confusion. The following list of CMS IDs links to our master plan pages without localization.
- Medicare.gov, "Compare types of Medicare Advantage Plans", Last Accessed 25 May, 2025
- Medicare.gov, "Your coverage options", Last Accessed 25 May, 2025
- Medicare.gov, "Joining a plan", Last Accessed 25 May, 2025
- CMS.gov, Landscape Source Files, Last Accessed March 15, 2025