Medicare Plans
Medicare Advantage (Part C) in Austin, TX
A Medicare Advantage plan is private coverage that takes over how your claims get paid instead of Original Medicare. You keep Medicare, but the plan manages your hospital, doctor and, in most cases, prescription benefits under one card.
These plans trade a lower monthly premium for copays as you use care, plus a provider network. Around Austin that network question decides everything: the right plan is the one your doctors and hospital, whether that is St. David's, Ascension Seton or Baylor Scott & White, actually accept.
- Lower or $0 monthly plan premium
- Yearly cap on your out-of-pocket costs
- Drug coverage usually built in
- Extras like dental, vision and hearing
Check the network before you compare premiums
Send us the doctors and hospital you want to keep. A licensed agent checks them against the Advantage plans we represent in your Austin ZIP code and calls you back during business hours with what turns up, including the plans that will not work for you.
What to expect
Free review- A licensed agent calls you back during business hours, Mon-Fri, 8:30am-5:30pm CT
- Your doctors and prescriptions get checked before any plan is suggested
- No fee for our help, and your premium is the same either way
- No obligation to enroll, and no pressure if you'd rather stay put
Reviewed by the licensed Texas agents at Austin Senior Insurance. Last reviewed: October 2026. Office hours: Mon-Fri, 8:30am-5:30pm CT.
Thanks, we have your request.
A licensed agent will call you during business hours, Mon-Fri, 8:30am-5:30pm CT. If you'd rather not wait, call 737-236-2017 now.
Plan types
HMO or PPO: the difference shows up at the specialist's office
| HMO | PPO | |
|---|---|---|
| Monthly premium | Usually lowest, often $0 | Modestly higher |
| Out-of-network care | Emergencies only | Covered at a higher cost share |
| Referrals | Usually required for specialists | Generally not required |
| Best for | Members settled with one Austin health system | Members who split care between systems or travel |
Check the network before the premium
Austin's big hospital systems do not contract with every plan every year. We verify your doctors, your hospital and your pharmacy against the current directory before you sign anything.
Costs
How you actually pay under Part C
You keep paying your Part B premium to Medicare, which is $202.90 a month in 2026 for most people. On top of that, the plan may charge $0 to a modest monthly amount, and then you pay copays as you go: a set dollar amount for a family doctor care visit, more for a specialist, more again for outpatient surgery or a hospital stay.
The protection is the annual out-of-pocket maximum. Once you hit it, the plan covers approved in-network services for the rest of the year at no extra cost to you. Original Medicare has no such cap, which is why people who skip a Medigap plan often choose Advantage instead. If you are weighing the two, start with Advantage vs. Medigap in Austin.
- You still pay your monthly Part B premium
- Copays replace most percentage-based coinsurance
- Annual out-of-pocket maximum limits a bad year
- Benefits, networks and drug lists reset every January 1
Extras
What the added benefits are really worth
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Dental, vision and hearing
Allowances vary widely. A large advertised dollar figure often applies only to specific services, so ask what the cleaning and the crown are each worth. -
Built-in Part D
Most Advantage plans include drug coverage. Check your exact prescriptions against the formulary. Tiers matter more than the premium. See Part D drug plans. -
Fitness and transportation
Gym memberships, over-the-counter cards and rides to appointments show up often and are genuinely useful if you will actually use them.
Timing
When you can enroll or change plans
Most people join during their Initial Enrollment Period around turning 65, or during the Annual Open Enrollment Period from October 15 to December 7. Advantage members also get a Medicare Advantage Open Enrollment Period from January 1 to March 31 to make one change.
Moving, losing employer coverage or qualifying for Extra Help can open a Special Enrollment Period at other times. If you are already enrolled and unhappy, start with switching your plan.
Prior authorization
The approval step Original Medicare does not have
Advantage plans commonly require prior authorization before they will pay for higher-cost services: imaging like MRI and CT, outpatient surgery, skilled nursing after a hospital stay, home health, durable medical equipment and some specialist referrals. Your doctor submits the request, the plan approves or denies it, and care waits on that answer.
Most requests are approved. What is worth knowing is that timelines vary by plan, and a denial can be appealed, first to the plan, then to an independent reviewer. If you hit a denial, we can help you with that appeal, so you are not left to sort it out alone.
Original Medicare paired with a Medigap plan has almost no prior authorization. If that friction matters to you more than a lower premium, say so early. It changes the recommendation.
Our process
How we verify an Austin provider network
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1
You send the list
Family doctor care, every specialist you see, your hospital preference and your pharmacy. Names and clinics are enough.
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2
We check the current directory
Each Advantage plan we represent is checked against your list for the current contract year, not last year's directory.
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3
We confirm with the clinic where it's unclear
Directories are wrong often enough that a phone call to the front desk is sometimes the only reliable answer.
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4
You get the plain answer
Which of the plans we can offer keep all your providers, which keep some, and what the gap would cost you.
We do not offer every plan available in your area
Our check covers the carriers we represent. For information on all plans available in your county, contact Medicare.gov, 1-800-MEDICARE, or Texas HICAP (Health Information, Counseling and Advocacy Program) at 1-800-252-9240.
Local networks
Advantage networks across Central Texas
Most Advantage networks around Austin are built around St. David's HealthCare, Ascension Seton and Baylor Scott & White. Dell Seton Medical Center at The University of Texas is the region's Level I trauma center, and veterans may get care at VA clinics in Austin. Residents of Georgetown, Kyle and Lakeway often head into Austin or Round Rock for specialists, so check that each doctor and hospital you use is in network, not just the one closest to home. See every community we help on our service areas page, or go back to the Austin Medicare overview.
Fit
When Advantage works well, and when it doesn't
It tends to fit when you
- Get your care from one Austin health system already
- Want a low or $0 plan premium
- Value a hard cap on a bad year's costs
- Would actually use dental, vision, hearing or fitness extras
- Are comfortable with copays and referrals
It tends not to fit when you
- Split care between systems or travel for months at a time
- See several specialists and want flat, predictable bills
- Are mid-treatment and can't risk a network change
- Don't want prior authorization in the middle of care
- Spend part of the year outside Texas
Before you sign
Questions to ask about any Advantage plan
Is every one of my doctors in network for the coming plan year?
What is the annual out-of-pocket maximum, in dollars?
What are the copays for a specialist, an outpatient surgery and a hospital stay?
Which of my medications need prior authorization or step therapy?
What is the dental allowance worth for the work I actually need?
What happens if I want to leave this plan?
Want your doctors checked against the plans we offer?
Send us your provider and prescription list and we'll tell you which of the Advantage plans we represent keep them, at no cost to you.