Medicare is a federal health insurance program that provides coverage for eligible individuals who are 65 years or older, as well as younger individuals with certain disabilities or end-stage renal disease and ALS.

Medicare can help cover a range of healthcare services, including hospital stays(Part A), doctor visits, preventive care (Part B),  and prescription drugs (Part D).

If you are eligible for Medicare coverage our experienced agents at Texas Medicare Advisors are ready to help!

Medicare and Parts of Medicare

Medicare Part A is also known as hospital insurance and covers inpatient hospital stays, skilled nursing facility care, hospice care, and limited home health services. Part A coverage includes room and board, nursing care, and other hospital services and supplies, such as diagnostic tests and medications.

Part A premium is typically provided at no cost to individuals who have paid into the Medicare system through payroll taxes for a certain number of years (at least 40 quarters). Medicare Part B is medical insurance that covers a wide range of healthcare services, including doctor visits, outpatient care, preventive services, and medical equipment. This includes lab tests, X-rays, mental health services, and ambulance services.

Part B also covers certain medications that are administered in a doctor’s office or outpatient setting. Medicare Part B comes with a monthly premium, which varies depending on income but is generally around $164.90 in 2023.

Medicare Part C, also known as Medicare Advantage, is an alternative to Original Medicare (Part A and Part B) that is offered by private insurance companies. Part C plans provide all the coverage of Parts A and B, as well as additional benefits such as dental, vision, and hearing coverage, wellness programs, and prescription drug coverage.

It is also important to consider the provider network when choosing a Medicare Advantage plan. Most Part C plans have provider networks, which means that you will need to choose doctors and healthcare providers that are in-network to receive the highest level of coverage.

If you see an out-of-network provider, you may be responsible for higher out-of-pocket costs or even the entire cost of the service. Some Part C plans have broader networks that allow you to see any provider that accepts Medicare, while others have more restrictive networks that limit your choices. Additionally, some Part C plans may require referrals from a primary care physician to see a specialist. 

Here is more information about the difference between HMO and PPO plans.

Medicare Part D is a prescription drug plan that provides coverage for prescription medications. Part D plans are offered by private insurance companies and can be added to Original Medicare (Parts A and B) or a Medicare Advantage plan. Part D covers a wide range of prescription drugs, including brand-name and generic drugs, and the list of covered drugs varies by plan.

The costs and coverage of each plan can change from year to year, so it is important to review your Part D coverage during the annual open enrollment period to ensure that you have the best coverage for your needs at an affordable cost.

Medicare Eligibility and Enrollment in Leander

Medicare eligibility in Leander is based on age, disability status, or certain medical conditions. Most people become eligible for Medicare at age 65, regardless of their health status or income. People with certain disabilities or medical conditions may also be eligible for Medicare, regardless of age.

Enrollment in Medicare can be done through the Social Security Administration or online at the Medicare website. To be eligible you must be a U.S. citizen or legal resident who has lived in the U.S. for five years or more. 

Medicare enrollment periods in Leander are specific times during which individuals can enroll in, make changes to, or disenroll from Medicare.

The initial enrollment period (IEP) is the first opportunity for most individuals to enroll in Medicare, which is seven months that starts three months before the person’s 65th birthday, includes their birthday month, and extends three months after their birthday month. Annual open enrollment periods (AEP) occur each year from October 15th to December 7th.

The Medicare Advantage Open Enrollment Period (OEP) occurs each year from January 1st to March 31st. During this time, individuals who are enrolled in a Medicare Advantage plan can switch to another Medicare Advantage plan or go back to Original Medicare.

Special enrollment periods (SEP) are also available to individuals who experience certain life events, such as moving to a new area or losing other healthcare coverage. These individuals may have a limited time to enroll in or make changes to their Medicare coverage outside of the standard enrollment periods.

Health Insurance in Leander

Health insurance in Leander is an essential aspect of healthcare for individuals and families. Health insurance policies are offered by various providers and cover a range of medical expenses, including doctor visits, hospitalizations, prescription drugs, and preventative care.

Individuals can purchase health insurance on their own or obtain coverage through their employer. If you are self-employed, you can purchase a health insurance policy through the federal Health Insurance Marketplace, or a private insurance company.

In Texas, there are different types of health insurance plans available, including Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), and Point of Service (POS) plans. Each plan has its advantages and disadvantages, and it is important to compare plans to find one that meets your specific healthcare needs and budget.

Health Insurance Plans and Benefits 

If you live in Leander, Texas, you have several health insurance options available to you, including major medical plans and other types of plans.  Here are some of the health insurance plans available in Leander and their benefits:

  • Health Maintenance Organization (HMO) Plans: HMO plans typically have lower out-of-pocket costs and require you to choose a primary care physician (PCP) who manages your healthcare. You can only see specialists and receive non-emergency care with a referral from your PCP.
  • Preferred Provider Organization (PPO) Plans: PPO plans offer more flexibility in choosing healthcare providers, but may come with higher out-of-pocket costs. You don’t need a referral to see specialists, but you will save money by seeing in-network providers.
  • Exclusive Provider Organization (EPO) Plans: EPO plans are similar to PPO plans, but typically only cover in-network providers, unless in the case of an emergency.
  • Point of Service (POS) Plans: POS plans are a mix between HMO and PPO plans, and require you to choose a PCP, but also allow you to see specialists without a referral in some cases.
  • Short-Term Health Insurance Plans provide temporary coverage for a limited period, typically up to 12 months. These plans may offer less comprehensive coverage than major medical plans, but they can be a more affordable option for individuals who need coverage for a short period.  Some benefits of short-term health insurance plans include lower premiums and the ability to enroll at any time during the year. However, these plans may not cover pre-existing conditions or provide coverage for some essential health benefits required under the Affordable Care Act.
  • Health Savings Account (HSA) Plans are a type of high-deductible health plan (HDHP) that allows you to save money for healthcare expenses on a tax-free basis. With an HSA, you can contribute pre-tax dollars to the account, and the funds can be used to pay for qualified medical expenses, such as deductibles, copays, and prescriptions.
  • Catastrophic Health Insurance Plans are a type of insurance that is designed to provide coverage for major medical expenses. These plans typically have lower monthly premiums compared to other types of health insurance plans, but come with high deductibles. They are designed to be a safety net for individuals who are relatively healthy and do not anticipate needing frequent medical care but want protection against high medical costs in the event of a serious illness or injury. These plans typically cover major medical expenses, such as hospitalization, surgery, and emergency care, but may not cover routine doctor visits or preventative care.

Cancer Insurance Leander

Cancer insurance is a type of policy that covers the costs of cancer treatment, including chemotherapy and surgery.

In Leander, there are multiple companies offering policies with varying specifics. Typically, cancer insurance provides a lump sum payment upon diagnosis, with benefits for screenings and preventive care.

It can be purchased as a standalone policy or as a rider for health insurance. It is important to review the policy terms and consider other types of insurance for comprehensive coverage in the event of a serious illness.

Frequently Asked Questions (FAQ)

1. What is Medicare coverage in Leander, and what does it include?

Medicare coverage is a federal health insurance program for people aged 65 and over, as well as those under 65 with certain disabilities or with end-stage renal disease. It includes different parts, such as:

  • Part A: Hospital insurance that covers inpatient hospital stays, hospice care, and skilled nursing facility care.
  • Part B: Medical insurance that covers doctor’s visits, preventive care, medical equipment, and outpatient services.
  • Part C: Medicare Advantage plans offered by private insurance companies that combine Parts A and B, and sometimes Part D, with additional benefits.
  • Part D: Prescription drug coverage that helps pay for prescription drugs.


2. What is the cost of Medicare coverage, and how can I pay for it?

The cost of Medicare coverage varies depending on the parts you enroll in and your income level. Here are some general guidelines:

  • Part A is usually free if you or your spouse paid Medicare taxes for at least 10 years.
  • Part B requires a monthly premium that can range from $164.90 to $560.50 in 2023, depending on your income.
  • Part C and Part D plans have different costs depending on the insurance company and the benefits they offer.


3. What services are not covered by Medicare, and how can I get additional coverage?

While Medicare covers many medical services, it doesn’t cover everything. Here are some services that are not covered by Medicare:

  • Dental care, except for some medically necessary procedures.
  • Vision care, except for some preventive services.
  • Hearing aids and exams for fitting them.
  • Long-term care, except for limited stays in a skilled nursing facility.


To get additional coverage for these services, you can:

  • Purchase a supplemental insurance policy, also known as a Medigap plan, from a private insurance company to help cover the out-of-pocket costs of Parts A and B.
  • Enroll in a Medicare Advantage plan that may offer additional benefits, such as dental, vision, and hearing coverage, and sometimes even prescription drug coverage.
  • Pay out of pocket for the services you need.

Five Common



and how you can avoid them

Five Common Medicare Mistakes Book Cover

For more information about asset based long term care, reach out to Texas Medicare Advisors today.

Living Benefits
of Life Insurance

Request an advisor contact you TODAY!!

Your one step away
from your FREE download.

Complete the form to instantly get access to our free book.