Medicare Advantage Plans

What is Medicare Advantage?

Medicare Advantage is an alternative way to get your Original Medicare (Part A and Part B) benefits, through a private health plan that Medicare has approved to deliver them. Instead of Medicare paying providers directly the way it does under Original Medicare, your Medicare Advantage plan manages your care and claims.

These plans come in several types, most commonly Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), and Special Needs Plans (SNP) for people with specific chronic conditions, dual Medicare/Medicaid eligibility, or institutional care needs. In Bexar County for 2027, the available plan types are HMO, HMO-POS, PPO, Regional PPO.

Private companies offer these plans under a contract with the Centers for Medicare & Medicaid Services (CMS), which pays the company a set amount per member and sets the rules every plan has to follow, including what a plan must cover at minimum and how it reports quality. CMS reviews and approves each plan's benefits every year, which is part of why plan details, premiums, and even which plans are offered in your county can change from one year to the next.

How does Medicare Advantage work with Original Medicare?

When you join a Medicare Advantage plan, you are still in the Medicare program, and you keep paying your Part B premium, but the plan (not Original Medicare) becomes responsible for your Part A and Part B benefits. You will generally use the plan's network of doctors and hospitals, and some services may need prior authorization before the plan will pay for them.

One exception: hospice care is still covered by Original Medicare directly, even if you are enrolled in a Medicare Advantage plan. And in every plan type, emergency care and urgently needed care are always covered, regardless of network.

In an HMO, you typically pick a primary care doctor and need a referral to see most specialists. A PPO usually lets you see any provider without a referral, though you pay less when you stay in network. You can ask your plan for a written advance coverage decision before a procedure, to confirm in writing that a service is medically necessary and will be covered, if a plan later denies a claim you believed was covered, you have the right to appeal that decision.

What does Medicare Advantage typically cover?

By law, a Medicare Advantage plan must cover everything Original Medicare covers, except hospice. Most plans also include Part D prescription drug coverage (these combined plans are called MA-PD plans), and many add extra benefits that Original Medicare does not cover at all, such as routine dental, vision, hearing, and sometimes a fitness or over-the-counter allowance.

Extra benefits vary a great deal from plan to plan and are never guaranteed just because a plan is a Medicare Advantage plan, the only way to know what a specific plan includes is to read its Summary of Benefits or ask a licensed agent to walk through it with you.

If a plan includes drug coverage, every covered drug sits on a tier, and your copay or coinsurance depends on which tier it falls into, generic drugs are typically the lowest tier and cost the least, while brand name and specialty drugs sit on higher tiers and cost more. The same drug can be on a different tier, or have different restrictions like prior authorization or a quantity limit, from one plan to the next, so it is worth checking a plan's formulary against your own prescriptions before enrolling, not after.

What does Medicare Advantage cost?

You almost always keep paying your Part B premium (the 2026 standard amount is $202.90 a month; CMS had not yet announced the 2027 amount as of this writing). On top of that, many Medicare Advantage plans charge their own monthly premium, though plenty do not.

In Bexar County for 2027, Medicare Advantage plan premiums range from $0 to $138 a month, and 27 of the 38 available plans have no monthly premium at all. You must continue to pay your Medicare Part B premium. Instead of (or alongside) a premium, you pay copays or coinsurance when you actually use care. Every Medicare Advantage plan has a yearly limit on your out-of-pocket costs for Part A and Part B services; in Bexar County for 2027 that in-network limit ranges from $2,800 to $ 9,850 depending on the plan. Once you hit your plan's limit, it pays 100% of covered Part A and Part B services for the rest of the year.

A copay is a flat dollar amount you pay for a service, like $20 for a primary care visit. Coinsurance is a percentage of the cost instead, like 20% of a procedure's cost. Which one applies depends on the service and the plan. If your income is above a certain threshold, Social Security also adds an income-related monthly adjustment amount (IRMAA) on top of your Part B premium; the IRMAA calculator estimates that amount using the published CMS bracket table.

Who is Medicare Advantage a good fit for?

Medicare Advantage tends to fit people who want their medical and drug coverage bundled into one plan and one card, who are comfortable using a defined network of doctors, and who want a predictable yearly cap on their out-of-pocket costs. The extra benefits, like dental and vision, also appeal to people who would otherwise pay for those out of pocket.

It may fit less well for someone who travels frequently outside their plan's service area, who wants the widest possible choice of doctors nationwide without network restrictions, or who has a specific specialist they want to keep seeing who is not in any local plan's network. A licensed agent can check your own doctors and prescriptions against a specific plan's network and formulary before you enroll.

Someone who splits the year between Texas and another state, for example, may find a plan's local network inconvenient for months at a time, while someone who stays in Bexar County year-round and mainly needs routine, in-network care often finds the bundled benefits and predictable yearly cap a good trade for the network restriction.

When can you enroll in or change a Medicare Advantage plan?

There are four separate windows, and which one applies to you depends on your situation, not the calendar alone.

• Initial Enrollment Period: the 7-month window around your 65th birthday month. See the turning 65 timeline tool for your exact dates.
• Annual Enrollment Period (AEP): October 15 to December 7 every year. Join, switch, or drop a Medicare Advantage plan for the following January 1.
• Medicare Advantage Open Enrollment Period: January 1 to March 31 every year, for people already in a Medicare Advantage plan to switch to a different Medicare Advantage plan or go back to Original Medicare, one change allowed.
• Special Enrollment Periods: triggered by specific events, such as moving out of your plan's service area or losing other coverage.

Outside of these windows, you generally cannot change Medicare Advantage plans at all, which is why it is worth reviewing your plan every AEP even if you are happy with it. Plans, premiums, and networks can change year to year, so a plan that fit your budget and doctors last year is not guaranteed to still fit them next year.

Medicare Advantage vs Medicare Supplement: key differences

Medicare Advantage replaces how your Part A and Part B benefits are delivered, usually with a network, extra benefits, and a yearly out-of-pocket maximum. Medicare Supplement (Medigap) instead works alongside Original Medicare, paying some of the coinsurance and deductibles Original Medicare leaves behind, with no network at all, but it does not include drug coverage or extra benefits like dental and vision. You cannot have both at the same time. See the full breakdown on the Medicare Supplement page.

Broadly, Medicare Advantage tends to cost less month to month but ties you to a network, while Medigap costs more month to month but lets you see any provider nationwide that accepts Medicare, with no plan network at all. Neither one is automatically the right choice, the right fit depends on your doctors, your prescriptions, how often you travel, and what you can comfortably budget month to month versus if a large medical bill came up.

How The Insurance Space helps

The Insurance Space is an independent, licensed Medicare agency based in San Antonio, by appointment only. A free plan review compares the Medicare Advantage plans actually available in your county against your own doctors, prescriptions, and budget, at no cost and no obligation to enroll. See local Bexar County plan detail on the San Antonio Medicare page, check the official 2027 Medicare & You handbook, or estimate your income-related premium adjustment if your income is higher.