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Any Questions about TexanPlus® Medicare Advantage Plans?

TexanPlus can help you get more out of your Medicare benefits. With low or no co-pays for doctors, hospitals, and prescription drugs it offers you the opportunity to save money on healthcare beyond the benefits of Original Medicare. And our caring community of health professionals is committed to helping you live healthier.

Q: What is an HMO (Health Maintenance Organization)?

It’s a type of Medicare Advantage Plan (Part C) that includes all your Part A (hospital insurance) and Part B (medical insurance) benefits. HMOs such as TexanPlus also cover additional benefits, like extra days in the hospital. With most HMOs, including TexanPlus, you can only go to doctors, specialists, or hospitals in the plan’s network except in an emergency. That allows us to offer you significant savings over Original Medicare—for low or no additional plan premiums.

Q:So how does an HMO work?

By working with a select team of doctors and hospitals, HMOs are able to keep costs low. When you join an HMO, you may go to any doctor or hospital that is included in the network. However, with the exception of emergency situations, if you choose a doctor or medical facility that is not included, you will be responsible for all costs. In addition, you will be asked to choose a primary care doctor. This doctor will coordinate all of your medical care, including choosing specialists when additional care is needed.

When you join TexanPlus, you’re still enrolled in Medicare and entitled to all medically necessary healthcare services that it covers. However, as a TexanPlus member, you will enjoy deductibles, co-payments, and coinsurance amounts that may be substantially lower than those under Original Medicare.

Q: Am I eligible for TexanPlus?

You can enroll in TexanPlus if:

  • You have both Medicare Part A (hospital insurance) and Part B (medical insurance).
  • You live in the service area of the Austin, Brazoria, Chambers, Fort Bend, Galveston (77510, 77511, 77517, 77518, 77539, 77546, 77549, 77563, 77568, 77573, 77574, 77590, 77591, 77592), Hardin, Harris, Jefferson, Liberty, Montgomery, Orange or Waller counties.
  • You do not have End-Stage Renal Disease (permanent kidney failure treated by dialysis or a transplant, sometimes called ESRD).
  • However, if you do have ESRD and are currently enrolled in a Medicare Advantage HMO, you may join TexanPlus.

If you have questions about your eligibility, ask a TexanPlus representative for more information.

Q: What if I already have a Medicare Supplement policy?

A Medicare Supplement policy will not cover any co-pays or deductibles associated with an HMO. Generally, it is not proper for anyone to sell you a Medicare Supplement policy while you are enrolled in a Medicare Advantage (Part C) program.

Q: Can I try TexanPlus without losing my Medicare Supplement?

Although you can keep your Medicare Supplement as long as you’d like, you’ll probably find that our Medicare Advantage plans cover the same benefits at a lower cost to you, so maintaining your Medicare Supplement at the same time you are covered by TexanPlus may not be economically optimal. If this is the first time you’ve joined a Medicare Advantage plan, you may have special protections that give you the right to get your old Medigap policy back if you choose to leave the plan within the first year. It’s best to check with a TexanPlus representative so you can make sure you don’t miss out on important benefits.

Q: If I choose a Medicare Advantage plan with prescription drug coverage “powered by” CCRx, how will I know if the medicines I currently take will be covered?

Our Medicare Advantage Prescription Drug (MAPD) plans have a formulary, or list of covered drugs. To learn if your medicines are covered, please contact a TexanPlus representative at 1-866-731-9589 (TTY for the hearing impaired: 1-866-338-4681) from 8 AM to 8 PM, 7 days a week. You can also see our formulary online at www.sctexas.com.

Q: What drugs are excluded from the Medicare Advantage Prescription Drug Plans (MAPD)?

The drugs that are excluded by Medicare are:

  • Medications used to treat anorexia, weight loss, or weight gain
  • Medications used to promote fertility
  • Medications used for cosmetic purposes or hair growth
  • Medications used to treat erectile dysfunction
  • Prescription vitamins and mineral products, except prenatal vitamins and fluoride preparation
  • Non-prescription drugs

Outpatient medications for which the manufacturer requires that associated tests or monitoring services be purchased exclusively from the manufacturer as a condition of sale

In addition, if a medication is covered by Medicare Parts A or B, it cannot be covered under Part D (Medicare Advantage Prescription Drug Plan). Some examples of Parts A or B medications include: diabetic test strips, injectables solely administered in the physician’s office and medications administered in the hospital. Also, each Medicare Advantage Prescription Drug plan may have its own specific exclusions.

Q: What if my prescription medicine is not on the formulary?

If your specific medicine is not on our formulary, there might be a similar, high-quality medicine available that offers the same benefits. For example, if you’re taking a cholesterol-lowering medicine, there might be a suitable alternative on our formulary. We’ll work with you and your doctor to find a covered medicine that best suits your condition.

Q: Does TexanPlus have materials that are in Spanish?

Yes, TexanPlus has Spanish materials, such as the 2009 Summary of Benefits, available upon request. You can request that Spanish materials be mailed to you by calling 1-866-731-9589 (TTY for the hearing impaired: 1-866-338-4681, 8 am to 8 pm (CST) everyday). A TexanPlus representative will be happy to help you.


M0018_H4506_webr6_1209 Pending CMS Approval Last updated: 1/11/2021

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