TexanPlus® Medicare Advantage Plans


TexanPlus Medicare Advantage HMO plans for Houston and Beaumont TexanPlus HMO/HMO-POS
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    • 4-Star Rated by Medicare 2016

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Our TexanPlus physician network is built and run by local doctors, just for you. The talented doctors covered by our plan are hand-picked by a panel of physicians in your area. We're also a local plan that is trusted and has been serving the Houston community for nearly 15 years.2 Find out what our 2016 TexanPlus® HMO (Houston/Beaumont) plans have to offer:

Access to Highly Qualified Doctors and Specialists

  • Our network of highly-qualified and compassionate doctors includes board-certified3 physicians and doctors appearing in the Super Doctors listing in Texas Monthly.4

  • Our Primary Care Physicians (PCP) can refer you to specialists in over 60 fields5, no matter what your medical condition may be.

  • Our doctors work together and provide personalized, coordinated care to give you the highest quality care to keep you healthy.

  • In our HMO-POS plan, you will have the flexibility to choose your provider. If you want to go outside the LPO network or PPO network, you can! You will generally have to pay a higher copay or coinsurance, except in emergency, urgent care and End Stage Renal Disease (ESRD) (dialysis) situations.

Value and Convenience of All-In-One Plan

  • Low or no monthly plan premium

  • $0 deductible for both medical and prescription drug coverage

  • $0 copay for visits to your Primary Care Physician

  • $0 copay on generic drugs in Tier 16

  • $0 blood work7

  • $0 preventive screenings

  • 90-day supply of prescription drugs by mail for one 30-day copay in Tiers 1 & 28

  • Worldwide Emergency Travel Coverage9

  • Dental benefits including preventive services and common procedures

  • Live Healthy services including check-up reminders, health coaching to help you manage chronic illness, and many other services. (Some services are available on a seasonal basis.)

  • 4-Star Quality Rating from the Centers for Medicare & Medicaid Services (CMS).

TexanPlus HMO and HMO-POS plans are offered in Austin, Brazoria, Chambers, Fort Bend, Galveston, Hardin, Harris, Jefferson, Liberty, Montgomery, Orange, and Waller counties in Texas.

How does a HMO-POS plan work?

If you choose our Point-of-Service (POS) plan, you'll work closely with a Primary Care Physician (PCP) within a Local Physician Organization (LPO) from our network to manage your care and coordinate your treatment. Your PCP will refer you to specialists within their network, if needed. With POS coverage you also have the flexibility to receive services from doctors or hospitals that participate in the Medicare program, inside and outside10 the plan's network and service area, at a higher copay or coinsurance.

Enrollment disclaimer information:
You must continue to pay your Medicare Part B premium. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or copayments/co-insurance may change on January 1 of each year. The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary. Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.

1 30 one-way trips per year for routine, non-emergent, transportation to and from approved locations; this must be scheduled at least 3 days in advance of services.

2 SCR Study: Member Awareness and evaluation of the Universal American Live Healthy Program and Its Impact on Retention. Plans scored an average of 9 out of 10 on trustworthiness, dependability and integrity among members, December 2012.

3 June 2015 analysis of Provider Network credentials.

4 June 2014 analysis of Provider Directory compared to Super Doctors Texas online database.

5 June 2015 analysis of Provider Network.

6 Tier 1 drugs as defined in the plan's drug list.

7 Medicare-approved lab work

8 3-month supply of most Tier 1 and Tier 2 prescription drugs for one 30-day copay. Available only from a preferred mail service pharmacy and filled during the initial coverage stage. See the Formulary and Evidence of Coverage (EOC) for availability and copays.

9 There is no worldwide coverage for care outside of the emergency room or emergency hospital admission. There is also no coverage for medication purchases while outside of the United States.

10 Out of network providers must choose to accept TexanPlus HMO-POS members as patients. Not all services are covered out-of-network under the Point of Service (POS). See the Evidence of Coverage (EOC) for more detail.

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