= available in the plan
Our TexanPlus Medicare Advantage plan Houston physician network is built and run by local doctors, just for you. The talented doctors covered by our Medicare Advantage plans 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 over 15 years.3 Find out what our 2017 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-certified4 physicians and doctors appearing in the Super Doctors listing in Texas Monthly.5
Our Primary Care Physicians (PCP) can refer you to specialists in over 60 fields6, 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 Medicare Advantage HMO-POS plan, you will have the flexibility to choose your provider. If you want to go outside the LPO network or HMO 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 an All-In-One Plan
Enjoy the benefits you need to stay healthy: Original Medicare benefits plus plans that offer Medicare Part D prescription drug coverage and additional benefits you can't get from Original Medicare, such as dental and vision benefits and transportation.2 And, it all comes in the convenience of one easy-to-use Medicare Advantage plan.
Original Medicare Benefits
Prescription Drug Coverage, if you need it
Dental and Vision
Silver&Fit® Exercise & Healthy Aging Program1
Transportation to Doctor Visits2
Plus, all-in-one value and convenience:
$0 Monthly Plan Premium
$0 Preventive Screenings
How does an HMO plan work?
Health Maintenance Organization (HMO) plans are a type of Medicare Advantage Plan (also known as Medicare Part C) that include Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) benefits. With an HMO plan, you receive care from doctors, providers or hospitals within the plan's network. In addition to providing all of the benefits of Original Medicare, many Medicare Advantage HMO plans include prescription drug coverage. Members of Medicare Advantage HMO plans select one doctor as their Primary Care Physician. You must go through a Primary Care Physician and get a referral before seeking outside health care. Health care visits outside the network typically are not covered.
How does an HMO-POS plan work?
If you choose our Medicare Advantage 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 Medicare Advantage POS coverage you also have the flexibility to receive services from doctors or hospitals that participate in the Medicare program, inside and outside7 the plan's network and service area, at a higher copay or coinsurance.
You may wonder how our Medicare Advantage HMO and HMO-POS plans compare to each other. They are similar in many ways. In both HMO and HMO-POS plans:
You receive care from a network of doctors, hospitals and other healthcare providers;
Your doctors may be part of a Local Physician Organization (LPO) and may refer you to specialists or providers in the LPO; and
You'll work closely with your Primary Care Physician (PCP) to manage your care and coordinate your treatment.
There are some important differences between our Medicare Advantage HMO and HMO-POS plans:
In an HMO plan, you'll be responsible for any fees for services provided by doctors or hospitals outside your PCP's LPO, except in emergency or urgent care situations.
In an HMO-POS plan, you have the flexibility to receive services from doctors or hospitals outside of your PCP's LPO, however, at a higher copayment or coinsurance, except in emergency or urgent care situations.
TexanPlus HMO and HMO-POS Medicare Advantage plans Houston are offered in select counties in the Houston-Beaumont Area.
Houston: Austin, Brazoria, Fort Bend, Galveston (zip codes: 77510, 77511, 77517, 77518, 77539, 77546, 77549, 77563, 77565, 77568, 77573, 77574, 77590, 77591, 77592), Harris, Liberty, Montgomery, and Waller.
Beaumont: Chambers, Hardin, Jefferson, and Orange.
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, premium 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 The Silver&Fit program is provided by American Specialty Health Fitness Inc. (ASH Fitness), a subsidiary of American Specialty Health Incorporated (ASH). Silver&Fit is a registered trademark of ASH and used with permission herein.
2 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.
3 SCR Study (2016 Universal American Net Promoter Scores): UAM plans scored average +56 Net Promoter Score compared to the industry average +23 found in 2015 Medicare Member Experience & Engage-ability Study from Deft Research.
4 June 2015 analysis of Provider Network credentials.
5 June 2014 analysis of Provider Directory compared to Super Doctors Texas online database.
6 June 2015 analysis of Provider Network.
7 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.