What Medicare Advantage plans are available in my area?
Plan availability is set by ZIP code and resets every year. Here is how to find what is actually offered where you live and how to narrow it down.
Medicare Advantage availability is decided by county and ZIP code. A plan offered in McAllen may not be offered in Rio Grande City, and the benefits can differ between them even under the same plan name.
The good news about this county
Hidalgo County is one of the more competitive Medicare markets in the country. There are many plans available, a large share of them with no additional premium, and the major local health systems are well represented in the networks.
Starr, Cameron and Willacy counties have their own plan sets, which overlap but are not identical. Your county is what determines your options.
How to look plans up yourself
- Go to the Plan Finder at Medicare.gov.
- Enter your ZIP code, not just your city.
- Enter every medication you take, with dosage. This is the step people skip and it is the most important one.
- Add your preferred pharmacy.
- Sort by total estimated annual cost rather than by premium.
That last instruction changes the ranking substantially. Sorting by premium tells you almost nothing about what you will spend.
How to narrow a long list down
You do not need to evaluate every plan. Three filters eliminate most of them quickly.
- Network. Are your doctors and your hospital contracted with that specific plan for the coming year? See how to check properly.
- Formulary. What do your actual prescriptions cost on that plan at your actual pharmacy?
- Out of pocket maximum. What is your worst case year?
Whatever survives all three is worth a closer look. Extra benefits are the tiebreaker, not the starting point.
If you are dual eligible
If you have Medicaid or qualify for a Medicare Savings Program, there is a category of plan built specifically for your situation with substantially better cost sharing. See dual eligible special needs plans.
This is worth checking even if you assume your income is too high. The savings program limits are higher than most people expect.
Why we do not list the plans on this page
Plan availability, premiums and benefits are set annually and vary by ZIP, and CMS regulates how agencies present plan specific information in public marketing. Anything we published here would be wrong by January and would not answer the question that matters anyway, which is how a given plan handles your doctors and your medications.
As an independent agency we can pull the actual plans available at your address and lay them side by side against your prescriptions and your providers. That costs nothing and it is a better use of an hour than reading brochures.
When to do this
Annual Enrollment runs October 15 through December 7 for coverage starting January 1. Plan details for the coming year become available in early October, so the useful comparison window is short.
Start in October, not the last week of November. See what to do during Annual Enrollment.
Common follow-up questions
Why do my options differ from my neighbor's?
Usually a different ZIP code, or different eligibility. Dual eligible status opens plan types that are not available otherwise.
Can I join a plan from another county?
No. Advantage plans have service areas and you must live in the plan's area. Moving out of it triggers a special enrollment window.
Does the plan list change every year?
Yes. Plans enter and leave the market annually, and benefits reset. Reviewing every fall is the only way to stay current.
Want this looked at properly?
We are an independent agency in McAllen serving Hidalgo, Cameron and Starr counties. No cost to talk it through.
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