How to Compare Medicare Plans in Texas

Decide Which Type of Coverage You Are Comparing

Before you compare individual plans, you need to know which category of Medicare coverage you are evaluating. The comparison process is different depending on what you are shopping for:

• Medicare Advantage plans — compare networks, premiums, copays, out-of-pocket maximums, drug formularies, and extra benefits
• Medicare Supplement (Medigap) plans — compare plan letters (G, N, High Deductible G) and carrier premiums, since benefits within each letter are standardized
• Part D drug plans — compare formularies, tier structures, pharmacy networks, and total annual drug cost estimates

If you are not sure which type is right for you, review our page on Medicare Advantage vs. Medicare Supplement before starting the comparison process. Starting with the right category makes everything else easier.

Make a List of Your Doctors and Confirm They Accept Medicare

Your provider relationships are non-negotiable — or at least they should be. Before evaluating any plan, write down the names of every doctor, specialist, and hospital you currently use or expect to need. Then confirm that each one accepts Medicare. Almost all providers in the Rio Grande Valley do, but it is worth verifying.

For Medicare Advantage plans specifically, you also need to confirm that your doctors are in that plan’s network — not just Medicare generally. A doctor can accept Medicare but not participate in a specific Medicare Advantage plan’s network. Always check the plan’s online directory or call the provider’s office directly to confirm network participation before enrolling.

• Call your doctor’s office and ask: “Do you accept [Plan Name] Medicare Advantage?” — not just “Do you accept Medicare?”
• Check the plan’s online provider directory — but also call to confirm, as directories are not always up to date
• If a specialist is critical to your ongoing care, confirm their network status before making any plan decision

List Every Medication You Take — Including Dosage and Frequency

Your prescription drug costs are often the single biggest variable in your total Medicare cost. Different plans cover different drugs at different tiers — and the difference between plans can be hundreds of dollars per year for the same medication.

Before comparing any Medicare Advantage or Part D plan, have your complete medication list ready. For each drug you take, you need to know:

• The exact drug name — brand name and generic name if applicable
• The dosage and strength
• How many pills or units you take per day or per month
• Your preferred pharmacy — is it a chain (CVS, Walgreens, HEB) or an independent pharmacy?

With this information, you — or your advisor — can run a personalized drug cost comparison across multiple plans using Medicare’s Plan Finder tool at Medicare.gov. This tool shows you exactly what each plan would charge for your specific medications, making the comparison concrete and accurate rather than speculative.

Compare Total Annual Cost — Not Just the Monthly Premium

The monthly premium is the most visible number in any Medicare plan comparison — but it is rarely the most important one. A plan with a $0 monthly premium can cost you significantly more than a plan with a $60 monthly premium if its copays, deductibles, and drug costs are higher.

For an accurate comparison, estimate your total annual cost across all plans — including:

• Monthly premium × 12
• Expected doctor visit copays based on how often you go
• Expected specialist visit copays
• Annual deductible (if applicable)
• Drug costs — based on your specific medication list and the plan’s formulary
• Any expected procedures or hospital stays based on your health history

This total annual cost estimate gives you a real basis for comparison — not a marketing number. A good Medicare advisor will run this calculation for you across multiple plans side by side before making any recommendation.

For Medigap Plans — Compare Carriers, Not Just Plan Letters

Medicare Supplement plans are standardized by the federal government — every Plan G from every carrier offers exactly the same benefits. The only thing that differs is the monthly premium and the carrier’s reputation for customer service and rate stability.

When comparing Medigap carriers, look at:

• Current premium — get quotes from at least 3–5 carriers for the same plan letter
• Rate increase history — has this carrier raised rates aggressively in past years? A low initial premium that rises sharply can cost more in the long run than a slightly higher premium from a more stable carrier
• AM Best financial rating — stick with carriers rated A- or better
• Pricing method — community-rated, issue-age-rated, or attained-age-rated plans have very different long-term cost trajectories
• Customer service reputation — how easy is it to reach someone when you have a claim or a question?

Check the Plan’s Star Rating

Medicare evaluates Medicare Advantage and Part D plans on a five-star quality rating system based on factors like customer service, member complaints, and health outcomes. These star ratings are published annually by CMS and are available at Medicare.gov.

• 5 stars — excellent. Top performing plan in the region.
• 4–4.5 stars — very good. Above average performance.
• 3–3.5 stars — average. Review carefully before enrolling.
• Below 3 stars — below average. Approach with caution.

Star ratings are not the only factor — a 4-star plan that covers your doctors and drugs at a lower cost may be a better choice than a 5-star plan that does not. But all else equal, a higher star rating generally means a better-run plan with fewer member complaints and better care coordination.

Review Extra Benefits — But Do Not Let Them Drive the Decision

Many Medicare Advantage plans in the Rio Grande Valley offer extra benefits beyond what Original Medicare covers — dental care, vision exams and eyewear, hearing aids, fitness memberships, over-the-counter allowances, and more. These benefits have real value and are worth factoring into your comparison.

However, extra benefits should never be the primary reason to choose a plan. A plan that covers your dental cleaning but does not cover your cardiologist is not the right plan — no matter how appealing the extras look. Evaluate extra benefits as a tiebreaker between otherwise comparable plans, not as the lead factor.

Questions to ask about extra benefits:

• What dental services are covered — cleanings only, or also fillings and extractions?
• What is the annual maximum for dental or vision benefits?
• Are hearing aids covered — and what brands or models?
• Is there an over-the-counter allowance, and how is it delivered?
• What fitness network is included — does it cover gyms I would actually use?