Medicare Plans
Medicare Advantage (Part C) in Waco, TX
A Medicare Advantage plan is private coverage that replaces the way Original Medicare pays your claims. You still have Medicare, but the plan handles your hospital, doctor and — in most cases — prescription benefits under one card.
These plans trade a lower monthly premium for copays as you use care, plus a provider network. In McLennan County that network question is the whole ballgame: the right plan is the one your doctors and hospital actually accept.
- Lower or $0 monthly plan premium
- Yearly cap on your out-of-pocket costs
- Drug coverage usually built in
- Extras like dental, vision and hearing
Check Medicare Advantage networks before you compare premiums
Send Dale the doctors and hospital you want to keep. He checks them against the Advantage plans we represent in your ZIP code and calls you back with what he finds — including the plans that don't work.
- Licensed Texas insurance agent
- Licensed since 2011
- AHIP Medicare certified, renewed annually
- No cost for our help
- In-person, phone and home appointments
Written and reviewed by Dale Whitaker, Licensed Texas insurance agent. Last reviewed: July 2026.
Plan types
HMO or PPO — the difference shows up at the specialist's office
| HMO | PPO | |
|---|---|---|
| Monthly premium | Usually lowest, often $0 | Modestly higher |
| Out-of-network care | Emergencies only | Covered at a higher cost share |
| Referrals | Usually required for specialists | Generally not required |
| Best for | Members settled with one Waco health system | Members who split care between systems or travel |
Check the network before the premium
Baylor Scott & White Hillcrest and Ascension Providence do not contract with every plan every year. We verify your doctors, your hospital and your pharmacy against the current directory before you sign anything.
Costs
How you actually pay under Part C
You keep paying your Part B premium to Medicare. On top of that, the plan may charge $0 to a modest monthly amount, and then you pay copays as you go: a set dollar amount for a primary care visit, more for a specialist, more again for outpatient surgery or a hospital stay.
The protection is the annual out-of-pocket maximum. Once you hit it, the plan covers approved in-network services for the rest of the year at no additional cost to you. Original Medicare has no such cap, which is why people who don't buy a Medigap plan often choose Advantage instead.
- You still pay your monthly Part B premium
- Copays replace most percentage-based coinsurance
- Annual out-of-pocket maximum limits a bad year
- Benefits, networks and drug lists reset every January 1
Extras
What the additional benefits are really worth
Dental, vision and hearing
Allowances vary widely. A large advertised dollar figure often applies only to specific services, so read what the cleaning and the crown are worth separately.Built-in Part D
Most Advantage plans include drug coverage. Check your exact prescriptions against the formulary — tiers matter more than the premium.Fitness and transportation
Gym memberships, over-the-counter cards and rides to appointments are common and genuinely useful if you'll use them.
Timing
When you can enroll or change plans
Most people join during their Initial Enrollment Period around turning 65, or during the Annual Open Enrollment Period from October 15 to December 7. Advantage members also get a Medicare Advantage Open Enrollment Period from January 1 to March 31 to make one change.
Moving, losing employer coverage or qualifying for Extra Help can open a Special Enrollment Period at other times. If you're already enrolled and unhappy, start with switching your plan.
Prior authorization
The approval step Original Medicare doesn't have
Advantage plans commonly require prior authorization before they'll pay for higher-cost services: imaging like MRI and CT, outpatient surgery, skilled nursing after a hospital stay, home health, durable medical equipment and some specialist referrals. Your doctor submits the request, the plan approves or denies it, and care waits on that answer.
Most requests are approved. The two things worth knowing are that timelines vary by plan, and that a denial can be appealed — first to the plan, then to an independent reviewer. When a Waco client hits a denial, that appeal is part of what we help with, not something you're left to work out alone.
Original Medicare paired with a Medigap plan has almost no prior authorization. If that friction matters to you more than a lower premium, say so early — it changes the recommendation.
Our process
How we verify a Waco provider network
- 1
You send the list
Primary care, every specialist you see, your hospital preference and your pharmacy. Names and clinics are enough.
- 2
We check the current directory
Each Advantage plan we represent is checked against your list for the current contract year — not last year's directory.
- 3
We confirm with the clinic where it's unclear
Directories are wrong often enough that a phone call to the office is sometimes the only reliable answer.
- 4
You get the plain answer
Which of the plans we can offer keep all your providers, which keep some, and what the gap would cost you.
We do not offer every plan available in your area
Our check covers the carriers we represent. For information on all plans available in McLennan County, contact Medicare.gov, 1-800-MEDICARE, or the Texas SHIP program.
Fit
When Advantage works well — and when it doesn't
It tends to fit when you
- Get your care from one Waco health system already
- Want a low or $0 plan premium
- Value a hard cap on a bad year's costs
- Would actually use dental, vision, hearing or fitness extras
- Are comfortable with copays and referrals
It tends not to fit when you
- Split care between systems or travel for months at a time
- See several specialists and want flat, predictable bills
- Are mid-treatment and can't risk a network change
- Don't want prior authorization in the middle of care
- Have a snowbird address outside Texas
Before you sign
Questions to ask about any Advantage plan
Is every one of my doctors in network for the coming plan year?
What is the annual out-of-pocket maximum, in dollars?
What are the copays for a specialist, an outpatient surgery and a hospital stay?
Which of my medications need prior authorization or step therapy?
What is the dental allowance worth for the work I actually need?
What happens if I want to leave this plan?
Related coverage
Medicare Supplement (Medigap)
No networks and predictable costs — the other side of the choice.
Read Medicare Supplement (Medigap) →Mistakes To Avoid
Network surprises and drug-tier errors we see every fall.
Read Mistakes To Avoid →Medicare Checklist
Everything to gather before you compare plans.
Read Medicare Checklist →Want your doctors checked against every Waco plan?
Send us your provider and prescription list and we'll tell you exactly which Advantage plans keep them — at no cost to you.