Medicare and Medicaid
Medicare is the federal health insurance program for people aged 65 or older and certain younger people with disabilities.
Medicaid is a joint federal and state program that helps pay medical costs for people with limited income who meet specific eligibility criteria. Medicaid also offers financial assistance for nursing home and personal care services. Every state has different rules for Medicaid.
Medical care must be deemed medically necessary in order to be covered by traditional Medicare. It is important to understand that traditional Medicare does not cover everything, and it does not pay the total cost for many covered services or supplies. The amount of your coverage is also dependent on whether you have coverage under Medicare Part A, Medicare Part B, or both. Talk to your doctor to be sure you are getting the services and supplies that best meet your health care needs.
Medicare Part A (hospital insurance) helps cover inpatient care during hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
Medicare Part B (medical insurance) helps cover doctor visits, outpatient care, medical supplies, some preventive services, and other services, such as physical therapy and occupational therapy. UT Physicians accepts Medicare Part B.
A Medicare supplement policy (also called Medigap) is sold by private companies and can help pay some of the health care costs that traditional Medicare doesn’t cover, like copayments, coinsurance, and deductibles. Some Medigap policies also offer coverage for services that traditional Medicare doesn’t cover. A Medigap policy is different from a Medicare Advantage Plan (see below). UT Physicians accepts all Medigap policies that do not restrict you from using a certain provider network.
Check the Texas Department of Insurance website for a list of companies that sell Medigap plans.
This type of plan replaces traditional Medicare. If you belong to a Medicare Advantage plan (also called Medicare Part C or Medicare Replacement), it must cover at least the same benefits covered under Medicare Part A, Part B, and a Medigap policy. However, your costs may be different, and you may have extra benefits, such as coverage for prescription drugs or extra days in the hospital. You should contact your Medicare Advantage plan administrator for specific coverage information for the plan in which you are enrolled. If you have a Medicare Advantage plan, you do not need a Medigap policy. UT Physicians accepts the following Medicare Advantage plans:
- AARP Medicare HMO
- Aetna Medicare HMO and PPO
- Amerigroup (Medicare HMO and Medicare with Medicaid)
- Blue Cross Blue Shield Texas Medicare HMO and PPO
- Cigna Medicare HMO and PPO, and Medicare HMO Dual Eligible Special Needs Plan (D-SNP)
- Community Health Choice Medicare HMO Dual Eligible Special Needs Plan (D-SNP)
- Coventry Healthcare Medicare HMO and PPO
- Humana Medicare HMO and PPO
- Memorial Hermann Medicare HMO
- ProCare Advantage Medicare Institutional Special Needs Plan (I-SNP)
- UnitedHealthcare Medicare HMO and PPO, Medicare HMO Chronic Condition Special Needs Plan (C-SNP), and Medicare HMO Dual Eligible Special Needs Plan (D-SNP)
- UnitedHealthcare Community Plan Medicare with Medicaid
- Wellcare Medicare Advantage HMO and PPO, Medicare HMO Chronic Condition Special Needs Plan (C-SNP), and Medicare HMO and PPO Dual Eligible Special Needs Plan (D-SNP)
Texas Medicaid is accepted at UT Physicians. Please note: you must select a Managed Medicaid HMO plan within 30-45 days of your enrollment; otherwise, one will be chosen for you by Texas Medicaid. Texas Medicaid is different from Managed Medicaid HMO plans.
Managed Medicaid HMO plans are operated by a health insurance company. UT Physicians accepts the following Managed Medicaid HMO and Children’s Health Insurance (CHIP) plans:
- Amerigroup Star, Star Plus, CHIP, STAR Kids
- Community Health Choice Star, CHIP
- Molina Star, CHIP
- Superior Healthplan Star, Star Plus, CHIP, STAR Kids, Star Health (Foster Care)
- UnitedHealthcare Community Plan Star, STAR Kids, CHIP
Out-of-State Medicaid: UT Physicians does not accept out-of-state Medicaid or out-of-state Managed Medicaid HMO plans.