Our Medical Group participates in SelectCare (Texanplus) Medicare plans. We have provided this section to answer some of the basic questions about the plan that recipients have when they begin to consider which plan they will join. We encourage you to call the health plan for additional information including when the next Open Enrollment Period will begin and how to join.
Frequently Asked Questions-
Will this cost me any more than I’m currently paying?
No. It should cost less because you do not have an annual deductible. SelectCare also offers low copayments for physician visits and hospital stays. The entire menu of benefits will be explained at the upcoming meetings.
How is a Medicare Advantage plan different from traditional Medicare?
Medicare Advantage plans offer beneficiaries more benefits than traditional Medicare. In addition, each plan is required to help manage the health of the members enrolled in conjunction with the providers in the network.
How does this compare in cost to traditional Medicare?
In traditional Medicare, you must meet an inpatient hospital deductible of $992 for each benefit period. You must also meet an annual deductible of $131 for outpatient services such as doctors’ visits, tests and outpatient surgery. Once you reach that limit, Medicare pays 80% of the bill and you pay 20%. Through SelectCare, you only pay a copayment, which id a fixed fee for services such as doctors’ visits, outpatient procedures and hospitalizations.
How much will a doctor’s visit cost?
Primary care- $5 per visit, Specialty care- $25 per visit
Will I have to pay anything for a physical?
No. Copayments are waived for one annual physical per year.
Do I need to get referrals from my PCP to see a specialist?
Certain specialties require an authorization. But, your physician is responsible for submitting the required paperwork, and receiving the approved authorization.
Will I be able to go to any specialist or hospital I want?
Select Care contracts with a comprehensive and complete network of providers. We will make sure you are seen by the physician or facility most qualified to meet your needs. If such a provider does not exist in the network, we arrange for you to see a provider outside the network.
What happens if I have an emergency and I’m not near a network hospital?
You can go to the nearest hospital of facility.
What happens if I’m out of town and I get sick?
SelectCare covers all emergency medical service throughout the country. Show your identification card to the provider and he or she will bill SelectCare for any services you have. Of course, you still are responsible for the applicable copayments as you would be were you to have been treated by your local providers.