Part A: Hospital Coverage
Part A primarily covers inpatient hospital care, skilled nursing facility care under certain conditions, hospice care, and some home health care. Most people qualify for premium-free Part A based on their work history.
Medicare Advantage, Supplement and Part D
Medicare doesn't have to be complicated
Turning 65 and navigating Medicare can feel overwhelming. Between Original Medicare, Medicare Advantage, Medicare Supplement plans, and prescription drug coverage, there are a lot of decisions to make, and the right choice isn't the same for everyone. At Clear HealthPlan Advisors, we'll help you understand how Medicare works, compare your options, and choose coverage based on your doctors, prescriptions, healthcare needs, and budget.
Independent broker
New Braunfels & Central Texas
Licensed in 10 states
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Understanding Medicare
Before comparing plans, it helps to understand the basic pieces of Medicare.
Part B: Medical Coverage
Part B covers many of the healthcare services you receive outside of the hospital, including doctor visits, outpatient care, preventive services, lab work, and durable medical equipment. Part B has a monthly premium, and higher-income beneficiaries may pay an additional amount based on income.
Part C: Medicare Advantage
Medicare Advantage plans are offered by private insurance companies approved by Medicare. These plans provide your Part A and Part B benefits through the private plan and commonly include prescription drug coverage. Many plans also offer additional benefits such as dental, vision, hearing, or fitness benefits.
Part D: Prescription Drug Coverage
Part D helps cover prescription medications. Coverage can be purchased as a standalone prescription drug plan alongside Original Medicare or included within many Medicare Advantage plans. Each plan has its own list of covered medications, costs, and preferred pharmacies, which is why it's important to compare plans based on the prescriptions you actually take.
The decision that matters most
Two Main Ways to Structure Your Medicare Coverage
Once you're enrolled in Medicare Parts A and B, one of the biggest decisions you'll make is how you want to receive and supplement those benefits.
For most people, the decision comes down to two primary paths.
Path one
Medicare Advantage
Medicare Advantage, also known as Part C, allows you to receive your Medicare benefits through a private insurance company.
Depending on the plan, Medicare Advantage may offer:
- Low or $0 additional monthly plan premiums
- Medical copays and coinsurance as services are used
- An annual maximum out-of-pocket limit
- Prescription drug coverage built into many plans
- Dental, vision, hearing, and other additional benefits
- HMO or PPO provider networks
Medicare Advantage can be attractive for someone who prefers lower monthly premiums and bundled benefits and is comfortable receiving care within the plan's network and rules.
Best suited for: People who value lower monthly costs, bundled benefits, and are comfortable with provider networks and paying copays as they use healthcare.
Path two
Medicare Supplement (Medigap)
Medicare Supplement insurance works alongside Original Medicare rather than replacing it.
Original Medicare remains your primary coverage, and the Medicare Supplement policy helps pay some or most of the deductibles, coinsurance, and other gaps left behind by Medicare, depending on the plan selected.
Medicare Supplement plans generally provide:
- Predictable healthcare expenses
- Very little out-of-pocket cost when receiving Medicare-covered care, depending on the plan
- Access to any provider nationwide who accepts Medicare
- No traditional HMO or PPO provider network
- No referral requirement for specialists
Medicare Supplement policies don't typically include prescription drug coverage, so beneficiaries who want drug coverage generally purchase a separate Part D plan.
Best suited for: People who value provider flexibility, predictable medical expenses, and are comfortable paying a higher monthly premium in exchange for lower costs when healthcare is used.
The real fork in the road
Medicare Advantage or Medicare Supplement
Once you have A and B, you pick one of two roads. Neither is better in the abstract. The right one depends on your health, your doctors, your travel and your budget for surprises.
| Medicare Advantage (Part C) | Original Medicare plus a Supplement | |
|---|---|---|
| Monthly cost | Often a low or zero plan premium on top of your Part B premium | A Medigap premium plus a Part D premium on top of Part B |
| Cost when you use care | Copays each time, up to an annual out of pocket maximum | Most or all of the gaps covered, so very little at the point of care |
| Doctor choice | A network. Going outside it costs more or is not covered | Any provider in the country who takes Medicare |
| Referrals | HMO plans usually require one. PPO plans usually do not | No referrals |
| Extras | Commonly bundles dental, vision, hearing and a fitness benefit | No extras. You buy dental and vision separately |
| Switching later | You can change during the annual window each fall | In Texas, switching Medigap after your open enrollment usually means health underwriting |
People get that last row wrong more often than any other one on this table.
The part people forget
Don't Forget Prescription Drug Coverage
The important question isn't simply "Which one costs less?" It's "Which structure fits the way I want to receive and pay for my healthcare?"
Prescription coverage is one of the most important parts of choosing Medicare coverage.
Two plans can look very similar on paper while producing dramatically different prescription costs.
When we compare plans, we'll look at:
- The medications you currently take
- Whether they're included on the plan's formulary
- Drug tiers and copays
- Deductibles
- Preferred pharmacies
- Estimated annual prescription costs
The lowest-premium drug plan isn't always the least expensive plan once your actual medications are considered.
Local detail
Your plan menu is set by your county, not your state
Carriers decide Medicare Advantage availability county by county. That matters here more than in most places, because New Braunfels sits across the Comal and Guadalupe line, and Schertz and Selma each touch three counties. Two neighbors a few streets apart can be shopping different plan lists.
60Comal CountyMedicare Advantage plans for the 2026 plan year
58Guadalupe CountyA different menu from Comal, same city in places
64Bexar CountyThe largest menu in the service area
44Hays CountySan Marcos, and about 20 fewer plans than Bexar
Plan counts from MedicareAdvantage.com for the 2026 plan year, which includes Special Needs Plans. Counts published elsewhere may be lower because they exclude SNPs. Always confirm your own options at Medicare.gov before you enroll.
How we narrow the field
What We Look at Before Recommending a Plan
We don't believe Medicare recommendations should be based on a television commercial or simply whichever plan has the lowest premium. Before helping you choose coverage, we'll consider:
Your Doctors
Are your physicians and preferred hospitals available under the coverage you're considering?
Your Prescriptions
How does each plan cover the medications you actually take?
Your Healthcare Needs
How frequently do you use healthcare, and what services matter most to you?
Your Budget
Would you rather pay more each month for predictable expenses or pay less monthly and share more of the cost when you use care?
Your Travel
Do you spend significant time outside your local area or want greater nationwide provider flexibility?
Your Long-Term Options
We'll also discuss how your initial Medicare decision could affect your ability to change coverage later. Our goal is to help you understand why a particular option may be right for you, not simply tell you which plan to buy.
How it works
Our Process
If the plan you already have is the best one on the table, we'll say so and leave it alone.
1
Learn About You
We'll discuss your doctors, prescriptions, healthcare needs, budget, and priorities.
2
Compare Your Options
We'll review available coverage from the insurance companies we represent and narrow the choices based on your needs.
3
Make an Informed Decision
We'll explain the differences, costs, and tradeoffs so you can choose your coverage with confidence.
4
Ongoing Support
Our relationship doesn't end after enrollment. If you have questions about your coverage, billing, prescriptions, claims, or future plan changes, you can call our team directly.
The gap Medicare leaves
Medicare does not pay for long-term care
This is the single most expensive misunderstanding in the whole program. Medicare covers skilled nursing for up to 100 days per benefit period, and only after a qualifying inpatient hospital stay, with a daily copay from day 21. What it does not cover at all is custodial care, meaning help with bathing, dressing, eating and moving around, which is what most people actually end up needing.
Medicaid does cover custodial care, but only after you have spent down your assets to qualify. Between those two is the gap, and it is where a family either writes checks or plans ahead. Texas Health and Human Services publishes the state Medicaid rules if you want to read the eligibility limits yourself.
Questions
Medicare questions
When should I start looking at Medicare?
It's a good idea to begin learning about Medicare several months before turning 65. Your Initial Enrollment Period generally begins three months before the month you turn 65 and continues through three months after your birthday month.
Do I have to enroll in Medicare at 65 if I'm still working?
Not always. If you or your spouse are actively working and you have qualifying employer-sponsored coverage, you may be able to delay certain parts of Medicare without a late-enrollment penalty. The rules depend on your specific situation, so it's important to review your employer coverage before making a decision.
Will a broker push me toward the plan that pays him most?
Carriers pay a licensed agent the same amount no matter which Medicare plan you pick, and CMS sets that amount, so there is nothing pulling the advice one way. Jordan decides on whether your doctors are in network and your prescriptions are on the drug list. That is why he checks both before he mentions premium.
Can I keep my doctors?
That depends on the type of coverage you choose. Medicare Advantage plans generally use provider networks, while Medicare Supplement coverage works with Original Medicare and generally allows you to see any provider nationwide who accepts Medicare. We'll check your doctors before recommending coverage.
What about my prescriptions?
Every drug plan has its own formulary, its own tiers and its own preferred pharmacies, so the same prescription can cost very different amounts depending on the plan. Bring your bottles or a list with the doses and we price your actual drugs, not a generic estimate.
Why do my neighbors have plans I cannot get?
Because Medicare Advantage availability is set at the county level. New Braunfels sits in both Comal and Guadalupe counties, so an address on one side of the line can have a different plan menu than an address on the other. Schertz and Selma each touch three counties.
Can I switch from Medicare Advantage to a Supplement later?
You can leave an Advantage plan during the annual window, but getting a Medicare Supplement afterward is the harder half. Texas has no Medigap birthday rule, so outside of your one-time six month open enrollment or a guaranteed issue situation, an insurer can ask health questions and decline you. It is worth thinking about that before you make the first choice, not after.
I am under 65 and on Medicare because of a disability. Can you help?
Yes. Texas rules are different for you. Your six month Medigap open enrollment applies to Plan A only, and you get a second full open enrollment period in the six months after you turn 65. Texas also passed protections effective September 1, 2025 for people who became Medicare eligible because of ESRD or ALS.
Does it cost anything to work with Clear HealthPlan Advisors?
There is typically no additional cost to you for our Medicare plan assistance. If you enroll in a plan through us, the insurance company generally compensates our agency.
What happens if I miss my enrollment window?
Missing Part B enrollment when you are not covered by a qualifying employer plan usually means a late enrollment penalty added to your premium for as long as you have Part B, plus a wait until the next General Enrollment Period, January 1 through March 31, with coverage starting the following month. Worth confirming your dates before your Initial Enrollment Period closes rather than after.
Let's Make Medicare Easier
Whether you're turning 65, already enrolled in Medicare, or simply want a second opinion on your current coverage, we're here to help. We'll compare your options, explain the differences, and help you make a confident decision based on what's best for you.
Rather just talk it through? Call Jordan Schwabe at (210) 410-0472.