Skip to main content
GailL1
January 26, 2026

ON It’s Way . . . . Hospitals Offering Their Own Medicare Advantage Plans

  • January 26, 2026
  • 21 replies
  • 2655 views

 

Seems like a normal course of change - rather restrictive in some cases but it seems like it should work pretty well.  Several already do this - 

 

I would imagine most are HMO type but there could be some PPO types too.

 

Wonder if beneficiaries would trust this type of MA plans any better than those from  MA insurers.

 

What do you think?  Anybody have one - I guess Kaiser could be one and is a good model but what about other hospitals in your area - are they going this way and would you consider them as your MAPD insurer?

Are they all HMO type plans ?  What about offering other benefits like dental, vision, hearing?  

 

 

 

    21 replies

    cat0w
    cat0w
    Conversationalist ⭐⭐⭐
    January 27, 2026

    I have had this for several years through Baylor Scott and White in Texas. Plan, SCAP, is HMO-POS and Dental is PPO. All health, dental and eye coverage is through my plan. 

     

    My suggestion, research the plans that are available in your area. Look at what is provided by AARP in your state. AARP In Your State

     

     

    GailL1Author
    January 28, 2026

    @cat0w 

    I saw that Baylor Scott and White were mentioned in the KFF article that I referenced in my OP on this subject.

     

    But I have a question on this type of specific Hospital Designed MA plans -

    How do they handle prescription drug coverage?

    Most MA plans today contain their own Medicare Prescription Drug coverage formularies - so when one picks a specific MA plan they are not only accepting the plan for services, they are also accepting the prescription drug coverage within that plan.

     

    So do you find that your specific Hospital Designed MA plan of Baylor Scott and White adequate for most all Medicare beneficiaries that want such a plan or all they constantly having to file for prescription exceptions?

     

    Also is Baylor Scott and White an HMO type or a PPO type - if the later, are most providers on the hospital registry in-network?  Can your pcp refer you to a specialist that is outside of the plan ? Maybe even within the plan of a competing specific Hospital Designed MA plan.  

     

    I am sure that in most cases it works great but for the perhaps somewhat unusual cases, do you not consider it too restrictive ?  IDK, I  am asking cause in one respect these sound great and could actually be the answer to affordable care and coverage.

     

    ALSO just wanted to point out that this thread has nothing to do with any AARP/UHC plan - the subject is about various Hospital chains designing and implementing their OWN Medicare Advantage Plans - 

     

     

     

     

    TRL1111
    Community Champion ⭐
    January 29, 2026
    @GailL1 wrote:

    I saw that Baylor Scott and White were mentioned in the KFF article that I referenced in my OP on this subject.

     

     

    FWIW, Baylor Scott and White has offered ACA plans on the exchange for several years.

     

    What's interesting is that cat0w is in a suburb of Austin that spans two counties:  Travis and Williamson.  (Or close enough that they ice skate there.) 

     

    All but a little section of Austin is in Travis County.  Williamson County includes a sliver of Austin along with the town/suburbs north of Austin--in the direction of Temple, which is where Scott & White Hospital was established over a century ago.  Scott & White merged with Baylor Healthcare System several years ago; Baylor is located in Waco, which is a little farther up the road from Temple.  It's Austin, and then Temple (Scott & White) 60 miles north of Austin, and then Waco (Baylor) 40 miles north of Temple.  So including only the northernmost part of the Austin area makes sense, I suppose.

     

    But BSW's ACA plans are available to residents of both Williamson County and Travis County.  

     

    So BSW offers ACA plans in both Williamson County and Travis County, but offers Advantage plans only in Williamson County, and not Travis County.  I would think that healthcare plans offered by a hospital would be more than typically focused on a given geographical area, and I wouldn't think the networks in an ACA plan and Advantage plan offered by the same hospital would be so significantly different, but it's insurance we're talking about, so who knows.

     

    Actually, I just checked and BSW offers 10 ACA plans to residents of Travis and Williamson Counties--they're they same plans, and all are HMOs.  So they run HMOs in Travis County for ACA plans but don't offer anything in Travis County on the Advantage side.  About five or ten  years ago I noticed that BSW offered PPO ACA plans in Austin, which was exciting because Blue Cross had quit offering any PPO plans in Texas, but it turned out that BSW's PPO plans had access only to a limited local network.  And now they don't even offer that--it's all HMOs with ACA plans.  HMOs that are in Travis County, while Advantage plans with the same company don't offer any plans in Travis County.

     

    Weird.

     

     

     

     

    TRL1111
    Community Champion ⭐
    January 28, 2026
    @cat0w wrote:

    My suggestion, research the plans that are available in your area. Look at what is provided by AARP in your state. 

     

    AARP/UHC Advantage plans may be a good fit, but they might not.  Anyone who reads this forum should realize that there is very little that is "special" about an AARP "endorsement."

     

    That's especially true with AARP/UHC Medigap (not Advantage) plans.  They have a huge market share, which could theoretically provide some stability, but not necessarily.  And they're unique in their somewhat deceptive declining discount and "community" rating.

     

    But it's not all the insurer's fault.  Insurance is highly variable from state to state, and is highly individual on top of that  There is no one-size-fits-all or even one-size-fits-many solution, but people seem to think there is.  Best to remember that AARP has not shopped insurance FOR YOU, and act accordingly.

    GailL1Author
    January 28, 2026

    @TRL1111 

    Just wanted to point out that this thread has nothing to do with any AARP/UHC plan - the subject is about various Hospital chains designing and implementing their OWN Medicare Advantage Plans - 

     

    Since many “insurers’ seem to be getting a bad rap right now due to [whatever] reasoning - some true / some not - then Hospital Chain Spedific Medicare Advantage plans seem to be somewhat of a solution.  

     

    But is this a good thing?  Is it as complete as a MA plan from an insurer rather than a hospital?

     

     

     

     

     

    Terms & ConditionsAccessibility statement