Plan Information

American Health Advantage of Texas is a Medicare Advantage Institutional Special Needs Plan contracted with Medicare. American Health Advantage of Texas offers a health plan specially designed for eligible Medicare beneficiaries living in one of our participating long-term care nursing homes. As a Member of American Health Advantage of Texas you receive not only the standard benefits offered by original Medicare, but the added attention and care that are so important to your health and well-being.

American Health Advantage of Texas focuses on Members who meet residential requirements in the American Health Advantage of Texas participating nursing homes located in the following counties:

Colorado, Comal, Cooke, Dallas, Denton, Ellis, Erath, Fannin, Fayette, Fort Bend, Franklin, Gregg, Grimes, Hamilton, Haskell, Henderson, Hood, Johnson, Kaufman, Kendall, Kleberg, Knox, Lamar, Lampasas, Lee, Leon, Llano, Lubbock, McLennan, Montgomery, Nacogdoches, Panola, Parker, Rusk, Smith, Tarrant, Wichita, Wilson, Wood

American Health Advantage of Texas covers all medically-necessary and preventive services covered under Medicare Part A and Part B, and prescription drug coverage under Part D.

Plus, American Health Advantage of Texas includes extra benefits including vision, routine foot care, preventive care, and In-Home/Out-of-Home Support Services. You pay nothing for these extra benefits! This is a brief list of benefits we cover and what you pay. It does not list every medical service or item covered or every limitation or exclusion. For a complete list of covered medical services or items, see the on-line or you may call American Health Advantage of Texas Member Services at 1-855-521-0628; TTY 1-833-312-0046 and request the Evidence of Coverage.

• • • Part D prescription drug coverage.
    • Vision, hearing, routine foot care, and preventive services and screenings.
    • Coordinated care and more personal attention.
    • Dedicated nurse practitioner as your trusted partner to manage your care and collaborate with your doctors, your family, and the nursing home staff.
    • Regular visits from your nurse practitioner to your residing nursing home to help avoid unnecessary and often unwanted trips to the hospital.
    • Your nurse practitioner can complete tests and treatments in the nursing home that are normally done in the hospital.
    • One point of contact for communication with you, your family, your doctors and nursing home staff.

We provide a personalized, compassionate clinical care and services model for our American Health Advantage of Texas Members.

Our model organizes best practices and industry innovations including:

• • • A Primary Care Physician (PCP) and an Advanced Nurse Practitioner RN Nurse Case Manager and Clinical Pharmacist care team providing onsite, nursing home-based PCP support for each and every enrolled Member.
    • A risk-assessment tool designed for a nursing home patient population.
    • A comprehensive history and physical assessment that drives an Individualized Care Plan (ICP).
    • A care management platform that helps identify needed preventive health/HEDIS services, ensures the use of evidence-based clinical guidelines, and facilitates care team communications for integrated care coordination.
    • Face-to-face Member interactions that identify Member care preferences and allow time for important care decision discussions and counseling.
      Every American Health Advantage of Texas Member has a dedicated Nurse Practitioner who is a trusted partner to manage their care by collaborating with the member, member’s family, member’s doctors, and the nursing home staff.

Through close monitoring of our enrolled Members, Nurse Practitioners can identify changes in a Member’s health conditions and quickly determine needs for preventive care.

One of the goals is to avoid unnecessary hospitalizations. Nurse Practitioners can perform tests and treatments normally done in a hospital (such as x-rays, IV therapy and dialysis) at the nursing home where the Member resides.

Our model allows for more comprehensive and coordinated care across medical, social, psychological, pharmaceutical, and economic lines. Our model evolves and adapts to the health care needs of our Members. And, we reduce the burden of unnecessary hospital visits, allowing Members to focus more on the important things in their lives.

American Health Advantage of Texas is designed to meet the needs of our Members and participating network providers and partners. In addition, we strive to meet the highest quality and safety standards. We follow standards developed by the National Committee for Quality Assurance (NCQA) to reach this goal.

The American Health Advantage of Texas Quality Improvement (QI) Program demonstrates hour mission to provide an effective, system-wide, measurable Quality Improvement plan for monitoring, evaluating and improving the quality of care and services in a cost-effective and efficient manner to our enrolled Members and participating network providers and partners.

• • • American Health Advantage of Texas’s mission, vision, and core values create the foundation for organizational QI.
    • American Health Advantage of Texas uses quality assurance and performance improvement to make decisions and guide our day-to-day operations.
    • American Health Advantage of Texas’s QI Program includes all business units of operations and administration, partners, and services.
    • American Health Advantage of Texas’s QI Program is comprehensive regarding systems of care, management practices, and business practices.
    • American Health Advantage of Texas’s QI Program is data-driven and is guided by our five performance improvement pillars: People, Service, Quality, Finance, and Growth and the respective business drivers in each performance improvement pillar.
    • American Health Advantage of Texas’s QI Program decisions are based on data, which is collected in a systematic format in alignment with American Health Advantage of Texas’s Policy.

• • • To improve the health status of American Health Advantage of Texas Members.
    • To ensure access to high quality and safe health care services in the American Health Advantage of Texas service area.

For more information about the American Health Advantage of Texas Quality Improvement Program, please call Member Services at 1-855-521-0628; TTY 1-833-312-0046. Calls to this number are free.

Our hours are 8 a.m. to 8 p.m., seven days a week (except Thanksgiving and Christmas) from October 1 through March 1, and Monday to Friday (except holidays) from April 1 through September 30.