Medicare plays a key role in providing health and financial security to beneficiaries residing in Texas. With more than 4.2 million Texas beneficiaries enrolled in Medicare, we’ll cover some very important information below about Medicare in Texas. We want to help you better understand your options and make the decision-process as seamless as possible once you’re ready to enroll in Medicare or discover different coverage options.

Who Qualifies for Medicare in Texas?

Medicare covers most Texas residents who are 65 or older, and it also covers disabled Texas residents. In general, Medicare enrollment in Texas works the same way as it does in the rest of the country. If you qualify for Original Medicare, also known as Part A and Part B, it will help cover 80% of your health care costs.

When you’re first eligible for Medicare, you have a 7-month Initial Enrollment Period to sign up for Part A and/or Part B. If you’re eligible for Medicare when you turn 65, you can sign up during the 7-month period that:

  • Begins 3 months before the month you turn 65
  • Includes the month you turn 65
  • Ends 3 months after the month you turn 65

In most cases, if you don’t sign up for Part B when you’re first eligible, you’ll have to pay a late enrollment penalty. You’ll be responsible for paying this penalty for as long as you have Part B, and you could have a gap in your health coverage.

Once you reach Medicare eligibility, you can begin choosing additional coverage options to help pay for the remaining 20% of your medical expenses through Medicare Advantage (Part C), Medigap, and/or a Medicare Prescription Drug (Part D) plan.

Who Qualifies for Medicare

Texas Medicare Enrollments

2,430,627

Original Medicare Plans
(Part A and B)

1,814,783

Medicare Advantage & Other Health Plans

1,658,530

Stand-alone Medicare
Part D (Drug plans)

4,245,410

Total Medicare Beneficiaries
in Texas

Texas Medicare Advantage Plans (Part C)

More than 40% of Texas Medicare beneficiaries select Medicare Advantage plans.

Medicare Advantage plans are private, Medicare-approved insurance companies. They provide all of your Original Medicare benefits and often include extra benefits such as drug, dental, and vision coverage.

The Medicare Advantage Open Enrollment Period runs from January 1 to March 31. During this period, Medicare beneficiaries in Texas who are already enrolled in a Medicare Advantage plan can switch to a different Medicare Advantage plan or drop their Medicare Advantage plan and enroll in Original Medicare instead.

According to the Centers for Medicare and Medicaid Services (CMS), as of May 2020, there are 1,814,783 beneficiaries enrolled in Medicare Advantage and other plans in Texas. More than 40% of Texas Medicare beneficiaries were enrolled in a private Medicare Advantage plan in 2019. 100% of people with Medicare have access to a Medicare Advantage plan.

As of 2020, 231 Medicare Advantage plans are available in Texas. The average monthly Medicare Advantage premium changed from $14.05 in 2019 to $13.03 in 2020. $0 is the lowest monthly premium for a Medicare Advantage plan in Texas. Medicare Advantage plans are currently available in all 254 counties in Texas in 2019. Depending on the county, Medicare Advantage plan availability in Texas ranges from eight to 54 plans.

Texas Medicare Supplement (Medigap) Insurance Plans

Texas law requires Medigap insurers to offer at least Medigap Plan A to disabled beneficiaries under age 65.

Medigap plans are used to supplement Original Medicare, covering some or all of the out-of-pocket costs (for coinsurance and deductibles) that beneficiaries would otherwise incur if they only had Original Medicare on its own. Typically, Medigap plans are popular for those who want little to no copay when they access healthcare services.

Texas Medigap insurance is available to everyone with Medicare in the state, including those who are under 65 and are enrolled in Medicare. Often, Medigap plans in Texas can be more expensive if you don’t enroll during your Initial Enrollment Period and wait for an Annual Open Enrollment Period. 

There are two initial times to enroll in a Medigap plan before and after you turn 65:

  • 6 months prior to turning 65
  • Once you turn 65, your 6 month period begins the month you enroll in Part B

During this period, an insurance company can’t use medical underwriting. There are currently 72 insurers licensed to sell Medigap plans throughout Texas. Texas has rules in place that ensure people under age 65 have at least some access to Medigap plans.

Texas Medicare Prescription Drug Coverage (Part D)

Original Medicare doesn’t cover outpatient prescription drugs. However, Medicare beneficiaries can get prescription coverage via a Medicare Advantage plan, an employer-sponsored plan (offered by a current or former employer), or a stand-alone Part D plan. Medigap plans don’t cover prescription drugs unless they’re covered under Part B.

As of May 2020, There are 1,658,530 Medicare beneficiaries in Texas enrolled in stand-alone Part D prescription drug plans and 1,501,966 enrolled in Medicare Advantage Prescription Drug plans. For 2020 coverage, there are 30 stand-alone Part D plans available in Texas, with premiums ranging from about $10 to $140 per month. About 30% of people with a stand-alone Medicare prescription drug plan get Extra Help (also called the low-income subsidy, or LIS).

When deciding on a Part D plan, it’s important to evaluate several factors such as each plan’s premium, formulary, and copays since every plan is different. Learn how you can save money on your out-of-pocket costs with a Medicare Advantage, Part D, or Medigap plan, fill out this form or give us a call.

Local Medicare Health Plan Resources in Texas

  • Texas Health Insurance Counseling and Advocacy Program (HICAP): If you are eligible for Medicare, the Texas’ Health Information, Counseling and Advocacy Program can help you enroll, find information and provide counseling about your options. This partnership between the Texas Health and Human Services system, Texas Legal Services Center, and the Area Agencies on Aging trains and oversees certified benefits counselors across the state. This service is free of charge and available to Medicare beneficiaries aged 60 and older and adults with disabilities.
    Contact: Call (800) 252-9240 or search for a local office online at the Texas Medicare website.

  • Texas’ Managed Care Quality Assurance Office helps members of the public who are enrolled in managed care plans, including Medicare Advantage HMOs. The organization is responsible for licensing HMO providers and assuring that program participants have access to the care they’re promised by their insurance provider.
    Contact: Call (866) 554-4926 and select option 8.

  • Texas Aging and Disability Resource Centers: The 28 area agencies on aging (AAA) provide services to help people age 60 and older, their family members and caregivers receive the information and assistance they need in locating and accessing community services.
    Contact: Log onto the Texas Health and Human Services website to find the location nearest you.

  • Houston-Galveston Area Medicare Benefits Counselors help older and disabled Texans that are new or on Medicare compare and choose the best Medicare plans that are offered in their area. They can help you choose between traditional Medicare and Medicare Advantage Plans (Part C). They can assist with comparing the different drug plans (Part D) that are available to beneficiaries. Benefits Counselors also can assist with general questions about meals, transportation, and unrelated questions to in-home care. Assistance with application for Supplemental Nutrition Assistance Program (SNAP) is also available.
    Contact: Call (713) 627-3200

The licensed agents that are partnered with Timefor65 can help you compare the availability, benefits, and costs of Medicare plans in your specific region of Texas. Our process makes it easier for you to access your Medicare eligibility in Texas so that you receive personalized, affordable, and easy-to-use coverage options and solutions. Fill out the form or give us a call at (866) 327‑0148 anytime to get a free quote or to ask any questions.

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