Medicare Options in Texas

How Medicare Enrollment Works in Texas

• You enroll in Original Medicare (Part A and Part B) through Social Security, not through an insurance agent.
• Medicare Advantage, Medicare Supplement (Medigap), and Part D plans are offered by private insurance companies approved to operate in Texas.
• If you have creditable coverage, such as employer insurance from a company with 20 or more employees, you may be able to delay Medicare past age 65 without late-enrollment penalties.
• Most Texans enroll during their 7-month Initial Enrollment Period, which begins 3 months before their 65th birthday, includes their birthday month, and ends 3 months after.

Medicare Coverage Options Available in Texas

Medicare in Texas is made up of four main parts and two primary ways to receive coverage. Plan availability and benefits can vary by county across Texas.

Original Medicare (Part A & Part B)

Original Medicare is provided by the federal government and is the foundation of Medicare coverage in Texas.

Medicare Part A (Hospital Insurance)

Part A helps cover:

• Inpatient hospital care
• Skilled nursing facility care (limited)
• Hospice services
• Certain home health services

Most Texans do not pay a monthly premium for Part A if they or their spouse paid Medicare taxes while working.

Medicare Part B (Medical Insurance)

Part B helps cover:

• Doctor visits and outpatient care
• Preventive services
• Diagnostic tests and lab work
• Durable medical equipment

Part B has a monthly premium set by Medicare, along with deductibles and coinsurance.

Medicare Advantage Plans (Part C) in Texas

Medicare Advantage plans are offered by private insurance carriers approved in Texas.

These plans:

• Combine Part A and Part B coverage
• Often include prescription drug coverage (Part D)
• May offer additional benefits such as dental, vision, hearing, and fitness programs
• Typically use provider networks (HMO or PPO), which vary by Texas county

Availability, benefits, and costs differ by location and plan.

Medicare Prescription Drug Plans (Part D) in Texas

Medicare Part D helps cover prescription medications.

Part D plans:

• Are offered by private insurance companies operating in Texas
• Can be added to Original Medicare
• Are included in many Medicare Advantage plans
• Use drug formularies and pharmacy networks

Having creditable prescription drug coverage can help avoid late-enrollment penalties.

Medicare Supplement (Medigap) Plans in Texas

Medigap plans help cover costs that Original Medicare does not pay, such as:

• Deductibles
• Copayments
• Coinsurance

Medigap plans in Texas:

• Work only with Original Medicare
• Do not include prescription drug coverage
• Are standardized by plan letter (A, G, N, etc.)
• Allow you to see any doctor nationwide who accepts Medicare

Premiums and availability may vary by carrier and location within Texas.

Choosing Medicare Coverage in Texas

Choosing the right Medicare coverage depends on:

• Your doctors and preferred hospitals
• Prescription medications you take
• Whether you travel frequently within or outside Texas
• Monthly premiums and out-of-pocket costs
• Desire for additional benefits versus provider flexibility

Medicare plans and benefits can change annually, so Texans are encouraged to review coverage each year during Medicare’s Annual Enrollment Period.

Official Medicare Resources

For official Medicare information, visit Medicare.gov or call 1-800-MEDICARE (TTY: 1-877-486-2048), available 24 hours a day, 7 days a week.