Medicare in Texas

If you are just interested in Original Medicare, then your coverage will be the same across the state. You are eligible if you are 65 and paid Medicare taxes while working — this includes Medicare Parts A and B, which cover inpatient and outpatient care, among other things.

You may also be interested in a Medicare Advantage plan, which includes everything in Original Medicare coverage as well as other benefits and expanded coverage in some cases.

According to the 2018 U.S. Census, a quarter of all older Americans live in Texas, California and Florida. In fact, the number of Texans older than 65 is projected to triple between 2010 and 2050. A large population of older Americans could lead to a greater demand for Medicare options.

Medigap, an alternative to Medicare Advantage, is also available to Texas and can help you handle the costs of Original Medicare.

Original Medicare is available everywhere in Texas, and you can receive premium-free Part A as long as you worked and paid Medicare taxes.

In 2023, the Part A deductible is $1,600. Part B requires a monthly premium of $164.90 that could increase depending on your income, as well as a $226 deductible.

Medicare Advantage plans are widely available in Texas, with 385 different plans. In 2023, the average monthly premium for a Medicare Advantage plan in Texas is $8.94, according to the U.S. Centers for Medicare & Medicaid Services (CMS). These plans can include benefits like reduced cost-sharing or rewards programs.

Your options include HMOs, preferred provider organizations, needs-based plans and private fee-for-service plans. Many of these plans are regional or require you to stay within a network, so make sure that you check the options available in your city or county when looking for a plan.

Medigap supplement insurance is also available throughout Texas to help you handle costs if you opt for Original Medicare.

While many Medicare Advantage plans include Part D prescription drug coverage, there are 27 stand-alone drug plans available in Texas. The lowest monthly premium for a stand-alone Part D plan in 2023 is $6.60.

Multiple plans in the state now offer lower out-of-pocket insulin costs as well through the senior savings model.

If you decide to stick with Original Medicare, you can enroll in the three months leading up to your 65th birthday and the three months after. Enrollment can start online or by calling 1-800-772-1213.

If you are already receiving Social Security benefits, then you should be enrolled automatically.

If you are interested in buying Medigap, you have a six-month window to enroll after enrolling in Original Medicare.

Since Medicare Advantage is provided through a private insurance company, you can often enroll online through the plan’s website or by phone, depending on your preferred plan and company.

According to an analysis by the U.S. News & World Report, some of your best options for Medicare plans in Texas are KelseyCare Advantage or Erickson Advantage. Erickson Advantage also has Part D drug coverage as well access to wellness programs.

Remember that Medicare Advantage plans include everything covered under Original Medicare. Also, be sure to identify a plan that is available in your location. Medicare Advantage plans may require you to stay within a plan network.

Since Medicare Advantage plans often come with different sets of expanded coverage or benefits, make sure you know your health care priorities or the particular coverage you might be interested in before selecting a plan.