Residents of Texas have various options for Medicare, including Original Medicare, Medicare Advantage, and Medicare Part D.
Medicare plans in Texas follow all federal guidelines for healthcare coverage for people ages 65 years or older or who have qualifying disabilities or medical conditions.
However, coverage specifications, additional benefits, and plans may vary. It is important to review all the options that are available in Texas.
Glossary of Medicare terms
- Out-of-pocket cost: This is the amount a person must pay for care when Medicare does not pay the total amount or offer coverage. Costs can include deductibles, coinsurance, copayments, and premiums.
- Premium: This is the amount of money someone pays each month for Medicare coverage.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before Medicare starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, coinsurance is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Original Medicare consists of two parts:
- Part A: Part A or hospital insurance, which covers inpatient hospital care, skilled nursing facilities, hospice care, and home healthcare.
- Part B: Part B, or medical insurance, covers outpatient services and treatments, including:
- services from doctors and other healthcare professionals
- durable medical equipment, such as wheelchairs, walkers, and hospital beds
- preventive services, such as vaccines, screenings, and yearly wellness visits
- home healthcare
Learn more about Original Medicare.
Medicare Advantage (Part C) is an alternative to Original Medicare that Medicare-approved private insurance companies provide.
Medicare Advantage plans provide the same coverage as Original Medicare. However, they often also include prescription drug (Part D) coverage and other benefits Original Medicare does not cover, such as:
- vision
- dental
- hearing
Some of the companies that offer Medicare Advantage plans include:
Not all plans are available in all areas. People can find which plans are available in their area by searching their ZIP code on the Medicare online tool.
Read about Original Medicare vs. Medicare Advantage.
Medicare Part D helps cover the cost of prescription medications, and private insurance companies administer these plans.
Many Medicare Advantage plans include prescription drug coverage. People who have an Advantage plan without drug coverage or who have Original Medicare can purchase a Part D plan.
Individuals may want to check with their Medicare Advantage plan provider before purchasing a Part D plan to be sure it will not affect their current plan.
Medicare eligibility
To be eligible for Medicare, a person must meet the following requirements:
- be 65 years old or older or have certain disabilities or medical conditions, such as end stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS)
- be a United States citizen or a legal resident of the United States
Medicare supplement insurance (Medigap) is extra insurance that people can purchase from private insurance companies. A Medigap plan can help cover some of the costs associated with Original Medicare, including:
- deductibles
- coinsurance
- copayments
Medigap is available only to people who are enrolled in Original Medicare.
Various companies offer Medigap plans in Texas, including:
- AARP – UnitedHealthcare
- Amerigroup
- Aetna
- Blue Cross Blue Shield of Texas
- State Farm
- Humana
People can use the Medicare online tool to find plans available in their area.
People who are choosing a Medicare plan in Texas may wish to consider various factors, such as:
- Out-of-pocket costs: Monthly premiums are not the only costs to consider when choosing Medicare plans. People are also responsible for copayments, coinsurance, and deductibles.
- Doctor choice: Many Medicare plans have a network of doctors and other healthcare professionals. Before choosing a plan, a person may wish to check if their current doctor is in the plan’s network.
- Healthcare needs: If a person has certain health conditions, such as diabetes or HIV, they may wish to look into Special Needs Plans, which are bespoke to an individual’s needs.
- Services covered: All Medicare plans must provide the same coverage as Part A and Part B. However, people may want to consider additional benefits that they may consider important, such as gym memberships, vision, and dental.
Learn about Medicare plans.
People in Texas who have questions about Medicare can contact the Texas Medicare Help Line at 800-252-9240.
They can also contact Medicare directly by phone at 800-633-4227 or via online chat.
Medicare resources
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.
Texas offers various Medicare options to its residents, including Original Medicare, Medicare Advantage, and Medigap.
Individuals with questions about Medicare can contact the Texas Medicare Help Line or Medicare directly by phone or online chat.
