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Medicare in Texas

A Texas-sized guide to navigating Medicare in your home state

Reviewed by: Malinda Cannon, Licensed Insurance Agent. Written by: Bryan Strickland.

Key Takeaways

  • All Texans who are U.S. citizens age 65 or older are eligible for Medicare in Texas.

  • Medicare covers many healthcare insurance needs, but not all. Private insurance companies working with Medicare can offer additional benefits like prescription drug coverage and more.

  • Private insurance companies also offer Medicare Advantage plans in Texas — regional plans that bundle Part A and Part B and offer additional coverage like dental and vision insurance.

 

Everything’s bigger in Texas. Well, almost everything.

Medicare is big everywhere, and with the enormous scope of the federal healthcare program comes a Texas-sized learning curve. Yes, healthcare can be complicated, but GoHealth is here to help you navigate Medicare in Texas.

Who is eligible for Medicare in Texas?

If you are 65 or older and a U.S. citizen, then Medicare in TX is an option for you. While U.S. citizenship is always required, there are cases when you’re eligible for some Medicare plans in Texas regardless of your age:

What is Texas Medicare?

Medicare in Texas looks a lot like Medicare in other states because it’s a federal health insurance program that provides affordable coverage options for older Americans. Original Medicare offers Parts A and B of the federal program and the option of adding Part D and Medicare Supplement (Medigap). Medicare Advantage in Texas (Medicare Part C) bundles coverages similar to Parts A, B, D.

Original Medicare

  • Medicare Part A is commonly known as “hospital insurance,” which covers inpatient hospital stays, SNF, hospice care and home health care
  • Medicare Part B is commonly known as “medical insurance,” which covers medically necessary services and preventive care services

Prescription Drugs and Supplement Coverage

  • Medicare Part D is drug coverage, administered by private insurance companies under federal guidance.
  • Medigap is Medicare supplemental insurance, also administered by private insurance companies, that helps control out-of-pocketThe maximum amount of money an individual will pay towards out of pocket expenses like deductibles, copayments, and coinsurance. costs for people with Parts A and B. Medigap plans have a monthly premium.

Medicare Advantage

  • Medicare Part C is private insurance approved by Medicare to meet all of the needs mentioned above while also offering additional benefits like dental and vision coverage.

How much is Medicare Texas?

While Medicare Part A doesn’t have a monthly premium for most Texans aged 65 or older, Medicare Part B usually carries a monthly premiumA premium is a fee you pay to your insurance company for health plan coverage. This is usually a monthly cost.. The monthly premium for 2021 is $148.50. If you have Parts A and B, Part D and Medigap are options for you, but each has a monthly premium.

If you need the type of medical coverage that Part B covers, Medicare Advantage plans also feature the benefits of Part D and Medigap (supplemental insurance). Some Medicare Advantage plans have a benefit that can reduce the Part b premium. A GoHealth licensed insurance agent who is knowledgeable about Medicare in TX can help you weigh your options.

Where do I apply for Medicare in Texas?

Generally, you are automatically enrolled in Original Medicare (Parts A and B) at age 65 if you receive Social Security benefits before your turn 65. If not, you have to apply for Medicare in Texas. Your options include:

  • Applying online with the Social Security Administration.
  • Visiting a Social Security office in Texas.
  • Enrolling by calling 1-800-772-1213 (TTY: 1-800-325-0778).

If you want to make sure you are eligible to apply for Medicare plans in Texas or have questions about applying, a GoHealth licensed insurance agent can answer your questions without obligation.

What does Medicare cover in Texas?

Original Medicare in Texas helps reduce your out-of-pocket costs for hospital stays (Part A) and doctor visits and related expenses (Part B). Optional Medicare plans in Texas help with prescription costs (Part D).

All Medicare in TX is required to offer 10 Essential Health Benefits, including:

  1. Outpatient care
  2. Emergency service
  3. Maternity
  4. Prescription drugs
  5. Pediatric services
  6. Laboratory services
  7. Rehabilitation and habilitation services
  8. Mental health and substance abuse
  9. Preventive or wellness services
  10. Hospitalization

What Medicare Advantage plans are available in Texas?

While there’s only one Original Medicare plan, Medicare Advantage in Texas offers multiple plan options. A GoHealth licensed insurance agent, just a phone call away, specializes in guiding you through the strengths of various plans, helping you make a confident decision.

Medicare in Texas by the Numbers

Thousands of older adults enroll in Medicare every day across the United States. The latest CMS data shows that 3,785,385 people are enrolled in Medicare in Texas. The total number of beneficiaries enrolled in Medicare Advantage in Texas is 1,633,021. The previous year, 1,454,789 enrolled in Medicare Advantage. Medicare Advantage participation in Texas went from 39.66% to 43.14% year over year. If you’d like to dive deeper into how Medicare in Texas breaks down across the state, we provide a glance at who is using Medicare, and how.

Outline of Texas
3,785,385
Beneficiaries with Part A & Part B
1,633,021
Medicare Advantage Beneficiaries
43.14%
Medicare Advantage Participation Rate
54.07%
% Female
45.93%
% Male
1.04
Average HCC Score
$11,643.11
Actual Per Capita Costs
16.93%
% Eligible for Medicaid
31.74%
% of Beneficiaries with an Emergency Department Visit
18.18%
Hospital Readmission Rate
70.13%
% Non-Hispanic White
8.98%
% African American
16.76%
% Hispanic
4.13%
% Other/Unknown

Table reflects the latest Beneficiary Demographics data: 2018, All Beneficiaries by State, Centers of Medicare & Medicaid Services (CMS)

Average HCC Score: The Hierarchical Condition Category score gauges a population’s overall health. The score is based on a value of 1.0. Populations with an HCC score of less than 1.0 are considered relatively healthy. The score can be used to estimate health costs.

Resources for Medicare in Texas

Beneficiaries spend an average of $11,664 each year on Medicare in Texas. To be certain you are not leaving anything on the table, let us help. A GoHealth licensed insurance agent can assess your coverage or explain which Texas-based resources, like these, may be able to help:

Texas Department of Insurance

1-800-252-3439
Phone lines open M-F, 8 a.m. to 5 p.m.

https://www.tdi.texas.gov/consumer/index.html

What should I know about the Texas Division of Insurance?
This department can answer questions, field complaints and share general knowledge about insurance.

Texas Veterans Commission (Health Care Advocacy Department)

1-800-252-8387

https://www.tvc.texas.gov/health-care-advocacy/

What should I know about the Texas Veterans Commission?
Serves as a liaison for Texans needing a helping hand related to their benefits earned through military service.

Department of State Health Services

1-888-963-7111
Phone lines open M-F, 8 a.m. to 5 p.m.
COVID-19 questions: call 2-1-1

https://dshs.texas.gov/

What should I know about the Department of State Health Services?
Headquartered in Austin with eight regional offices, DSHS is “here to assist Texans who need services or help.

Texas Medicaid services (Texas Health and Human Services)

1-800-252-8263

https://hhs.texas.gov/services/health/medicaid-chip/about-medicaid-chip/state-plan

What should I know about Medicaid in Texas?
Texans can call this hotline for Medicaid questions. The “State Plan” for Medicaid follows the federal roadmap for the program.

Nationwide Resources

Speak with an insurance agent that is licensed in Texas about your Medicare questions.

1-855-792-0088 TTY: 711

Monday - Friday, 8 AM - 9 PM CT

Medicare & Medicaid

If you have general questions about Medicare in TX, or need help with current Medicare benefits.

1-800-MEDICARE (1-800-633-4227)

Social Security Administration

You can reach the SSA by phone for general questions. Not all questions can be answered over the phone.

Also, SSA.gov provides online resources for the following: Review information, apply for benefits, or manage your account online

Speak to SSA Representative, Monday - Friday, 8 AM - 7 PM ET

Medicare Learning Guides

Healthcare is personal. So is choosing insurance. If you are new to Medicare, a beneficiary researching options, or a caregiver, we have tailored Medicare Guides for you.

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