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.
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.
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.
- 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-pocketOut-of-Pocket Maximum (OOP) is the maximum amount of money an individual will pay towards out of pocket expenses like deductibles, co-payments, and co-insurance. costs for people with Parts A and B. Medigap plans have a monthly premium.
- 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.
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 a 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:
- Outpatient care
- Emergency service
- Prescription drugs
- Pediatric services
- Laboratory services
- Rehabilitation and habilitation services
- Mental health and substance abuse
- Preventive or wellness services
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.
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.
Texas Department of Insurance
Texas Veterans Commission (Health Care Advocacy Department)
Department of State Health Services
Texas Medicaid services (Texas Health and Human Services)
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.
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