Medicare in Texas
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 (Part C) 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:
- If you have end-stage renal disease (ESRD) or Lou Gehrig’s disease (also known as amyotrophic lateral sclerosis, or ALS), you qualify.
- If you have received 24 monthly payments of Social Security Disability Insurance or Railroad Benefits, you qualify.
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, skilled nursing facility services, 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 Supplement Insurance, also administered by private insurance companies, that helps control out-of-pocket 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 age 65 or older, Medicare Part B usually carries a monthly premium and other standardized costs. 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.
- Calling Social Security at 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
- Maternity
- Prescription drugs
- Pediatric services
- Laboratory services
- Rehabilitation and habilitation services
- Mental health and substance abuse
- Preventive or wellness services
- 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 4,032,221 people are enrolled in Medicare Part A and B in Texas. The total number of beneficiaries enrolled in Medicare Advantage Increased from 1,755,287 to 1,926,289 year over year. Medicare Advantage participation in Texas went from 44.98% to 47.77% 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.
Medicare
Texas
4,032,221 Beneficiaries with Part A & Part B
1,926,289 Medicare Advantage Beneficiaries
47.77% Meducare Advantage Participation Rate
53.92% Female
46.08% Male
71.20% Non-Hispanic White
8.39% African American
15.87% Hispanic
4.54% Other/Unknown
14.31% Eligible for Medicaid
1.04 Average HCC Score
$11,937.76 Actual Per Capita Costs
18.31% Hospital Readmission Rate
27.06% of Beneficiaries with an Emergency Department Visit
1,755,287 Medicare Advantage Beneficiaries, Previous Year
Increased Medicare Advantage, Year over year
44.98% Meducare Advantage Participation Rate, Previous Year
See more +
Table reflects the latest Beneficiary Demographics Data: Medicare Geographic Variation – by National, State & County
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 $12,171.39 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:
Nationwide Resources
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.
Medicare guide
Before 65 Guide
Understanding health insurance before age 65, especially when considering early retirement
Medicare guide
Medicare Plans Guide
Costs, coverage and enrollment details for each Medicare plan
Medicare guide
Medicare Beneficiary Guide
For those currently enrolled in Medicare
Medicare guide
Low Income and Medicare Guide
For individuals with a qualifying income status
Medicare guide
A Caregiver’s Guide
For individuals with a qualifying income status
