Finding Medicare Plans in Texas
The great news is that there are a lot of Medicare plans in Texas to choose from. But sorting through all of the options to find the right coverage can be draining. We don’t think it has to be! We’ve done the research and created this guide to help navigate you through your options and find the right plan for you.
When Am I eligible for Medicare Plans in Texas?
Medicare is a federal health insurance program for citizens and permanent US residents age 65 or older and younger people with specific illnesses or disabilities.
If you’re 65 or older, you may qualify for Medicare if:
- You are a citizen or permanent resident (having lived in the US for at least 5 years), and
- You or your spouse worked at a job that paid towards your Medicare through Social Security deductions for at least 10 years.
If you’re under 65, you may qualify for Medicare if you have:
- been diagnosed with Amyotrophic Lateral Sclerosis (ALS) or End-Stage Renal Disease (ESRD)
- received Social Security Disability Insurance (SSDI) for at least 24 months
We can help you determine your eligibility for Medicare plans in Texas or help you prepare for your upcoming eligibility. View plans in your area online or talk to a licensed insurance agent by calling us.
What Medicare Plans are Available in Texas?
Original Medicare (Parts A and B)
Original Medicare is the governmental component of Medicare, which has two parts:
Part A (Hospital Insurance) covers inpatient services, like hospital care, hospice, skilled nursing facility care, and nursing home care (as long as custodial care isn’t the only care needed).
Part B (Medical Insurance) covers outpatient services and supplies, like mental health, ambulance services, and durable medical equipment (blood sugar monitors, walkers, canes, etc). Part B also covers certain services that prevent or detect illnesses early, like flu shots, cardiovascular and diabetes screenings.
Original Medicare doesn’t cover everything. Services generally not covered by Original Medicare include:
- Long term care (custodial care)
- Most outpatient prescription drugs
- Hearing aids
- Eye exams and eyeglasses
- Most dental care and dentures
- Routine foot care
- Cosmetic surgery
Medicare doesn’t cover everything and isn’t intended to pay 100% of your medical bills. Medicare beneficiaries typically pay a portion of medical expenses in the form of deductibles, coinsurance, and copayments. For this reason, there are many additional Medicare plans available in Texas to choose from and expand your coverage
Medicare Advantage Plans (Part C)
Medicare Advantage plans, offered by Medicare-approved private insurance companies, work as an alternative to the coverage provided by Original Medicare (Parts A and B). These plans provide the same coverage as Original Medicare and can also include additional benefits, like dental, vision, and prescription drug coverage. Medicare Advantage plans with prescription drug coverage are called Medicare Advantage Prescription Drug (MAPD) plans.
You must be enrolled in both parts of Original Medicare to enroll in a Medicare Advantage plan. Premiums can start at $0 and increase depending on the level of coverage selected. You’ll continue paying your Part B premium in addition to your Part C premium.
For more information about Medicare Advantage plans, click here.
Medicare Prescription Drug Plans (Part D)
Prescription drugs are not covered by Original Medicare (Parts A and B) or Medigap plans. Stand-alone Medicare Prescription Drug plans, offered by Medicare-approved private insurance companies, work alongside Original Medicare to limit your out-of-pocket costs for medications. Medications are put into tiers, each tier with a certain copay or coinsurance. Each Medicare Part D plan provides a formulary, so you can see what the coinsurance/copay would be for each drug. This way, you can select the plan that best matches your prescription needs.
For more information about Medicare Prescription Drug plans, click here.
Medicare Supplement Plans (Medigap)
As mentioned earlier, Medicare beneficiaries are still responsible for paying a portion of their medical bills. This is where Medicare Supplement plans come in. These plans are available through private insurance companies, approved by Medicare, and work alongside Original Medicare to cover certain costs, like copayments, coinsurance, and deductibles. If you plan to stick with Original Medicare, a Medigap plan can help reduce your out-of-pocket costs.
For more information about Medicare Supplement plans, click here.
When Can I Enroll In A Medicare Plan in Texas?
Medicare Advantage and Medicare Prescription Drug Plans
Your Initial Enrollment Period (IEP) is your first opportunity to enroll in Medicare. This IEP is a seven-month period, starting three months before your 65th birthday month.
You can then make changes to your Medicare Advantage or Medicare Prescription Drug coverage during the Annual Election Period (AEP). This period runs from October 15th to December 7th every year.
Key Fact: The General Enrollment Period offers another chance to enroll in Original Medicare, in case you missed your IEP. This period occurs each year from January 1st to March 31st. If you want to enroll in a Medicare Advantage plan, you can do so from April 1st to June 30th every year.
Medicare Supplement Plans (Medigap)
The best time to enroll in a Medicare Supplement plan is during your Medigap Open Enrollment Period. This six-month period begins at the start of your 65th birthday month, assuming you’ve enrolled in Medicare Part B. Otherwise, your Medigap Open Enrollment Period would start the same month as your Medicare Part B coverage.
Important Note: You are guaranteed the Medigap plan of your choice if you enroll during this period. But if you don’t enroll within this period, you could be charged higher premiums or be denied coverage entirely.
Special Enrollment Periods
If you’ve recently experienced a qualifying life event, you may be eligible for a Special Enrollment Period. Special Enrollment Periods allow you to make changes to your Medicare coverage outside of the periods discussed above. Qualifying life events include moving outside of your plan’s coverage area, moving into or out of a care facility, and more. Our licensed insurance agents can help determine whether you qualify for a Special Enrollment Period.
How Do I Pick the Right Medicare Plan?
We have access to a wide variety of Medicare plans in Texas and can help you find the coverage that best fits your needs.
Give us a call to speak to a licensed insurance agent or compare plans online by using our form below.
Other Medicare Resources in Texas
The Texas Medicare Savings Program is available to Medicare beneficiaries with little or no income to help pay for Medicare premiums, co-pays, and deductibles.
Sources: Medicare.gov; https://yourtexasbenefits.hhsc.texas.gov