Medicare in Texas
Key Takeaways
- All Texans who are U.S. citizens or permanent residents 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)Medicare Advantage (Medicare Part C) is health insurance for Americans aged 65 and older that blends Medicare benefits with private health insurance. This typically includes a bundle of Original Medicare (Parts A and B) and Medicare Prescription Drug Plan (Part D). 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 or permanent resident of at least five years, then Medicare in TX is an option for you. 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.
Your Ideal Medicare Plan is out there.
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 consists of Parts A and B with the option to add Part D and Medicare Supplement (Medigap) plans. Medicare Advantage plans in Texas (Medicare Part C) usually bundle Parts A, B, and D coverage, plus supplemental benefits.
Original Medicare
- Medicare Part A is hospital insurance, which covers inpatient hospital stays, skilled nursing facility services, hospice care and home health care
- Medicare Part B is 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-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 in 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 premiumA premium is a fee you pay to your insurance company for health plan coverage. This is usually a monthly cost.
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.
My Medicare coverage doesn’t address all of my needs.
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).
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
Start your Medicare PlanFit CheckUp today.
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.
4,032,221 Beneficiaries with Part A & Part B
1,926,289 Medicare Advantage Beneficiaries
47.77% Medicare 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% Medicare Advantage Participation Rate, Previous Year
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.
Texas Department of Insurance
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 Department of Insurance?
This department can answer questions, field complaints, and share general knowledge about insurance.
Texas Veterans Commission (Health Care Advocacy Department)
https://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
Phone lines open M-F, 8 a.m. to 5 p.m.
COVID-19 questions: call 2-1-1
https://www.dshs.texas.gov/
What should I know about the Department of State Health Services?
Headquartered in Austin with eight regional offices, DSHS assists Texans who need services or help.
Texas Medicaid services (Texas Health and Human Services)
https://www.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 a GoHealth insurance agent that is licensed in Texas about your Medicare questions.
Mon – Fri, 8 a.m. – 6 p.m. CT
Centers for Medicare and Medicaid Services
You can reach the Social Security Administration 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
1-800-722-1213
TTY 1-800-325-0778
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.
Before 65 Guide
Understanding health insurance before age 65, especially when considering early retirement
Medicare Plans Guide
Costs, coverage and enrollment details for each Medicare plan
Medicare Beneficiary Guide
For those currently enrolled in Medicare
Low Income and Medicare Guide
For individuals with a qualifying income status
A Caregiver's Guide
For individuals with a qualifying income status