Medicare Advantage Plans in Texas
Key Takeaways
- Medicare Advantage 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). is a private insurance product that expands on the essential services offered as part of Original Medicare Original Medicare is a fee-for-service health insurance program available to Americans aged 65 and older and some individuals with disabilities. Original Medicare is provided by the federal government and is made up of two parts: Part A (hospital insurance) and Part B (medical insurance). .
- Medicare Advantage plans in Texas must offer the same services as Medicare Parts A and B, but additional covered services can vary.
- The cost of Medicare Advantage in Texas will depend on the plans that are available where you live.
Medicare Advantage is a private insurance product that offers all the coverage of Original Medicare and may add an array of additional services like prescription drug coverage as well as hearing, vision, and dental services. There are 376 Medicare Advantage plans available in Texas as of 2024, but your access to specific plans depends on your ZIP code.
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Texas Medicare Advantage Plan Coverage
Medicare Advantage is available in Texas to anyone who is enrolled in both Parts A and B of Original Medicare, which for most U.S. citizens first becomes an option when they reach 65 years of age.
Medicare Part A covers services you receive in an inpatient hospital setting. Medicare Part B covers outpatient care, including wellness visits, examinations in your doctor’s office and therapy sessions.
Medicare Part C — another name for Medicare Advantage — is offered by private insurance companies under guidance from the federal Medicare program. All Medicare Advantage plans must offer at least the same coverage as Parts A and B, but many also offer benefits like prescription coverage (known as Part D), dental, vision, and hearing.
You must be enrolled in both Parts A and B of Original Medicare in order to switch to Medicare Advantage.
TX Medicare Advantage Plan Costs
The cost of Medicare Advantage in Texas varies based on what plans are available in your area and what coverage you want. You can find available plans by entering your zip code at Medicare.gov, or by contacting a GoHealth licensed insurance agent to help find the right plan for your needs.
The average monthly premium for a Medicare Advantage plan in Texas as of 2024 is $9.36. Every person on Medicare in the state has at least one Medicare Advantage plan with a $0 premium offered in their area.
Your overall costs will also depend on rules set by your individual plan. Many Medicare Advantage plans require you to receive care within a particular network of providers to receive the maximum coverage for your healthcare services. However, these plans also set a limit on your out-of-pocket expenses for the year.
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Medicare Advantage Plan Eligibility and Enrollment in Texas
The federal government sets Medicare Advantage eligibility requirements.
Any U.S. citizen age 65 and over is eligible for Original Medicare, as are people regardless of age who have received Social Security disability for at least 24 months, as well as people living with End Stage Renal Disease and Amyotrophic Lateral Sclerosis.
Medicare has set up specific periods for when you can enroll. For most people, your Initial Enrollment Period (IEP) is the three months before you turn 65, your birthday month and the three months after your birthday.
A Special Enrollment Period also may be available based on specific circumstances, like a new disability or a move to an area where your current plan isn’t currently offered.
If you don’t have access to a Special Enrollment Period and didn’t enroll in Medicare Advantage during your Initial Enrollment Period, you can enroll in a new plan during the Medicare Open Enrollment Period, held annually from Oct. 15 to Dec. 7. Coverage purchased during this time begins Jan. 1. Also, from Jan. 1 to March 31 each year, you can change from one Medicare Advantage plan to another.
Are There Texas Medicare Advantage Plans With Prescription Drug Coverage?
Most Medicare Advantage plans include Part D prescription drug coverage. Without a Part D plan added to your Medicare Advantage coverage, you should expect to pay the entire cost of your outpatient prescription medications, unless you have other insurance.
You may add Part D coverage to your plan when you are first eligible or during the Medicare Open Enrollment Period, also called the Annual Enrollment Period. Still, if you don’t sign up when you are first eligible, you may have to pay an enrollment penalty for the period if you didn’t have other creditable coverage — and that penalty continues to be added to your regular monthly premium for the rest of your life.
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
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Sources
- FACT SHEET. CMS.gov.
- Your health plan options. Medicare.gov.
- Joining a plan. Medicare.gov.
- Information for my situation. Medicare.gov.
- Special Enrollment Periods. Medicare.gov.
- Drug coverage (Part D). Medicare.gov.
This website is operated by GoHealth, LLC., a licensed health insurance company. The website and its contents are for informational and educational purposes; helping people understand Medicare in a simple way. The purpose of this website is the solicitation of insurance. Contact will be made by a licensed insurance agent/producer or insurance company. Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. Our mission is to help every American get better health insurance and save money.
Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.