Orlando Harmon
Medicare is a federal health insurance program in the United States that provides coverage for over 4.4 million people in Texas who qualify. Texas residents have multiple Medicare plans to choose from, including Original Medicare (Parts A, B, and D), which covers hospital, medical, and prescription costs, and Medicare Advantage or Medicare Part C plans, which are offered by private companies and provide similar coverage to Original Medicare. Texans can also access resources to help them navigate the complexities of Medicare and understand their plan options, such as the Texas Health Information, Counseling, and Advocacy Program.
| Characteristics | Values |
|---|---|
| Medicare beneficiaries | Those 65 or older or considered to have a qualifying disability |
| Medicare beneficiaries under 65 | About 10% as of late 2024 |
| Medicare Advantage Open Enrollment Period | January 1 to March 31 |
| Medicare Advantage plans in Texas | 385 |
| Medicare Part A cost in 2023 | $506 per month |
| Medicare Part B cost in 2023 | $164.90 per month |
| Medicare Part B cost in Texas | Around $150 a year |
| Medicare Part B co-insurance payment in Texas | $200 for the year |
| Medicare Part C or Medicare Advantage | Offered through private insurers |
| Medicare Part D | Prescription drug insurance |
| Texas Medicare initial enrollment period | Begins 3 months before turning 65, lasts the month of the birthday, and continues for 3 months after |
| Texas Health and Human Services | Offers a free helpline to guide residents through the complexities of Medicare |
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What You'll Learn
Medicare Advantage plans
You can switch to a different Medicare Advantage Plan or Original Medicare during the Medicare Advantage Open Enrollment Period, which runs from January 1 to March 31. Before joining, it is important to talk to your employer, union, or benefits administrator about their rules, as joining a Medicare Advantage Plan might cause you to lose your employer or union coverage.
To pick the right Medicare plan, you should compare costs and check with your doctors to see what plans they accept. Texas has a free helpline (800-252-9240) to guide residents through the complexities of Medicare. The Health Information, Counselling, and Advocacy Program (HICAP) can also help with any questions related to Medicare coverage in Texas.
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Medicare eligibility
Medicare is a federal medical insurance program that provides coverage for over 4.4 million people in Texas who qualify for it. Texas offers a variety of Medicare plans to choose from, including Original Medicare (Parts A and B) and Medicare Advantage Plans.
Eligibility Criteria
Medicare beneficiaries include those aged 65 or older or those considered to have a qualifying disability by the Social Security Administration. To qualify for Medicare due to a disability, you must have received at least 24 Social Security or Railroad Retirement Board (RRB) disability insurance payments. Additionally, those with End-Stage Renal Disease (ESRD) or amyotrophic lateral sclerosis (ALS) are eligible for Medicare.
Financial Assistance
Texas has resources to help residents understand their Medicare options and provide financial assistance. The Texas Health Information, Counseling, and Advocacy Program, in partnership with other organizations, offers free benefits counseling and helps eligible individuals enroll in Medicare. The Health Information, Counseling, and Advocacy Program (HICAP) also provides assistance with questions related to Medicare coverage.
The Low-Income Subsidy, or "Extra Help," is available under the Medicare Prescription Drug (Part D) coverage for individuals with limited income and assets. This program provides extra support for the costs of prescription medicines. Additionally, Medicare Savings Programs help pay for Medicare monthly payments, co-pays, and deductibles.
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Medicare costs
Medicare is a federal government health program that provides coverage for people aged 65 or older or those with qualifying disabilities. In Texas, Medicare covers more than 4.4 million people. Texas residents have multiple Medicare plans to choose from, including Original Medicare and Medicare Advantage Plans.
Original Medicare is provided directly by the federal government and includes Medicare Part A and Medicare Part B. Part A, also called hospital insurance, helps cover inpatient stays at hospitals, skilled nursing facilities, and hospice centers. Most people have premium-free Part A, but if you have to buy it, the cost can be up to $506 per month. Part B, also known as medical insurance, helps pay for outpatient care, such as physician services, kidney dialysis, and preventive care. The standard Medicare Part B premium was $164.90 per month in 2023 and $185 per month in 2025, but can vary based on income.
Medicare Advantage Plans are an alternative to Original Medicare, with 385 plans available in Texas. These plans vary in design, provider network, and cost structure, and some offer $0 premiums. The Medicare Advantage Open Enrollment Period runs from January 1 to March 31, during which enrollees can switch to a different Medicare Advantage plan or to Original Medicare.
Medicare Supplement plans, also known as Medigap plans, help pay for costs that Original Medicare doesn't cover, such as copays, coinsurance, and deductibles. These plans can also include extra benefits, such as coverage when travelling internationally. Many insurance companies offer Medigap plans in Texas, and some offer additional prescription drug add-ons.
Texas offers a variety of resources to help residents understand their Medicare options and enrol in the appropriate plan. The Texas Health Information, Counseling, and Advocacy Program provides free benefits counselling and can help eligible individuals enrol in Medicare and understand their options. The Texas Department of Insurance also has a resource page for Texas residents with Medicare coverage.
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Medicare Savings Programs
Texas offers a range of Medicare Savings Programs to assist eligible individuals in covering their Medicare costs. These programs are designed to help those with limited financial means access the healthcare they need. The specific MSPs available in Texas include:
- QMB (Qualified Medicare Beneficiary) Program: This program covers Medicare premiums for Parts A, B, and B-ID, as well as deductibles and coinsurance fees for Medicare services. To be eligible, individuals must have an income range of $1,305.01 to less than $1,565 per month, while couples must have an income range of $1,763.01 to less than $2,115 per month.
- SLMB (Specified Low-Income Medicare Beneficiary) Program: The SLMB program covers the payment of Medicare Part B or Part B-ID premiums. The income range for individuals is $1,565 to less than $1,761 per month, while couples must have an income range of $2,115 to less than $2,380 per month.
- QI-1 (Qualified Individual-1) Program: QI-1 covers the payment of Medicare Part B or Part B-ID premiums for those who do not qualify for any other Medicaid coverage or benefits. Individuals with end-stage renal disease (ESRD) who receive a kidney transplant may remain eligible for Medicare coverage for 36 months after the transplant.
Texas also offers additional resources to support Medicare enrollees and inform them about their plan options. The Texas Health Information, Counseling, and Advocacy Program provides free benefits counselling and assistance with Medicare enrollment, eligibility, and understanding the various options available. The state also has a free helpline (800-252-9240) to guide residents through the complexities of Medicare and ensure they receive the support they need.
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Medicare helpline
Medicare is the United States federal medical insurance program that provides coverage for over 4.4 million people in Texas who qualify. Texas residents have multiple Medicare plans to choose from, including Original Medicare and Medicare Advantage plans.
The Medicare website provides a range of helpful tools and resources to assist individuals with their Medicare journey. These include:
- Comparing options for coverage, including Medicare Advantage Plans (Part C), other Medicare health plans, and Medicare drug plans (Part D).
- Finding a Medicare Supplement Insurance (Medigap) policy by entering your ZIP code to get premium costs and companies that sell policies in your area.
- Finding a Pharmaceutical Assistance Program by entering your prescription drugs to check if any drug companies offer extra cost savings.
- Downloading the free "What's Covered?" mobile app to find out if an item or service is covered by Medicare.
- Live chat is available on the website, and local organizations can also help answer Medicare questions.
- Calling the Medicare helpline at 1-800-MEDICARE (1-800-633-4227). Help is available 24 hours a day, 7 days a week, except some federal holidays. TTY users can call 1-877-486-2048.
Texas Medicare Helpline
Texas has a dedicated helpline to guide residents through the complexities of Medicare. The Texas Health Information, Counseling, and Advocacy Program (HICAP) can provide free benefits counseling and help with enrollment, finding information, and understanding your options. They can be reached at 800-252-9240.
Additionally, the Texas Department of Insurance has a resources page for Texas residents with Medicare coverage, and the State Health Insurance Assistance Program (SHIP) offers free personalized health insurance counseling.
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Frequently asked questions
Medicare is a federal health insurance program that provides coverage for hospital-type services, such as inpatient hospital care, skilled nursing facility care, hospice care, and some home health care.
Medicare beneficiaries include those deemed eligible by being 65 or older or considered to have a qualifying disability by the Social Security Administration. About 10% of all Medicare beneficiaries in Texas were under the age of 65 as of late 2024.
Texas residents have multiple Medicare plans to choose from, including Original Medicare (Parts A, B, and D) and Medicare Advantage or Medicare Part C plans. Original Medicare is provided directly by the federal government and includes Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). Medicare Part D provides prescription drug insurance. Medicare Advantage plans are offered by private companies and offer the same coverage as Original Medicare plans, with additional benefits and varying costs.
Medicare costs vary depending on the plan chosen. Most people don't pay anything for Medicare Part A coverage, but there are coinsurance fees associated with this plan. The usual premium for Medicare Part B in Texas is around $150 a year, with a coinsurance payment of around $200. Medicare Advantage plans may have different costs depending on the specific plan chosen.
