Haris Ashley
Medicare is the federal health insurance programme for Americans aged 65 and over, but each state has its own rules and programmes that can affect coverage and costs. Texas has a Medicare Savings Programme to help cover costs, and seniors in Texas can also benefit from Medicare Supplemental (Medigap) insurance. Seniors in Texas may also be eligible for Medicaid, which is the most affordable insurance plan for those on low incomes, even if they are already enrolled in Medicare. This guide will explore the pros and cons of Texan insurance for seniors versus Medicare to help you decide which is the best option for you.
| Characteristics | Values |
|---|---|
| Customer satisfaction | AARP/UnitedHealthcare has strong customer service ratings in Texas |
| Cost | Medicare is the most affordable plan for seniors and retirees |
| Eligibility | Texans aged 65 and over are eligible for Medicare |
| Enrollment | Must be entitled to Medicare Part A or Part B-ID |
| Income requirement for individuals | $1,565 to $1,761 monthly |
| Income requirement for couples | $2,115 to $2,380 monthly |
| Additional benefits | Medicare Savings Program helps pay for premiums, co-pays, and deductibles |
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What You'll Learn
Medicare Savings Program
MSP income limits are based on the federal poverty level (FPL), which is adjusted annually. The resource limits for MSPs, except QDWI, are updated annually based on the Consumer Price Index (CPI). The QDWI resource limits are based on the current SSI resource limits. MSPs do not include transfer of assets, spousal impoverishment, and co-payment policies and procedures.
In Texas, the Medicare Savings Program helps cover all or some of your Medicare premiums, co-pays, and deductibles. To qualify for a Medicare Savings Program, you must have income and resources below a certain limit, which varies by state and increases each year.
In Texas, the income range for an individual is between $1,305.01 and $1,565 per month, while the income range for a couple is between $1,763.01 and $2,115 per month. If only one spouse is eligible, use the individual income range to test eligibility. A portion of the spouse's income may be considered part of the applicant's income. Income limit amounts do not include the $20 general income disregard. Additionally, applicants and their spouses can have separately identifiable burial funds of $1,500, less any excluded life insurance or irrevocable arrangement for burial.
Texas seniors, adults with disabilities, and some children with disabilities who don't have health insurance may be able to get health coverage through the Medicaid for the Elderly and People with Disabilities program. It is possible to get Medicaid even if you are already on Medicare.
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Medicaid for low-income seniors
Medicaid is a health care program for low-income individuals of all ages. Texas seniors aged 65 and over who meet the financial eligibility requirements can qualify for long-term care Medicaid. There are three categories of Medicaid long-term care programs for which senior Texans may be eligible:
- Institutional / Nursing Home Medicaid: An entitlement where benefits are provided only in nursing homes. To qualify in 2025, a single applicant must have an income under $2,901 per month, assets under $2,000, and require a nursing home level of care.
- Medicaid Waivers / Home and Community-Based Services: This is not an entitlement and the number of participants is limited. Benefits are provided at home, adult day care, adult foster care home, or in assisted living.
- Traditional Medicaid: The state pays your doctors, nurses, and other caregivers directly.
Seniors who are already enrolled in Medicare may still be able to get health coverage through Medicaid. Medicaid provides health coverage to 7.2 million low-income seniors who are also enrolled in Medicare, and can help pay for premiums, co-pays, and deductibles.
Seniors who earn too much to qualify for Medicaid may still be able to qualify if they have high medical costs. The Medicaid spend-down program lets you subtract your medical costs from your income, and you can use this reduced amount to qualify for Medicaid. Qualified Income Trusts (QITs) or Miller Trusts allow applicants who are over the income limit to become income-eligible.
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Medicare Supplemental Insurance
Medicare is the best health insurance option for most seniors and retirees. Seniors aged 65 and over who earn too much to qualify for Medicaid may still be able to qualify if they have high medical costs. The Medicaid spend-down program lets you subtract your medical costs from your income. You can use this reduced amount to qualify for Medicaid.
Medicare Supplement Insurance, also known as Medigap, is extra insurance you can buy from a private health insurance company to help pay your share of out-of-pocket costs in Original Medicare. Generally, you must have Original Medicare – Part A (Hospital Insurance) and Part B (Medical Insurance) – to buy a Medigap policy.
Medigap plans are lettered A through G and K through N. Plans A through G generally provide benefits at higher premiums with limited out-of-pocket costs compared to Plans K through N. Plans K through N are cost-sharing plans offering similar benefits at lower premiums with greater out-of-pocket costs. If you live in Massachusetts, Minnesota, or Wisconsin, your Medicare Supplement policy may be called something different.
Medigap plans may help pay some of the healthcare costs that Medicare Parts A and B do not, like coinsurance, copayments, or deductibles. If a percentage appears, the Medigap plan covers that percentage of the benefit, and you pay the rest. If a box is blank, the plan doesn't cover that benefit.
In Texas, seniors can get help finding and applying for long-term care programs through Aging and Disability Resource Centers (ADRCs). The Texas Health Information, Counseling, and Advocacy Program can also help seniors find information and enroll in Medicare, Medicaid, and long-term care. Additionally, the Medicare Savings Program can help pay for all or some of the Medicare premiums, co-pays, and deductibles.
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Medicare Prescription Drug Coverage
Medicare is the best health insurance for retirees and seniors in the US. While Medicare is a federal program, each state has its own rules for eligibility and coverage. In Texas, there are a few ways to get help with Medicare costs and coverage.
The Medicare Savings Program helps pay for all or some of your Medicare premiums, co-pays, and deductibles. This is a useful way to reduce the costs associated with Medicare. Additionally, seniors who are already on Medicare might be able to get health coverage through the Medicaid for the Elderly and People with Disabilities program. Medicaid is a good option for seniors with low incomes, as it is the most affordable plan for this demographic. Even if you earn too much to qualify for Medicaid, you may still be able to qualify if you have high medical costs. The Medicaid spend-down program lets you subtract your medical costs from your income, and you can use this reduced amount to qualify for Medicaid.
To enroll in Medicare prescription drug coverage, you must first be enrolled in Medicare Part A or Part B. You can then choose a plan that best suits your needs and budget. Costs vary depending on the plan, and you may be able to get extra help paying for your medications if you have limited income and resources. This extra help could include assistance with paying premiums, annual deductibles, and prescription co-payments.
In summary, Medicare prescription drug coverage is an important benefit for retirees and seniors, offering them access to necessary medications. With a variety of plans available and financial assistance options, Medicare users across the US can ensure they are getting the best coverage for their needs.
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Customer satisfaction with insurance providers
Medicare Advantage Plans in Texas:
Medicare Advantage Plans, offered by private insurance companies, provide an alternative to original Medicare with additional benefits. Texas has a wide range of Medicare Advantage Plans available, with nearly 1 in 7 residents aged 65 and older. The average monthly premium for a Medicare Advantage Plan in Texas in 2025 is $6.81, and there are 373 plans to choose from.
Several providers scored above the regional average on member satisfaction in Texas:
- Blue Cross and Blue Shield of Texas
- Humana
- Cigna Healthcare
- UnitedHealthcare
UnitedHealthcare, one of the largest health insurance companies in the country, offers affordable plans with good coverage and high customer satisfaction. They have strong customer service ratings in Texas and five other states. However, their ratings are below average in California, Ohio, and Pennsylvania.
Original Medicare:
Original Medicare, run directly by the government, consists of Part A (hospital insurance) and Part B (medical insurance). People aged 65 and older or those with qualifying disabilities are generally covered by Medicare. Overall satisfaction with Medicare is high, especially among beneficiaries aged 65 and older. However, younger beneficiaries with disabilities experience more insurance problems and have lower satisfaction with their coverage.
Medicare Supplement Plans:
Medicare Supplement Plans, also known as Medigap plans, help cover out-of-pocket costs and may include benefits not covered by original Medicare. AARP/UnitedHealthcare offers Medicare Supplement Plans with good ratings, affordability, and nationwide availability, except in Alaska.
Other Options:
Kaiser Permanente is known for its excellent customer service and highly-rated Medicare Advantage Plans in eight states and Washington, D.C. They are highly regarded for their ability to provide quick access to care and appointments.
Wellcare stands out for its Medicare Part D plans for prescription drugs, offering a combination of good ratings and affordability.
Choosing the Right Plan:
When choosing a Medicare plan, it's important to consider factors beyond cost. The Medicare Plan Finder can help compare plans, benefits, and costs. Checking with your doctors to ensure they accept the plan is also crucial. Texas offers a free helpline (800-252-9240) to guide residents through the complexities of Medicare and provide unbiased benefits counseling.
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Frequently asked questions
Medicare is a health insurance plan for retirees and seniors aged 65 and over.
The Medicare Savings Program helps cover the cost of Medicare premiums, co-pays, and deductibles.
Medicare is the best health insurance for retirees and seniors. However, seniors in Texas can also benefit from Medicare Supplemental (Medigap) insurance and Medicare Prescription Drug (Part D) coverage. Additionally, Texas offers the Medicaid for the Elderly and People with Disabilities program, which may be a better option for low-income seniors who do not qualify for Medicare.
