Alyssa Lane
Medicare is a federal health insurance program available to those 65 years or older and adults with certain disabilities. In Texas, Medicare is part of a nationwide program and is managed by the federal government. Texas Medicare is split into four parts, with Part A covering inpatient hospital stays, skilled nursing facility treatment, hospice care, and some home health services. Part B covers outpatient care, medical materials, supplies, and preventative or wellness care. Part C, also known as Medicare Advantage, combines Parts A and B with prescription drug insurance and is administered by private insurance companies. Texans with Medicare can also enroll in Part D, which covers prescription drugs.
| Characteristics | Values |
|---|---|
| What is Medicare? | A federal health insurance program |
| Who is eligible? | Those 65 years or older and adults with certain disabilities |
| What does it cover? | Hospital stays, skilled nursing facility treatment, hospice care, home health services, doctor's appointments, outpatient care, medical materials and supplies, preventative or wellness care, prescription drugs, and more |
| What are the different parts? | Medicare is split into four parts: Part A (hospital insurance), Part B (medical insurance), Part C/Medicare Advantage (offered by private companies, combines Parts A, B, and sometimes D), and Part D (prescription drug insurance) |
| What is the Low-Income Subsidy or "Extra Help"? | A program that helps with the costs of prescription medicines for Medicare recipients with limited income and assets |
| What are Medicare Savings Programs? | Programs that help pay for deductibles, premiums, and copayments; there are four programs (QMB, SLMB, QI, and QDWI) with different income and resource limits |
| How many people in Texas have Medicare plans? | Over 4.7 million as of 2025 |
| How many Texas Medicare beneficiaries have Medicare Advantage plans? | More than half, as of late-2024 |
| What is Medigap? | A supplemental plan offered by private insurers to reduce out-of-pocket costs; Texas requires Medigap insurers to offer Plan A to disabled beneficiaries under 65 |
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What You'll Learn
Medicare Part A: Hospital insurance
Medicare is federal health insurance for anyone aged 65 and older, and some people under 65 with certain disabilities or conditions. In Texas, eligible individuals can choose to enrol in "original" Medicare options, which include Medicare Parts A, B, and D.
Medicare Part A is hospital insurance. This portion covers inpatient hospital stays, skilled nursing facility treatment, hospice care, and some home health services. It also helps pay for inpatient care in critical access hospitals. In general, Medicare Part A helps cover the costs associated with inpatient hospital care, skilled nursing facility (SNF) care, hospice care, and some home health services.
Most people become eligible for Medicare when they turn 65. Eligible individuals can apply for Medicare coverage starting three months before their 65th birthday. The Initial Enrollment Period spans seven months, including three months before and three months after a patient's 65th birthday. Seniors who are still working and are covered by their employer's insurance can delay their Medicare enrollment until retirement.
Medicare Part A is free if you have worked and paid Medicare taxes for at least 10 years. You may also be eligible due to your current or former spouse's work. Additionally, Medicare recipients with limited income and assets may qualify for extra help with the costs of their prescription medicines under the Low-Income Subsidy program.
In Texas, individuals can seek assistance with Medicare enrollment and understanding their options from the Texas Health Information, Counseling, and Advocacy Program. This program is a partnership between the Texas Health and Human Services Commission, the Texas Legal Services Center, and the Area Agencies on Aging. These agencies can help individuals understand their coverage options, benefits, and provide counselling on their Medicare choices.
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Medicare Part B: Medical insurance
Medicare Part B is medical insurance that covers medically necessary services and preventive services. It is one of the four parts of Medicare, along with Part A (Hospital Insurance), Part C (Medicare Advantage), and Part D (Prescription Drug Insurance). Most people become eligible for Medicare when they turn 65, and they can apply for coverage starting three months before their birthday. The Initial Enrollment Period spans seven months, including three months before and after the patient's 65th birthday. Seniors who are still working and are covered by their employer's insurance can delay their Medicare enrollment until retirement.
Medically necessary services under Part B include services or supplies that meet accepted standards of medical practice to diagnose or treat a medical condition. This includes visits to doctors' offices, outpatient care, medical materials, and supplies. Preventive services under Part B include healthcare to prevent illness (like the flu) or detect it at an early stage when treatment is likely to be most effective. Most preventive services are free if provided by a healthcare provider who accepts assignments.
Part B also covers insulin pumps under its durable medical equipment benefit, and the monthly cost of insulin covered by Part B cannot be more than $35. If you have Part B and Medicare Supplement Insurance (Medigap) that pays your Part B coinsurance, your Medigap plan should cover the $35 (or less) cost for insulin.
Medicare is a federal government-administered program, and eligibility is mainly based on age, with certain disabilities allowing younger individuals to qualify. In Texas, the Texas Health Information, Counseling, and Advocacy Program can help eligible individuals enroll, find information, and provide counseling about their options. This partnership between the Texas Health and Human Services Commission, Texas Legal Services Center, and the Area Agencies on Aging trains and oversees certified benefits counselors across the state.
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Medicare Part D: Prescription drug insurance
Medicare Part D is prescription drug insurance. This is available in Texas and covers the costs of prescription drugs, including routine injections and vaccines. Medicare Part D is available to everyone with Medicare, regardless of income, resources, health status, or current prescription expenses. It is a voluntary program that can be particularly helpful for those with high drug costs and no drug coverage.
There are a variety of plans available, offered by private companies approved by Medicare. These plans have different costs and selections of prescription drugs. You can select a plan based on the prescriptions you take and the company that best suits your needs. You usually pay a monthly premium, which varies by plan, and you may also pay a yearly deductible. There will also be additional costs for your prescriptions, known as copays or coinsurance, depending on the plan.
Medicare sets standard costs for the prescription drug benefit each year, and you can use tools provided by companies such as Blue Cross and Blue Shield of Texas to select the right plan for your prescription drugs and find an in-network pharmacy near you. Blue Cross and Blue Shield of Texas offer plans that can work for your health needs and budget, with nationwide pharmacy networks.
If you need help understanding your Medicare prescription drug coverage, benefits counselors at the Texas Health and Human Services are available to help you. You can also contact your local Area Agency on Aging (AAA) for assistance.
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Medicare Advantage: Private insurance alternative
Medicare Advantage, also known as Medicare Part C, is a popular alternative to Original Medicare. It is administered by private insurance companies and offers the same coverage as Original Medicare (Parts A and B) but with some added benefits.
Original Medicare is managed by the U.S. Department of Health and Human Services, while Medicare Advantage is provided by private companies. The Texas Health Information, Counseling and Advocacy Program can help eligible individuals enroll in Medicare and understand their options.
Medicare Advantage plans combine hospital insurance, medical insurance, and prescription drug insurance. They may also offer additional benefits not included in Original Medicare, such as vision, hearing, and dental services. However, it is important to note that these plans may charge fees for these extra benefits.
To enroll in a Medicare Advantage plan, individuals must already be signed up for Parts A and B of Medicare. These plans are available to those eligible for Medicare, typically those aged 65 or older, although certain disabilities may qualify younger individuals.
Medicare Advantage plans can vary in costs and benefits, and it is essential to research and compare different plans to find the one that best suits an individual's needs.
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Medicare Savings Programs: Assistance for low-income Texans
Medicare is a federal government-administered program that helps cover healthcare costs. While Medicare eligibility is mainly based on age, certain circumstances, such as specific disabilities, may allow younger individuals to qualify. Most people become eligible for Medicare when they turn 65. However, individuals who are still working and are covered by their employer's insurance can delay their Medicare enrollment until retirement.
Medicare Savings Programs (MSPs) are designed to assist Medicare beneficiaries with limited income and resources in covering their out-of-pocket Medicare expenses. These programs are run by individual states, and Texas offers four such programs: QMB, SLMB, QI, and QDWI. These programs can help cover Medicare Part A and Part B costs, including deductibles, coinsurance, and copayments.
To qualify for a Medicare Savings Program, you must generally meet certain income and resource limits, which vary by program and state. In Texas, the income limits for 2022 were $8,400 for individuals and $12,600 for married couples for the QMB, SLMB, and QI programs. The QDWI program has lower limits of $4,000 for individuals and $6,000 for couples. Additionally, there are maximum gross income limits for individuals and couples, which were $4,615 and $6,189, respectively.
It's important to note that these limits may be slightly higher in some states, such as Alaska and Hawaii, and individuals may still qualify even if their income or resources are higher than the federal limits. Texas residents can also explore other options, such as Medicare Advantage plans, Medigap plans, and the Low-Income Subsidy (Extra Help) under Medicare Prescription Drug (Part D) coverage, to manage their healthcare costs effectively.
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Frequently asked questions
Medicare is a federal health insurance program available to those 65 years or older and adults with certain disabilities. Texas Medicare is part of a nationwide program.
There are four Medicare plans in Texas: Medicare Part A, Part B, Part C, and Part D. Part A covers inpatient hospital stays, skilled nursing facility treatment, hospice care, and some home health services. Part B covers outpatient care, medical supplies, and preventative care. Part C, also known as Medicare Advantage, offers the same coverage as Parts A and B but is administered by private insurance companies and may include additional benefits. Part D covers prescription drugs.
Medicare Savings Programs help cover the costs of deductibles, premiums, and copayments for those who qualify. There are four programs with different income and resource limits: QMB, SLMB, QI, and QDWI. For example, in 2022, the income limit for QMB was $8,400 for an individual and $12,600 for a married couple.
