Medicare is a private health insurance program based in the United States. This fee-for-service program is administered by the US Federal Government and funded by the General Revenue and Federal Insurance Contributions Act.
This health insurance program aims to provide healthcare insurance to seniors aged 65 and above or people with certain disabilities who fulfill the eligibility criteria.
Medicare significantly lowers hospital bills by providing coverage for prescription drugs and inpatient and outpatient care.
This health insurance program features various medical insurance plans such as Original Medicare, Medicare Advantage plans, Medigap, etc.
Medicare in Texas by the Numbers
| Total number of people enrolled in Medicare | Medicare Advantage plans | Medicare Supplement Plan (Medigap) | Medicare Part D (Prescription Drug Coverage) |
| 4.4 million beneficiaries. | Nearly 45.45% (2.2 million) of all Texas residents with Medicare are enrolled in private Medicare Advantage plans. | More than 21% (931,000) of Texas residents are enrolled in Medigap plans. | About 34.09% (1.5 million) of Medicare beneficiaries in Texas have stand-alone Medicare Part D. |
Medicare Plans in Texas
With the ever growing population, Texas is now home to more than 25 million residents. About 28% of this population is over the age of 50.
With growing age and healthcare needs, Medicare plans for senior citizens become more crucial than ever. As hospital bills are skyrocketing, the cost of frequent hospital visits is becoming increasingly expensive. To cut down healthcare bills in Texas, Medicare plans in the State aim to provide coverage for inpatient and outpatient care.
About 4.4 million people in Texas are enrolled in Medicare plans. This whopping 17.6% of the total population makes use of Medicare plans to lower out-of-pocket healthcare expenses as per their needs.
Beneficiaries can enroll themselves in different Medicare plans. Let us look into the available Medicare plans in Texas and how you can enroll yourself in one.
General Analysis | Ratings of Medicare Plan Providers in Texas
| Insurance Company | Medicare Rating | A.M. Best rating | Better Business Bureau (BBB) rating | J.D. Power ranking |
| Aetna | 4 stars | A | A+ | 6th out of 9 |
| Anthem | 3.9 stars | A | F | 7th out of 9 |
| Blue Cross Blue Shield | 3.9 stars | A | B | 5th out of 9 |
| Humana | 4.2 stars | A- | A+ | 2nd out of 9 |
| UnitedHealthcare | 4.2 stars | A | A | 4th out of 9 |
Type of Medicare Plans in Texas
Several Medicare plans are available for Texans. If you fulfill the eligibility criteria, you can enroll yourself into the following Medicare plans.
- Original Medicare (Part A and Part B)
- Medicare Advantage (Part C)
- Medicare Supplement Plan (Medigap)
- Medicare Part D (Prescription Drug Coverage)
However, before you choose a Medicare plan, you must evaluate your healthcare concerns and budget to pick a plan that best meets your needs. Let us look into the various Medicare plans available for Texas residents.
Original Medicare
Original Medicare, which consists of Medicare Parts A and B, is the standard coverage provided to beneficiaries.
Medicare Part A (hospital insurance) provides coverage for inpatient care such as hospital stays, skilled nursing facilities, hospice, and home health care. Thus, Part A primarily covers expenses associated with your basic hospital and medical needs such as semi-private rooms, meals, and medications.
In contrast, Medicare Part B primarily provides coverage for outpatient care, including your doctor’s visit, emergency care, labs, medical supplies, medical equipment, and preventive care. Preventive care includes coverage for screenings for tumors, cancers, or mental health issues.
However, if you enroll yourself in Original Medicare you have to pay deductibles along with the charges incurred from outpatient and inpatient care.
Original Medicare also provides the benefit of flexibility in accessing any Medicare-collaborating healthcare professional and hospital across the United States without the restriction of out-of-pocket expenses.
| Medicare Part A | Medicare Part B |
| Premium: usually free | Premium: $164.90 per month |
| Part A covers 80% of your medical expenses. You are responsible for paying the remaining 20% deductibles, copays, and coinsurance. Part A is premium free if you have paid Medicare tax. If you do not meet the required Medicare tax to qualify for a free Part A premium, you could pay up to $500 per month. | Part B provides coverage for outpatient services, emergency care, diagnostic testing, and medical supplies. Part B covers some prescription drugs that you administer at a medical facility. Part B premium depends on your income but has an average cost of $164.90 per month. |
Medicare Advantage Plan (Part C)
Individuals enrolled in Original Medicare have the option to join a Medicare Advantage plan, which consolidates the benefits of Parts A and B through a private insurance provider.
As of 2023, about 2.2 million Medicare beneficiaries are a part of Medicare Advantage plans in Texas. Due to this considerable figure, there was a 14% increase in Medicare Advantage plans since the year 2022.
In 2022, Texas was served by 334 Medicare Advantage plans. However, there has been a notable surge in the offering, with the count rising impressively to 385 plans as of 2023.
Medicare Advantage plans work as an alternative to Original Medicare but with additional benefits such as coverage for hearing, vision, and dental care. Some plans also provide prescription coverage and gym memberships.
However, Medicare Advantage plans do come with one downside—a limited choice of providers. Since Medicare Advantage plans have contracts with certain service providers and hospitals, you cannot seek treatment outside of your network of choice. To consult a specialist outside of your network, you need prior authorization or referrals.
Cost of Medicare Advantage Plan in Texas
The monthly cost of a Medicare Advantage plan is called a premium. Medicare Advantage plans in 2024 often do not require an additional premium, making them an all-in-one healthcare insurance solution.
Plans in Texas can start at a $0 premium with an average monthly premium of $9.36. However, the cost fluctuates according to the type of plan you choose. Some additional services may cost up to $505.
In Texas, there are four types of Medicare Advantage plans.
- Health Maintenance Organizations (HMOs)
- Preferred Provider Organizations (PPOs)
- Special Needs Plans (SNPs)
- Private Fee-For-Service Plans (PFFS)
Medicare Supplement Plans (Medigap)
Medigap, a secondary coverage plan, provides additional health insurance for out-of-pocket expenses that your Original Medicare does not cover.
This means that Original Medicare is a prerequisite for having a Medicare supplement plan as it does not function as a stand-alone policy, providing insurance for only what’s not covered by Medicare Part A and B.
Medicare Part D (Prescription Drug Coverage)
Medicare Part D, also called Prescription Drug Coverage, is designed to cover the cost of prescription medications. Anyone with Original Medicare is eligible for Part D regardless of income, resources, and health status.
Part D plans are offered by private health insurance companies. These plans help cover the cost of drugs, significantly lowering medicine bills for long-term treatments.
Cost for Part D includes a monthly premium that may vary from plan to plan. A yearly deductible also applies with copayments and coinsurance for medications.
You must annually review your drug prescriptions before the open enrollment period to make changes to your plan in case of a difference in the formulary. Part D coverage is ideal for Texans looking to get substantial assistance with the cost of prescription medicines.
Cost of Medicare Plans in Texas 2024
| Original Medicare | Medicare Advantage | Medigap | Part D |
| Part A premium: $0 to $506 per month Part B premium: $164.90 per month | Average monthly premium in 2024 for a Medicare Advantage plan in Texas is $9.36. | $102 to $175. | Lowest monthly premium: $6.60 |
How to Find an Affordable Medicare Plan in Texas?
Choosing the most affordable Medicare plan in Texas may seem daunting. You can consider your healthcare needs before making a cost-efficient decision.
The comparative table below can help you better understand the two primary available plans in Texas.
| Original Medicare | Medicare Advantage Plans |
| Original Medicare includes Part A (inpatient care) and Part B (outpatient care). Original Medicare with Medigap. Original Medicare with Part D (Prescription Drug Coverage). | Medicare Advantage Plan as a bundled healthcare coverage plan with Part A, B, and D. |
Besides the comparison, you must consider out-of-pocket expenses. For example, if your medical needs require additional benefits such as dental care, you can enroll in a Medicare Advantage plan.
In contrast, if you require standard Part A and B coverage, Original Medicare with Prescription Drug Coverage may work well for you.
Enrollment in Medicare: Key Steps for Texans
What makes you eligible for Medicare in Texas and how can you enroll yourself? Medicare has the same eligibility criteria across all the States.
You can qualify for Medicare if you are approved by the Social Security Administration for either your age or disability. You must enroll yourself during the initial enrollment period or wait for the general enrollment period.
If you receive your social security benefits four months before your 65th birthday, you get enrolled into Medicare automatically. Otherwise, you must apply for Medicare through mail or by contacting a local Social Security office.
Your initial enrollment period (IEP) starts three months before you turn 65 and ends three months after it. If you don’t have Medicare, you can use this enrollment period for initial enrollment.
In case you missed your IEP, you can apply for Medicare during the General Enrolment period (GEP) from 1st January to 31st march. If you already have Medicare enrollment and you wish to make changes to your plan, you can do so during the GEP. This period allows you to switch from one plan to another or make changes for the following year.
Professional Advice for Signing up for Medicare in Texas
With the right approach, you can not only make cost-efficient decisions but also enroll yourself into a plan that provides coverage for all your medical needs.
Here are expert tips to help you sign up for Medicare in Texas.
- Make use of Medicare tools: Medicare.gov features a Medicare plan finder tool. Use this tool to learn about the different plans in your area.
- Evaluate your health status: You must assess your current health status and your medical requirements, such as prescription drugs, medical equipment, or any other medical supplies. This will help you choose a plan that provides extensive coverage for all your medical needs.
- Understand Medicare plans: Compare different plans and familiarize yourself with the differences, limitations, and benefits of Original Medicare, Medicare Advantage Plans, Medigap, and Prescription Drug Plans.
- Make use of the open enrollment period: Medicare plans tend to change over time. Use the annual OEP to review and make changes to your plan for the upcoming year.
- Seek professional help: Consult a Medicare counselor from the Texas State Health Insurance Assistance Program (SHIP). Free, unbiased advice can help you understand your options.
- Check star ratings: Medicare rates plans from 1 to 5 stars based on quality and performance. A higher rating represents better quality and more satisfied members. Look into the ratings to make the right choice.
- Be cautious of penalties: If you fail to sign up for Medicare Part A and B on time, it results in penalties. To evade these late enrollment penalties, ensure you have qualifying coverage.
- Choose the appropriate plan: If you travel frequently, consider opting for a plan with an extensive network that offers coverage beyond Texas.
Helpful Resources for Medicare in Texas
Medicare, a primary healthcare coverage program, can help senior adults manage the high costs associated with treatments. Utilizing the maximum resources and tools available in your State makes the process seamless.
Many organizations can provide information about health insurance programs in your area. It’s best to seek advice before signing up for a health insurance plan. Here are some of the best Texas Medicare resources.
| Organization | How you can get help | Website & Contact Info |
| Texas Health and Human Services | The Texas Health and Human Services offers various services to support the well-being, dignity, and choices of older Texans, along with resources for family caregivers. This includes information on state and federal benefits like Medicare and legal rights. | Website (512) 424-6500 |
| Texas Health Information, Counseling and Advocacy Program | This service assists with Medicare enrollment, offers advice, and provides information on your options. Across the state, trained certified benefits counselors are available to help you identify and apply for suitable programs. | Website (512) 424-6500 |
| Texas Area Agencies on Aging | Area Agencies on Aging (AAA) provide support for individuals aged 60 and above, along with their families and caregivers, by providing information and help in finding and using community services. These agencies also offer counseling on benefits and legal aid. | Website (855) 937-2372 |
| Texas Consumer Assistance | This advocacy group serves as a central hub where residents can find information about different types of health insurance coverage and address any related issues or questions. | Website (800) 252-3439 |
Securing Your Health in the Lone Star State with Silveredge
Texas, the lone star state houses a considerable senior population. The inevitable health challenges of old age make it crucial for you or your loved ones to make informed, cost-efficient decisions regarding healthcare.
Medicare services are vital resources that can cut down your healthcare bills and provide you necessary comfort. Leveraging the right resources makes it easier to navigate through the challenges of healthcare insurance.
At Silveredge, a team of licensed advisors with industry expertise provide guidance and help resolve queries regarding the complexities of Medicare. Contact today to equip yourself with necessary information before signing up for Medicare.
