Today we’re talking all about Medicare Plans in Texas! Our JBird Insurance Group offices are in Austin, Texas, but we are licensed nationwide to help you find the right Medicare Plan. Medicare is a federal program but there are aspects of Medicare that vary from state to state.
Did you know that more than 4 million Texans are enrolled in Medicare as of 2020? That is 14% of the state’s total population! Original Medicare continues to be the main way Texans get their Medicare coverage. As a reminder, original Medicare includes both Part A, which is hospital insurance, and Part B, which is medical insurance. Original Medicare does not cover all healthcare related expenses, which is why Medicare Supplement Plans are available. You are likely eligible for Medicare if you are 65 and older, or if you’re under age 65 and you receive disability benefits.
Where Do I Apply for Medicare in Texas?
You can apply for Medicare (Part A and Part B) in Texas with Social Security, either online at ssa.gov, by phone, or in person by appointment. If you receive benefits from Social Security or the Railroad Retirement Board, you qualify for automatic enrollment.
When Can I Enroll in a Medicare Texas Plan?
One thing we can’t stress enough is DO NOT WAIT! Yes, there are rules around enrollment and getting coverage, but you should start your research early even before you are eligible for enrollment.
Coverage is not available until the month of your 65th birthday, however, you can and should start the application and enrollment process three months before your birthday. Your Texas Medicare Initial Enrollment Period (IEP) begins 3 months before you turn 65 and continues for 3 months after, for a total of a 7-month period.
If you do not enroll during your IEP, if, for example, you are still full-time employed and prefer to stay enrolled in your employer-sponsored group plan, you may qualify for a Special Enrollment Period (SEP) later if your coverage status changes.
Questions about when you can enroll? We’ll help you determine if you qualify for Medicare and help explore your coverage options.
Which Medicare Insurance is Offered in Texas?
Medicare is divided into four specific parts that cover different services, parts A, B, C, D, and Medigap/Supplement. Original Medicare is composed of Part A and Part B and is the way many Texans receive their benefits.
Texas Medicare Part A
Medicare Part A is hospital coverage. In Texas as in the rest of the country, Part A is free for most people. This means that you do not have to pay a monthly premium to have coverage. In Texas, you are eligible for premium-free Medicare Part A if:
- you are age 65 or older and you or your spouse worked and have paid Medicare taxes for at least 40 quarters during your lifetime
- you are under age 65 and receive benefits from Social Security or from the Railroad Retirement Board, and have received those benefits for at least 24 consecutive months
- you have End Stage Renal Disease or Amyotrophic Lateral Sclerosis (ALS)
Even people who do not meet any of these requirements can get Medicare Part A for a monthly out-of-pocket premium once they are 65 years old.
Texas Medicare Part B
Medicare Part B is medical coverage. If you are eligible for Medicare Part A, you are also eligible for Medicare Part B. This part of Medicare is not premium free; that means there is a monthly cost associated with it.
The cost of Medicare Part B in Texas is comparable to the rest of the country. That is because what you pay for your Medicare Part B is determined by your or your spouse’s income history, not by your ZIP code or state.
Your Medicare Part B costs include an annual deductible and a monthly premium. Your monthly premium may be higher if you make more than a certain amount. If this is the case, you will get an Income Related Monthly Adjusted Amount (RMAA) charge.
Texas Medicare Part C (Medicare Advantage)
Medicare Part C , also called Medicare Advantage, is purchased through Medicare-approved private insurers. If you are eligible for Medicare, you are eligible for Medicare Advantage. You must, however, enroll in original Medicare before you can get a Texas Medicare Advantage plan.
The premium and copay rates for Medicare Part C vary from insurer to insurer and from state to state.
Texas plans also vary in what they cover, as well as the service areas where they are available. A close friend who lives in a neighboring Texas town may be eligible for a plan that does not cover your area and vice versa.
Some Texas Medicare Advantage plans cover prescription drugs and others do not. Some Part C plans also cover services that original Medicare does not, such as vision and dental. There may be restrictions on the doctors you can see with a Medicare Advantage plan, so carefully reviewing the plan you are considering is important.
In Texas, your options for Medicare Advantage plans vary by your county and your ZIP code. They include:
- Health Maintenance Organizations (HMOs)
- Preferred Provider Organizations (PPOs)
- Provider-Sponsored Organizations (PSOs)
- Private Fee-For-Service (PFFS) plans
- Special Needs Plans (SNPs)
Tips for Enrolling in Medicare in Texas
If you’re shopping for a Texas Medicare Advantage plan, be aware that not all plans are the same. They vary in plan design, provider network, cost structure, and more.
Texas Medicare Supplement Insurance (Medigap)
Private insurance companies that are licensed by the Texas Department of Insurance are authorized to sell Medigap/Supplement plans. These plans are paired with Original Medicare to help pay for the services that Original Medicare does not, such as copays, deductibles, and coinsurance.
You cannot have a Texas Medigap/ Supplement plan if you are enrolled in a Texas Medicare Advantage plan.
Medigap/Supplement plans will only pay for services that Medicare considers medically necessary. Some plans pay for emergency medical treatment outside of the United States.
You can purchase a Texas Medigap/ Supplement plan during your 6-month open enrollment period. At that time, you can buy any Medigap/Supplement plan that is sold in Texas, even if you have medical problems. Open enrollment for Medigap/ Supplement plans begins the month you turn 65 and enroll in Medicare Part B. If you miss open enrollment, you may not be able to purchase a Medigap/Supplement plan for the same initial rate, or at all.
There are 10 standard Medigap/Supplement plans available in Texas, which are designated by the letters A, B, C, D, F, G, K, L, M, and N. Each plan offers different benefits.
Enrollment Deadlines in Texas
Initial Enrollment Period
This refers to the first time when you are eligible for Medicare. For people who are getting Medicare because they are approaching their 65th birthday, initial enrollment begins 3 months before your birthday and ends 3 months after it takes place, for a total of 7 months.
25th Disability Benefit
If you are under age 65 and are getting Medicare due to a disability, you can sign up for Medicare during the 3-month period that occurs prior to receiving your 25th disability benefit through to the 3-month period that will occur after that date.
Every year from January 1 through March 31, you may enroll in Medicare. If you miss initial enrollment and must sign up during general enrollment, you may have to pay higher premiums.
Open enrollment for Medicare is an annual event that begins on October 15 and ends on December 7. During open enrollment, you can change plans Medicare Part D plans, make changes to your Medicare Part C plan, and add or drop services. Medigap/Supplement Plans can be changed at any time during the year., there is no lock in period like Medicare Advantage plans ( Medicare Part C) and drug plans (Medicare Part D).
Get a Texas Medicare Expert on Your Side
There is SO much to know about Medicare in Texas! Medicare Dana is a Texas expert – a Texas resident herself. With the amazing benefits of today’s technology, she services clients in states across the nation.
As an independent Medicare insurance agent, we are not tied to any one particular insurance carrier. When you work with us, we’ll be evaluating every option on the market to the best of our ability. That means we’ll be looking at your specific medical needs and finding you a plan offering the right services at a low price for YOU.
Give us a call and let us help you with your Medicare plan options today!