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Guide to Texas Medicare

There are 3.6 million Medicare beneficiaries in the state of Texas. That means that there are 3.6 million very different people with unique needs. That’s why even though Medicare is a federally regulated program, there are hundreds of different Texas Medicare plans. Thankfully, we have knowledgeable benefits advisors all throughout the state of Texas that can help you pick the right plan with the right coverage for you and your needs.

A Guide to Texas Medicare includes:

Texas Medicare Coverage and Limits

All Medicare beneficiaries must start with Part A and Part B. Part A covers hospital visits, while Part B covers doctor visits. Then, you must enroll in prescription drug coverage. You can do this either by adding a standalone Part D plan or switching to a Medicare Advantage plan (otherwise known as Part C). Medicare Advantage plans include Part A, Part B, Part D, and additional benefits like dental, vision, hearing, and fitness plans.

If Medicare Advantage is not right for you, you can instead opt for Medicare Supplements, otherwise known as Medigap. Texas Medigap plans help you pay for your copayments, coinsurance, and deductibles. There are ten different types of Medicare Supplement plans in Texas, but not all of them will be good options for you. One of our agents can help you pick the best option for you and your needs.

Medicare Advantage Texas Options

Medicare Advantage plans are great options if you’re looking for more coverage than what Original Medicare will provide. Medicare Advantage Texas plans can vary based on where you live within the state and what amount of coverage you need. You can look for a plan that covers a few things you need, like prescription drugs and hearing aids, or you can look for a plan that covers everything from your wheelchair to a car service to get you to your pharmacy or doctor.

Texas Medicare Supplement Options

Most Texas Medicare Supplement options will have the same basic coverage. As mentioned earlier, Medicare Supplement (Medigap) plans can help you cover your premiums, copayments, and deductibles. Medigap plans are labeled A, B, C, D, F, G, K, L, M, and N. Each letter represents a plan with a different amount of coverage. However, some carriers will take those letter plans and add additional benefits, like prescription drug coverage or fitness memberships. Not every Texas Medigap plan will include those types of benefits, so if that’s what you’re looking for you may be better off searching for a Medicare Advantage plan.

The Cost of Medicare in Texas

Your Texas Medicare costs will, of course, vary based on the plan you choose. If you decide to stick with Original Medicare, your costs will be based on your work history. If you worked full time throughout your life and paid Medicare taxes, you won’t have to pay for Medicare Part A (hospital coverage).

If you opt for Medicare Advantage or Medicare Supplements, you’ll have a few options. You can select a plan with a high premium and a low deductible (pay more every month but have little out-of-pocket costs) or a plan with a high deductible and a low premium (pay less or even nothing every month, but have more out-of-pocket costs).

Finding Texas Medicare Providers

To find a doctor or specialist in your area who accepts Medicare assignment, use the search function on Medicare.gov. This should be all you need if all you have is Original Medicare. However, if you have a Medicare Advantage plan, you will have a separate Texas Medicare provider network. Check with your plan’s website for a provider search tool so you can find a doctor in your area who accepts your plan. Your agent may also be able to help you!

Texas Medicare Eligibility Checklist

Use this Texas Medicare Eligibility Checklist to find out if you can enroll in Texas Medicare. You must be at least one of the following:

  • Age 65 or older
  • Diagnosed with ESRD (End Stage Renal Disease)
  • Diagnosed with ALS
  • A social security income beneficiary for at least 24 months
  • A railroad retirement board beneficiary

Please remember that Texas Medicare eligibility is subject to change each year based on CMS and governmental decisions.

Texas Medicare Application

To apply for Texas Medicare, go to www.SocialSecurity.gov, call Social Security at 1-800-772-1213 (TTY 1-800-325-0778), or visit your local Social Security office.

Medicaid and Medicare in Texas

You can qualify for both Medicare and Medicaid and receive more benefits! If you meet the qualifications for Texas Medicaid and Medicare at the same time, you can qualify for a Special Enrollment Period. That means that you can switch plans during every month of the year instead of having to wait for the annual enrollment period in the fall. You can also qualify for the Medicare Extra Help program and save money on your prescription drug coverage!

Texas Medicare Resources

No Wrong Door System - The Texas “No Wrong Door” system provides long-term care services and care programs for elderly and disabled Texans. The system is built on counseling, public outreach, and helping people enroll in public programs.

ADRCs (Aging and Disability Resource Centers) - ADRCs in Texas are a part of the No Wrong Door system. They are a one-stop-shop for disabled and senior assistance in Texas. You can find your local ADRC by clicking here.

Long Term Care Provider Search - Texas residents can search for a long-term care provider in their area with this unique tool. Search for a nursing home, assisted living facility, adult day care, hospice, or personal nurse.

Take Time Texas - Thousands of elderly and disabled persons in Texas cannot afford professional care, so they have friends or relatives act as caregivers. Under the Texas Health and Human Services department, the Take Time Texas program can assist caregivers in staying educated about caring for their loved ones.

Centers for Independent Living (CIL) - CILs help seniors, Medicare eligibles and disabled persons have greater independence by adding home modifications and skilled professionals to assist with daily living. They can allow people to stay at home instead of moving into skilled facilities.

Transportation - Those who have Medicaid can get a ride to a hospital, drug store, doctor’s office, dentist, or another medical provider. You must call at least two days before you need the transportation and must already have an appointment scheduled. You will need to provide your Medicaid ID or SSN. If you have special needs (like a wheelchair), make that known so that a suitable vehicle can pick you up. Call one of the following toll-free numbers to set up your ride:

  • Houston/Beaumont: 855-687-4786
  • Dallas: 855-687-3255
  • Other areas: 877-633-8747

Consumer Resource Coordination Groups (CRCG) - These groups help families or individuals coordinate their health care needs. A representative will speak with a person in need for as long as an hour to figure out what sorts of services can help. The representative can then create a plan for the family or individual to get the services they need. You can find your local CRCG here.

Find Texas Medicare Savings and More

At Medicare Plan Finder, we can help you figure out what sorts of cost savings you are eligible for and help you apply. We can also help you pick the best plan out of your countless Medicare options. We have agents throughout the state of Texas that can review your Texas Medicare eligibility and walk through various Medicare Advantage Texas plans and other options that may be right for you

Contact Us for Texas Medicare Help

To get started, give us a call at 833-GET-ENROLLED (833-438-3676) or click to request a call.

We can help connect you to licensed agents in Dallas, Fort Worth, Austin, Houston, San Antonio, Lubbock, El Paso, Katy, Waco, Corpus Christi, Arlington, Amarillo, Plano, Laredo, Galveston, McAllen, Abilene, Beaumont, Irving, Frisco, Denton, McKinney, Killeen, Brownsville, Wichita Falls, New Braunfels, The Woodlands,  San Angelo, Grand Prairie, San Marcos, Round Rock, Conroe, College Station, Fredericksburg, Sugar Land, Allen, Carrollton, Edinburg, Baytown, Texas City, Texarkana, Pearland, South Padre Island, Luckenbach, Port Aransas, & Nacogdoches. Request a Call from a Local & Licensed Agent.

Have questions? Ask a Licensed Agent!