Know your options for Medicare plans in Texas, whether you’re looking for Original Medicare or Medicare Advantage.
Medicare plan options include:
You may also elect to add a Medicare Supplement Plan (Medigap) to go along with Original Medicare to help with additional out-of-pocket expenses.
Before you pick a plan, learn about your costs, coverage, and choosing the best Medicare plan for your needs.
To qualify for Medicare, you must meet certain eligibility requirements. First, you must be a U.S. citizen or permanent resident. You must also be at least 65 years old or have a disability and receive Social Security Disability Insurance (SSDI) benefits for at least 24 months. You may qualify for Medicare at a younger age if you have end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease).
If you start receiving your Social Security or Railroad Retirement Board (RRB) benefits at least four months before you turn 65, you’ll be enrolled in Medicare automatically. Otherwise, you must fill out an application online or contact your local Social Security office. You can enroll in Medicare during the following periods:
Texas has several Medicare options available to U.S. citizens or permanent residents at least age 65. You are eligible if under age 65 and you have ESRD, ALS, or have been disabled for at least 24 months and draw SSDI.
Original Medicare is the standard coverage for Medicare beneficiaries and has two parts: Part A (hospital insurance) and Part B (medical insurance). Here’s a look at the details about Original Medicare:
Who Original Medicare is best for: Original Medicare is a good option if you want more flexibility. It has a broad coverage area throughout the U.S. If you have several health conditions, you may want to pair your Medicare with a Medigap. Because Original Medicare does not cover prescriptions, enrolling in a stand-alone drug plan is important. If not paired with a Medigap, the out-of-pocket cost is a drawback to the plan.
|Part A premium||Standard Part B premium|
|Usually free||$170.10 per month|
An alternative to Original Medicare, Medicare Advantage Plans – also known as Part C – cover everything Part A and Part B do, but typically offer additional coverage.
Texas Medicare Advantage programs have networks and may only be available in certain areas of the state. Plan options are based on ZIP code. These plans usually consist of copayments, deductibles, and out-of-pocket maximums that you are responsible for. However, plans can start at a $0 premium and go up from there. The average monthly premium in Texas is $10.68 (in 2022).
The Texas Medicare Advantage Program is made up of four types of plans:
The best Medicare Advantage Plan is the one that meets your individual needs and matches what is most important to you in terms of costs, choice of providers, and ease of access. Texas has 337 plans available in 2022. Medicare Advantage has continued to rise in popularity with Texans.
Who Medicare Advantage Plans are best for: This type of plan is best if you are on a fixed income or you are in good health and don’t want to overpay for coverage you don’t use very often. Having one card to use and the additional benefits bundled in the plan can be attractive. To be eligible, you need to be enrolled in Medicare Part A and Part B.
The downsides to Medicare Advantage Plans are mostly related to a limited choice of providers and service areas. Prior authorizations and referrals may also be necessary before receiving certain procedures.
|Medicare Advantage insurance company||Medicare rating||A.M. Best rating||Better Business Bureau (BBB) rating||National Committee for Quality Assurance (NCQA) rating||J.D. Power ranking|
|3.9 stars||A||A+||2.5 to 4.5 stars||Seventh out of 10|
|3.9 stars||A||F||Not rated||Sixth out of 10|
|3.9 stars||A||B||3 to 3.5 stars||Eighth out of 10|
|4.2 stars||A-||A+||3.5 to 4 stars||Fourth out of 10|
|4.2 stars||A||Not rated||3.5 to 4 stars||Seventh out of 10|
|Plan name||Monthly premium||Yearly drug and premium cost||Deductibles|
|Humana Gold Plus HMO||$0||$0||Health: $0
|AARP Medicare Advantage (HMO)||$0||$0||Health: $0
|AARP Medicare Advantage Patriot (HMO-POS)||$0||$0||Health: $0
Plans calculated based on Austin ZIP code 78745.
Medicare Part D is offered by private insurance but is regulated by Medicare. Part D can be purchased as a stand-alone PDP or as part of a Medicare Advantage Plan (MA-PD).
Texas Part D premiums start at $7.70 a month.
Currently, there are 28 stand-alone PDPs in Texas. Eight of the stand-alone plans and 94 Medicare Advantage Plans with prescription drug coverage participate in the Senior Savings Model, which lowers the cost of insulin out of pocket.
Who Part D plans are best for: PDPs are always best even if you don’t take any medications. If you do not enroll when becoming eligible, you will be penalized for every month you do not have one.
|Medicare Advantage insurance company||Medicare rating||A.M. Best rating||BBB rating||NCQA rating||J.D. Power ranking|
|3.8 stars||A||A+||2.5 to 4.5 stars||Sixth out of 10|
|4 stars||A||Not rated||2.5 to 3.5 stars||Eighth out of 10|
|4.2 stars||A||A+||2.5 to 4 stars||Eighth out of 10|
|3.7 stars||Not rated||A-||2.5 to 3.5 stars||Ninth out of 10|
|Plan name||Monthly premium||Yearly drug and premium cost||Deductible|
|SilverScript SmartRx (PDP)||$6.90||$82.80||$480|
|Wellcare Value Script (PDP)||$12.90||$154.80||$480|
|Wellcare Classic (PDP)||$21.70||$260.40||$480|
Plans calculated based on Austin ZIP code 78745.
Medigap plans are standardized plans sold by private insurance companies. These plans are designed to pick up costs where Original Medicare leaves off in coverage. There are 10 standardized plans available in Texas designated by different letters of the alphabet (A, B, C, D, F, G, K, L, M, and N). Plans C & F are only eligible to those who became eligible for Medicare prior to January 1, 2020.
A Plan G for a 65-year-old nonsmoking female in Austin ranges from $95 to $417 per month. You will also be responsible for the Part B deductible of $233.
Who Medigap plans are best for: Medigap is a good fit if you utilize benefits frequently, do not want to be restricted to a small coverage area, and prefer to choose your own provider. You should not choose a supplement if you cannot afford the monthly premium and you want extra benefits available with Medicare Advantage, such as having the PDP, dental, vision, and hearing benefits included.
If you are considering purchasing a supplement, always check to see if the company offers additional discounts for having people that live in your household or for nonsmoking.
|Plan name||Monthly premium range||Copays/coinsurance||Deductibles||Plan benefits|
|Plan F||$106 to $440||$0||$0 hospital (Part A)
$0 medical (Part B)
|Plan G||$95 to $417||$0||$0 hospital (Part A)
$233 medical (Part B)
|Plan N||$70 to $398||$0 Generally, your cost for approved Part B services with
You pay $20 for some office visits and $50 for emergency services that don’t result in a hospital admission
|$0 hospital (Part A)
$233 medical (Part B)
Calculated based on a nonsmoking 65-year-old female in Austin ZIP code 78745.
Texans have many plan options available. It is always good to make a list of pros and cons of the plans. Important things to consider are out-of-pocket costs, provider network, coverage area, insurance company ratings and the overall ability of the plan to meet your specific need.
|People enrolled in Original Medicare||Average plan cost||Annual Texas spending per beneficiary||Spending per beneficiary compared to the national average|
|2,507,002||Part A: $0 to $499 per month*
Part B: $170.10 **
*Most people pay no premium but this can vary depending on how long they paid Medicare taxes.
**This is the average number but it can vary based on income.
Making Medicare decisions can be overwhelming at times. It is good to utilize the resources and tools available in Texas. Medicare support organizations have people knowledgeable in the programs specific to your state. Most of the services provided are free. For example, the Texas Consumer Assistance advocacy organization can help you gather information about health insurance and get answers to questions or assistance with issues.
Never be afraid to ask questions. Get started with these Texas Medicare resources:
|Organization||How you can get help||Contact Information|
|Texas Health and Human Services||Texas Health and Human Services provides a range of services for older Texans to help ensure their well-being, dignity, and choices. Programs also are in place to support family caregivers. The staff and contractors provide information about state and federal benefits like Medicare as well as legal rights.||Website | (512) 424-6500|
|Texas Health Information, Counseling and Advocacy Program||The program can help you enroll, find information and provide counseling about your Medicare options. Certified benefits counselors across the state are trained to help find and apply for the right program.||Website | (512) 424-6500|
|Texas Consumer Assistance||This advocacy organization is a clearinghouse for residents to gather information on health insurance types of coverage, issues or questions.||Website | (800) 252-3439|
|Texas Medicaid Program||Medicaid and the Children’s Health Insurance Program (CHIP) provide health coverage for low-income children, families, seniors and people with disabilities. It’s also a resource for information about insurance.||Website | (512) 424-6500|
|Texas Area Agencies on Aging||The 28 area agencies on aging (AAA) provide services to help people age 60 and older, their family members and caregivers receive the information and assistance they need in locating and accessing community services. They provide benefits counseling and legal assistance.||Website | (855) 937-2372|
Tammy Burns is an experienced health insurance advisor. She earned her nursing degree in 1990 from Jacksonville State University, obtained her insurance billing and coding certification in 1995, and holds a health and life insurance license in Alabama, Georgia, Iowa, Mississippi, and Tennessee. Burns is Affordable Care Act (ACA)-certified for health insurance and other ancillary, life, and annuity products. She maintains an active nursing license and practices private-duty nursing.
Burns’ background as a nurse, insurance biller and coder, and insurance consultant includes infectious disease, oncology, gynecology, phlebotomy, post operative, family medicine, geriatrics, home health, hospice, human resources, management, billing, coding, claims, fixed annuities, group and individual health and life products, and Medicare. She’s always been driven by a desire to help people, spending more than 25 years as a practicing nurse in hospitals, private doctors’ offices, home health, and hospice. As a nurse, Burns supported patients filing insurance claims with Medicare, Medicaid, and private insurance companies as well as responding to billing questions from confused patients.
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