Texas is the second-most populated state in the U.S, so if you’re a Texan eligible for Medicare, there are many benefits to choosing the right plan!
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Texas Medicare Insurance Trends
The Centers for Medicare & Medicaid Services (CMS) reported the following information on 2024 Medicare trends in Texas:
- 4,589,620 residents of Texas are enrolled in Medicare.
- The average Medicare Advantage monthly premium increased in Texas from $8.82 in 2023 to $9.36 in 2024.
- There are 376 Medicare Advantage plans available in Texas.
- All Texas residents with Medicare can purchase a Medicare Advantage plan, including those with $0 premiums.
- There are currently 22 different Medicare prescription drug plans offered in Texas.
- The lowest monthly premium for a Medicare prescription drug plan is $0.50.
Medicare Offered in Texas
Medicare is a government health care program that offers financial assistance to those 65 or older and people of any age with specific disabilities.
Original Medicare
Original Medicare is a term used to describe the original components of Medicare made available directly through the federal government. Two parts make up Original Medicare, Part A and Part B, respectively, provide coverage for hospital costs and general health care expenses such as doctor visits.
Medicare Advantage
Medicare Advantage combines the benefits of Original Medicare (Part A and Part B) and specific supplemental plans in a single program. Medicare Advantage plans have the same coverage as Part A and Part B, plus Part D and other healthcare services not found in Original Medicare.
These plans can be purchased from Medicare-approved private carriers in Texas. Each plan comes with various benefits and will have differing costs.
Some Medicare Advantage plans in Texas provide prescription drug coverage alongside Original Medicare benefits. Medicare Advantage plans including this coverage are known as Medicare Advantage Prescription Drug plans.
Medicare Advantage holders should get prescription drug coverage through a Medicare Advantage plan instead of a stand-alone Medicare Prescription Drug Plan (Part D). If you join a Part D plan while enrolled in a Medicare Advantage plan, you’ll have to return to Original Medicare.
Texas Medicare Advantage options include plans from the following private insurance companies, with ratings:
- AARP – 4/5 stars
- Aetna Medicare
- Amerigroup – 3.5/5 stars
- Blue Cross and Blue Shield of Texas – 3.5/5 stars
- Cigna – 4.5/5 stars
- Devoted Health – 4.5/5 stars
- Erickson Advantage – 5/5 stars
- Imperial Insurance Companies, Inc
- KelseyCare Advantage – 5/5 stars
- Lasso Healthcare – 2/5 stars
- Memorial Hermann Health Plan – 3.5/5 stars
- Molina Healthcare – 3.5/5 stars
- Oscar
- WellCare – 4.5/5 stars
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Medicare Supplement Plans
There are many different Medigap plans (including high-deductible versions of plans F and G) available to choose from in Texas. Your eligibility varies depending on where you live within the state. All of the plan categories are standardized under Medigap so that the same plan will have the same benefits regardless of the insurer.
However, the cost and out-of-pocket expenses will vary from company to company. When comparing Medicare supplement insurance plans in Texas, it’s important to remember that the plans with the lowest premiums often have higher out-of-pocket expenses.
Some companies offering Medigap plans in Texas include:
- AARP – UnitedHealthcare
- Aetna
- Amerigroup
- Blue Cross and Blue Shield of Texas
- Cigna
- Colonial Penn
- Garden State
- Heartland International
- Oxford
- Pan-American
- Shenandoah
- State Farm
Texas Medicare Enrollment
Texans are eligible for Medicare if they are a U.S. citizen and above 65 years old or are under 65 but are permanently disabled, have end-stage renal disease, or Amyotrophic Lateral Sclerosis. Use Medicare’s online eligibility tool if you are unsure if you qualify.
Requirements
- You are 65 or older, and you or your spouse worked and paid Medicare taxes for at least 40 quarters.
- You are under age 65 and collect benefits from Social Security or the Railroad Retirement Board for at least 24 consecutive months.
- You have ESRD or ALS.
Enrollment Period Dates
Initial Enrollment Period
This is a seven-month window that allows you to sign up for a plan
- Begins 3 months before the month you turn 65
- Ends 3 months after the month you turn 65
Medicare Open Enrollment Period
This is when you can sign up for a plan, switch a plan or leave a plan
- Begins Starts January 1st
- Ends March 31st
Special Enrollment Period
Special enrollment periods allow you to enroll outside the regular enrollment periods under specific circumstances.
General Enrollment Period
This is when you can sign up for Medicare Part A and/or Part B if you didn’t sign up when first eligible or if you’re not qualified for a Special Enrollment Period.
- Starts January 1st
- Ends March 31st
Medicare Advantage Open Enrollment Period
This is when you can switch or leave a Medicare Advantage Plan
- Starts January 1st
- Ends March 31st
Texas Enrollment Tips & Advice
With a poverty rate higher than the national average, a significant number of Medicare beneficiaries in Texas unknowingly qualify for Medicare Savings Programs. The four Medicare Savings Programs offer varying levels of financial assistance:
- Qualified Medicare Beneficiary Program provides financial assistance for Medicare Part A and Part B premiums. It can also cover the cost of deductibles and copayments. To be eligible, an individual or married couple must not earn over a certain amount a month.
- The Specified Low-Income Medicare Beneficiary Program helps pay for the premium for Medicare Part B. To be eligible, an individual or married couple must not earn over a certain amount a month.
- The Qualified Individuals Program also assists in paying for Part B premiums. To be eligible, an individual or married couple must not earn over a certain amount a month.
- The Qualified Disabled and Working Individuals Program helps pay for Part A premiums only. To be eligible, an individual or married couple must not earn over a certain amount a month.
To find out if you qualify, please contact one of our licensed agents to find out which plan is best for you, your budget, and your needs.
Additional Resources:
How Do I Enroll in a Medicare Plan?
If you have any questions about Texas Medicare and your eligibility for supplement or advantage plans, speak to one of our licensed agents today. Our agents will discuss your Medicare options and help find a plan that works for you.
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