Medicare Plan Options
Medicare-eligible Texans have numerous options for covering their health care needs. Original Medicare’s scope of coverage may be sufficient for you. However, you might need additional benefits available with Texas’ Medicare Advantage program and Medicare Supplement Insurance such as vision and dental coverage, prescription drug coverage or help covering some of Medicare’s cost-sharing expenses. Original Medicare
Original Medicare is the health insurance program offered through the federal government for seniors and people with certain disabilities or illnesses. It’s made up of two parts, and each covers specific services. Part A is hospital insurance. This coverage pays for hospital stays, hospice, nursing home care and, in some cases, in-home skilled nursing services. Part B is medical insurance, which includes routine and preventative care, durable medical equipment and mental health services. Prescription drugs generally aren’t paid for under Original Medicare, but some types of outpatient prescription drugs are covered, including those used in nebulizers and certain injectables. Most people don’t pay a monthly premium for their Part A coverage, but everyone pays a standard Part B monthly premium.
Medicare Advantage Plans
Medicare Advantage is also referred to as Part C and is comparable to private health insurance that many Texans receive through their employer or the federal Marketplace. Texas’ Medicare Advantage programs, delivered by private health insurance companies, offer all the coverage in Original Medicare Part A and Part B. Plans may also have additional benefits, such as prescription drug coverage, homemaker services, gym memberships, and vision and dental care. Monthly premium, maximum out-of-pocket limits, copays and rules regarding in-network providers and specialist referrals vary depending on the plan type and insurance provider.
Medicare Prescription Drug Coverage Plans
Medicare prescription drug coverage is optional. However, it’s a good idea to purchase this coverage when you sign up for Original Medicare to avoid late enrollment penalties. There are two ways to obtain prescription drug coverage: signing up for an MA plan that includes this coverage, or adding Part D coverage to Original Medicare or another eligible Medicare policy. Prescription drug plans vary widely in cost and drug coverage, so you should research available plans to enroll in one that covers the prescriptions you need.
Medicare Supplement Insurance Plans
Medicare Supplement Insurance plans, also called Medigap plans, fill in the gaps in Medicare coverage. Like Medicare Advantage plans, Medigap plans are sold by private insurance companies. Rather than being stand-alone plans, they work with Original Medicare to provide customized coverage. Some Medigap plans help pay for out-of-pocket expenses such as deductibles and copays, while others offer additional coverage benefits. Beneficiaries pay the Part D premium in addition to their Part B premium.
Medicare in Texas by the Numbers
|People enrolled in Original Medicare||Average plan cost||Annual state spendingper beneficiary||Spending per beneficiary compared to the national average|
|2,438,051||Plan A: $0 to $471 per month*
Plan B: $148.50 per month**
*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.
Medicare Resources in Texas
Medicare-eligible seniors in Texas have a variety of coverage options available, and it can be a challenge to determine which plan best suits your health care needs and budget. Texas is home to a variety of nonprofit and government agencies that provide free, unbiased assistance to seniors, which can help you obtain the best coverage, understand your benefits and navigate the claims process.
Harris County Area Agency on Aging
The Harris County Area Agency on Aging is one of the state’s 28 Area Agencies on Aging. Like all AAAs in the state, it provides free, unbiased Medicare counseling for seniors 60 and over. Benefits counselors are certified and work with representatives from partner agencies including the state’s Department of Insurance, legal hotlines, and Medicare. They’re trained to help seniors resolve insurance-related issues, understand their Medicare benefits, compare Medicare Advantage and supplement plans, and obtain health care coverage that meets their needs.
Contact Information: Website | 832-393-4301
Texas Health Information, Counseling and Advocacy Program
HICAP is a statewide program that helps Medicare beneficiaries understand Original Medicare benefits, compare Medicare Advantage plans and Medicare supplements, and obtain prescription drug coverage. Counselors aren’t licensed insurance agents and aren’t authorized to sell plans, but they’re trained to provide unbiased answers to questions regarding coverage, help organize and settle medical bills, and dispute denied coverage or canceled policies. Counselors can also help you identify solutions for covering Medicare premiums and cost-sharing responsibilities. All services are free of charge.
Contact Information: Website | 800-252-9240
Texas Legal Services Center
The nonprofit Texas Legal Services Center provides free statewide civil legal assistance for income-qualifying Texans. It operates the Legal Hotline for Texans, a contact line that offers free legal advice for those aged 60 and over. This service, which is reached at 800-622-2520, helps seniors find free public and nonprofit services and legal forms and addresses legal issues pertaining to their Medicare coverage and benefits. The organization also operates family law clinics in libraries, neighborhood centers and other community centers throughout the state, where seniors and veterans can obtain assistance with accessing Medicare benefits.
Contact Information: Website | 512-477-6000
Texas Senior Medicare Patrol
Senior Medicare Patrol helps Medicare beneficiaries prevent, identify and report Medicare fraud and errors. Through its network of volunteers, SMP provides one-on-one counseling for beneficiaries and gives group presentations to educate the community about Medicare fraud and common scams. You can submit complaints of suspected Medicare fraud or misuse and get referrals for further investigation to state and federal agencies as needed.
Contact Information: Website | 888-341-6187
Texas Department of Insurance
The Texas Department of Insurance regulates the insurance industry in the state and ensures fair treatment for Texans. It provides several resources for Medicare beneficiaries, including informational tools regarding Medicare Part D coverage and long-term health insurance. It also helps seniors recognize Medicare scams and billing fraud. Through the Department, seniors can locate their nearest benefits counselors, who can help them obtain coverage, understand their medical bills, and dispute denied coverage.
Contact Information: Website | 800-252-3439