Medicare Eligibility in Texas

For Medicare eligibility in Texas, you must have U.S. citizenship or be a permanent resident for at least five years.

You also qualify if you meet one of the following eligibility conditions:

  • You are 65 years old.
  • You collect disability payments from Social Security or the Railroad Retirement Board.
  • You are not yet 65 but have end-stage renal disease or amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease).

If you meet these eligibility criteria, you will have no trouble qualifying for free Medicare Part A. In addition, if you or your spouse worked and paid into Medicare for at least ten years, you also meet the eligibility requirements for free Medicare Part A.

How Do I Apply for Medicare in Texas?

If you are 65 or soon will be, here are a few ways to sign up for Original Medicare.

You have a seven-month eligibility timespan to enroll, called your Initial Enrollment Period.

Enrollment in Medicare Part A and Part B is automatic if you already receive disability benefits through Social Security or Railroad Retirement.

If you don’t enroll in Part B when you’re first eligible, you can sign up from Oct. 15 through Dec. 7 during the Open Enrollment Period.

Medicare Plan Options in Texas

Here are the different health plans available to Medicare beneficiaries in Texas. Remember, eligibility hinges on paying your Medicare premiums.

Medicare Part A & B

Medicare Part A and Part B are referred to as Original Medicare or traditional Medicare. Part A is hospital insurance that pays for inpatient services such as hospital and short-term care in a skilled nursing facility. Medicare Part B medical insurance is for outpatient health care services such as doctor visits and durable medical equipment.

Medicare Part D

Part D is coverage for prescription drugs. If you have Original Medicare, you must buy a separate Part D plan. Medicare enrollees who don’t join a plan when they’re first eligible might pay a penalty for late enrollment. Private insurance companies sell Prescription Drug Plans.

Medicare Supplement Insurance

Original Medicare doesn’t pay 100% of your costs, leaving you with out-of-pocket expenses such as deductibles, coinsurance, and copays. Medicare Supplement insurance, also known as Medigap, picks up these out-of-pocket expenses. Texans can choose among 10 Medigap plan options, each offering different benefits and monthly premiums. However, Medicare Supplement insurance does not include prescription drug coverage.

Medicare Advantage (Medicare Part C)

Part C, also known as Medicare Advantage, is a different way for Medicare beneficiaries in Texas to obtain their Part A and Part B Medicare coverage. Part C includes all of Parts A and B coverage except hospice care. Many Advantage plans have zero premiums but typically include Part D coverage and extra benefits such as transportation and gym memberships. In addition, many Advantage plans are PPOs and HMOs that require you to live in the plan’s service area and use specific healthcare providers.

Private insurance companies sell Medicare Advantage Plans in Texas. Eligibility for Medicare Advantage follows the same criteria as eligibility for Original Medicare. You cannot have Medicare Supplement insurance if you have Medicare Advantage.

Almost half of Texas Medicare recipients have a Medicare Advantage Plan.

Ready to Learn More?

Making a decision on which Medigap Plan is best is difficult. However, educating yourself on the different Medicare health plan types, comparing rates and policies, and talking to a licensed insurance agent will help you make the right choice.

Resource links

Texas Department of Insurance
Areas on Aging in Texas
Texas Health and Human Services