If you’re a resident of Texas and eligible for Medicare, you may have a lot of questions when it comes to choosing a plan. How does Medicare work? What do the different types cover? How is Medicare Advantage different from original Medicare? And how do you begin the process of enrolling?
There’s a lot of information to digest, but knowing someof the basics about how Medicare works in general is a great place for MedicareTexas shoppers to begin.
The Centers for Medicare & Medicaid Services (CMS) reported the following information on Medicare trends in Texas for the 2021 plan year:
- A total of 4,272,049 residents of Texas are enrolled in Medicare.
- The average Medicare Advantage monthly premium decreased in Texas compared to last year — from $12.43 in 2020 to $11.42 in 2021.
- There are 289 Medicare Advantage plans available in Texas for 2021, compared to 231 plans in 2020.
- All Texas residents with Medicare have access to buy a Medicare Advantage plan, including plans with $0 premiums.
- There are 12 different Medigap plans offered in Texas for 2021.
Medicare is a federal government health program that helps people age 65 or older, and people of any age with certain disabilities, pay for their medical care.
You may have heard the phrase “original Medicare.” This refers to the Medicare components made available directly through the federal government. There are two parts of original Medicare.
- Part A covers hospital expenses, specifically inpatient care received at a hospital, skilled nursing facility or hospice care facility, plus some home health costs.
- Part B covers general health expenses, such as those you would incur when you seek outpatient medical care from your regular doctor or a specialist.
There are additional options for expanding or replacing the original Medicare coverage that the government provides. These options are offered through private insurance companies and are described below.
Medicare Advantage in Texas
Medicare Advantage (Part C) plans are available as a full replacement for original Medicare. They cover all of the same benefits as parts A and B and more.
These plans typically include all the benefits you’d get from adding a supplemental or prescription drug plan, plus perks, programs, and discounts that can help you make your health a priority.
Texas Medicare Advantage options include plans from the following private insurance companies:
- Aetna Medicare
- Blue Cross and Blue Shield of Texas
- Care N’ Care Insurance Company
- Clover Health
- Devoted Health
- Imperial Insurance Companies, Inc
- KelseyCare Advantage
- Lasso Healthcare
- Memorial Hermann Health Plan
- Scott and White Health Plan
These companies offer plans in many counties in Texas. However, Medicare Advantage plan offerings vary by county, so enter your specific ZIP code when searching for plans where you live.
Medicare Supplement plans in Texas
Medicare Supplement plans are sometimes called Medigap plans. They help pay costs original Medicare doesn’t, including copays, coinsurance, and deductibles. They also may add coverage for dental and vision services, private duty nursing, hearing aids, and more.
Many insurance companies offer Medigap plans in Texas. In 2021, some of the companies offering Medigap plans in Texas include:
- AARP – UnitedHealthcare
- Blue Cross and Blue Shield of Texas
- Colonial Penn
- Garden State
- Heartland National
- State Farm
There is a total of 12 different Medigap plans (including high-deductible versions of plans F and G) available to choose from in different areas across Texas.
To qualify for Medicare in Texas, you must be either:
- age 65 or older
- a person of any age with certain disabilities
- a person of any age with end stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS)
When can I enroll in Medicare Texas plans?
While coverage isn’t available until your 65th birthday, you can begin the application and enrollment process a few months before your birthday. Your Texas Medicare initial enrollment period begins 3 months before you turn 65 and continues for 3 months after.
If you choose not to enroll during this time, such as if you are still full-time employed and prefer to stay enrolled in your employer-sponsored group plan, you may qualify for a special enrollment period later if your coverage status changes.
There’s also an open enrollment period specifically for Medicare Advantage plans every year from January 1 through March 31. During this time, you can sign up for Medicare Advantage for the first time or switch Medicare plans in Texas.
Tips for enrolling in Medicare in Texas
If you’re shopping for a Texas Medicare Advantage plan, be aware that not all plans are the same. They vary in plan design, provider network, cost structure, and more.
You may want to consider the following when weighing your options:
- Which plan design works best for you? Do you prefer an HMO in which a primary care doctor oversees you care and refers you to specialists as needed? Or would you rather the flexibility of a PPO that would allow you to see any specialist in your network at your choosing?
- What is the provider network like? Texas is a big state. You want to be sure to choose one of the Medicare plans in Texas with a network that makes geographic sense for your lifestyle. If you travel, be sure to ask about coverage outside of the state as well.
- What will you have to spend? Look beyond just monthly premiums. Find out what you can expect to spend when you see a doctor or fill a prescription. Sometimes it ends up being cheaper overall to pay a higher premium for lower out-of-pocket costs at the point of care.
- What extras are offered? Gym memberships and fitness programs aren’t just perks; they can save you money if you might otherwise pay for them yourself. And if you have a chronic condition, you might benefit from a plan that offers a health management or health coaching program dedicated to helping members manage that condition.
If you’re shopping for Medicare in Texas, you can learn more about plans in your state through these organizations:
- Over 4.2 million people in Texas are enrolled in Medicare.
- There are several private insurance companies offering various types of Overall, monthly premium costs have decreased for 2021 Medicare Advantage plans in Texas.