Medicare in Texas

Medicare in Texas works under the same federal rules that apply nationwide, but the plans available to you, their premiums, and their provider networks depend on your county. Medicare is the federal health insurance program for people 65 and older and for some younger people with disabilities or End-Stage Renal Disease (ESRD). Texas has some of the largest Medicare Advantage markets in the country, and residents also have access to standardized Medicare Supplement (Medigap) plans and Part D prescription drug coverage. This guide explains how Medicare in Texas differs by ZIP code, when Medigap medical underwriting applies, and how to compare Medicare Advantage, Medigap, and Part D options before you enroll.

Most Texas residents become eligible for Medicare at age 65 through Social Security. Coverage typically starts around your 65th birthday if you enroll during your Initial Enrollment Period, a 7-month window that begins 3 months before your birth month. Missing that window can trigger a late enrollment penalty, so check our guide to the Medicare late enrollment penalty if you're weighing when to sign up. If you're losing employer coverage or qualify for another Special Enrollment Period, see our guide to Medicare Special Enrollment Period qualifying events for the rules that apply in Texas as in every other state.

The core Medicare program, Original Medicare (Part A hospital coverage and Part B medical coverage), Medicare Advantage (Part C, private plans that replace Original Medicare), and Part D (prescription drug coverage), is federal. What varies by state and by county is which private plans are sold, what they cost, and which providers and pharmacies are in-network.

Texas residents comparing Medicare coverage usually weigh three options:

• Medicare Advantage (Part C): Medicare Advantage plans are private insurance plans, approved by Medicare, that bundle Part A, Part B, and usually Part D coverage into one plan. Many Texas counties list dozens of Medicare Advantage plans, and plan counts, premiums, and extra benefits such as dental and vision vary by county. See our Medicare vs. Medicare Advantage comparison for how the two paths differ.
• Medicare Supplement (Medigap): Medigap is a standardized private insurance policy that helps pay costs Original Medicare doesn't cover, such as copayments, coinsurance, and deductibles. Plans are standardized under federal law, so a Plan G sold in Houston covers the same benefits as a Plan G sold in Dallas. What differs is the premium and, outside your enrollment window, whether a carrier can medically underwrite you. See Medigap Plan G vs. Plan N for a side-by-side look at the two most common plans.
• Part D prescription drug plans: Part D plans are private, standalone drug plans, or drug coverage bundled into a Medicare Advantage plan, that help pay for prescription medications. Available statewide, but each plan's formulary and preferred pharmacy network differ. Our guide on reducing Medicare Part D costs covers how to check whether your specific drugs are covered.

According to the Centers for Medicare & Medicaid Services (CMS), the federal agency that administers Medicare, more than half of Medicare beneficiaries nationwide are now enrolled in Medicare Advantage plans, which is one reason comparison shopping has become a standard part of enrolling or renewing coverage in Texas.

The federal Medigap Open Enrollment Period is the same in Texas as in every state: a 6-month window that starts the month you turn 65 and are enrolled in Part B. During that window, a Medigap carrier cannot deny you coverage or charge more based on your health, according to Medicare.gov.

Outside that window, Texas generally allows Medigap carriers to use medical underwriting, meaning they can deny an application or charge higher premiums based on health history. Certain situations trigger federal guaranteed-issue rights regardless of timing, such as involuntarily losing other coverage. See our guide to Medigap guaranteed issue rights for the specific situations that qualify.

For free, unbiased help understanding your options, contact Texas's program, known locally as HICAP (Health Information, Counseling and Advocacy Program), the state's branch of the national State Health Insurance Assistance Program (SHIP), a federally funded Medicare counseling service available in every state. You can find local contact details through the SHIP TA Center.

If you're comparing Texas to other states, see our guides to Medicare in Arizona or Medicare in Virginia. If you're switching from an employer plan, our guide to enrolling in Medicare after losing employer coverage covers the timing rules. For a plain-English breakdown of what Medicare actually costs, see Medicare costs explained, and for term definitions, check our Medicare glossary.