The Complete Guide to Medicare in Texas (2026)

Medicare in Texas can seem overwhelming, but this complete guide will walk you through everything you need to know as a Texas senior. Whether you’re approaching 65, already enrolled, or helping a loved one navigate their options, understanding Medicare in Texas is crucial for making informed healthcare decisions.

In this comprehensive Medicare Texas guide, we’ll cover all four parts of Medicare, enrollment periods, costs, and Texas-specific resources to help you make the best choices for your healthcare needs in 2026.

What Is Medicare and Who Qualifies in Texas?

Medicare is a federal health insurance program primarily for people 65 and older, regardless of income or health status. In Texas, over 4.2 million residents are enrolled in Medicare, making it one of the largest Medicare populations in the United States.

Who Qualifies for Medicare in Texas

Age 65 and older: Most people become eligible at age 65
Under 65 with qualifying disabilities: After receiving Social Security Disability Insurance (SSDI) for 24 months
End-Stage Renal Disease (ESRD): People of any age with permanent kidney failure requiring dialysis or transplant
ALS (Lou Gehrig’s Disease): Coverage begins immediately upon diagnosis

Texas-Specific Medicare Facts

Texas has the second-largest Medicare population in the US
Over 60% of Texas Medicare beneficiaries choose Medicare Advantage plans
The Texas Health and Human Services Commission (HHSC) provides additional support for dual-eligible beneficiaries
Texas has over 50 State Health Insurance Assistance Program (SHIP) offices statewide

The Four Parts of Medicare Explained

Understanding the four parts of Medicare is essential for making informed decisions about your healthcare coverage in Texas.

Medicare Part A: Hospital Insurance

Medicare Part A covers inpatient hospital care, skilled nursing facility care, hospice care, and some home health care.

What Part A Covers in Texas:

Inpatient hospital stays
Skilled nursing facility care (up to 100 days per benefit period)
Hospice care
Home health care services
Inpatient care in religious non-medical health care institutions

Part A Costs in 2026:

Premium: $0 for most people (if you or your spouse paid Medicare taxes for at least 10 years)
Deductible: $1,676 per benefit period
Coinsurance:
- Days 1-60: $0
- Days 61-90: $419 per day
- Days 91+: $838 per “lifetime reserve day”

Texas Part A Considerations: Many major Texas hospitals participate in Medicare, including Houston Methodist, Baylor Scott & White, and Memorial Hermann. Always verify your preferred hospital accepts Medicare before scheduling procedures.

Medicare Part B: Medical Insurance

Medicare Part B covers medically necessary services, outpatient care, medical supplies, and preventive services.

What Part B Covers:

Doctor visits and outpatient care
Preventive services (annual wellness visits, screenings)
Durable medical equipment
Mental health services
Ambulance services
Some home health care

Part B Costs in 2026:

Standard Premium: $185 per month
Deductible: $240 per year
Coinsurance: 20% of Medicare-approved amounts

Income-Related Monthly Adjustment Amount (IRMAA): High-income beneficiaries pay additional premiums based on their modified adjusted gross income from two years prior.

Medicare Part C: Medicare Advantage

Medicare Advantage plans in Texas are an alternative way to receive Medicare benefits through private insurance companies approved by Medicare.

Medicare Advantage in Texas:

Available in all 254 Texas counties
Often includes prescription drug coverage (Part D)
May offer additional benefits like dental, vision, hearing aids
Network restrictions apply
Popular carriers: Humana, UnitedHealthcare, Aetna, Cigna

Texas Medicare Advantage Statistics:

Over 60% of Texas Medicare beneficiaries choose Medicare Advantage
Average of 25+ plan options per county
Plans must cover everything Original Medicare covers

Medicare Part D: Prescription Drug Coverage

Medicare Part D provides prescription drug coverage through private insurance companies.

Part D Key Features:

Voluntary but recommended
Late enrollment penalty if you don’t sign up when first eligible
Coverage gap (“donut hole”) at $5,030 in 2026
Extra Help program available for low-income beneficiaries

Learn more about Medicare Part D options in Texas.

Medicare Enrollment Periods in Texas

Understanding when you can enroll or make changes to your Medicare coverage is crucial. Texas follows the same federal enrollment periods as all other states.

Initial Enrollment Period (IEP)

Your Initial Enrollment Period is your first opportunity to enroll in Medicare. It begins three months before your 65th birthday month and ends three months after.

IEP Timeline:

3 months before your birth month
Your birth month
3 months after your birth month

Special Considerations for Working Texans: If you have employer health coverage at age 65, you may be able to delay Medicare enrollment without penalty. However, you’ll want to understand how your employer plan works with Medicare.

Annual Open Enrollment Period (OEP)

From October 15 to December 7 each year, you can:

Switch from Original Medicare to Medicare Advantage
Switch from Medicare Advantage back to Original Medicare
Change Medicare Advantage plans
Add, drop, or change Medicare Part D plans

Texas-Specific Enrollment Tips:

Plan changes take effect January 1
Texas SHIP counselors provide free enrollment assistance
Compare plans annually as benefits and costs change

Special Enrollment Periods (SEP)

Special circumstances allow you to make changes outside of regular enrollment periods:

Moving to a new area
Losing employer coverage
Changes in dual-eligible status
Plan contract termination

For detailed enrollment guidance, see our complete Medicare enrollment guide for Texas.

Medicare Costs in Texas

Medicare costs can vary significantly based on your choices and income level. Here’s what Texas Medicare beneficiaries can expect in 2026.

Original Medicare Costs

Part A (Hospital Insurance):

Premium: $0 for most beneficiaries
Deductible: $1,676 per benefit period
Coinsurance varies by service

Part B (Medical Insurance):

Standard premium: $185/month
High earners pay IRMAA surcharge
Deductible: $240/year
Coinsurance: 20% after deductible

Medicare Supplement Insurance (Medigap)

Medicare Supplement plans in Texas help cover Original Medicare’s out-of-pocket costs.

Average Texas Medigap Costs (2026):

Plan F: $180-$300/month
Plan G: $150-$280/month
Plan N: $130-$250/month

Costs vary by insurance company, age, tobacco use, and location within Texas.

Medicare Advantage Costs

Many Medicare Advantage plans in Texas have $0 monthly premiums, but consider:

Copays and coinsurance for services
Out-of-pocket maximums
Network restrictions
Prior authorization requirements

Medicare Providers and Networks in Texas

Texas has an extensive network of Medicare providers, but coverage can vary significantly by plan type and location.

Major Texas Health Systems Accepting Medicare

Houston Area:

Houston Methodist
Memorial Hermann Health System
MD Anderson Cancer Center
Texas Children’s Hospital
CHI St. Joseph Health

Dallas-Fort Worth Area:

Baylor Scott & White Health
Texas Health Resources
UT Southwestern Medical Center
Children’s Medical Center Dallas
Presbyterian Healthcare Services

San Antonio Area:

University Health System
Methodist Healthcare
Baptist Health System
Southwest General Hospital
Christus Santa Rosa

Austin Area:

Ascension Seton
St. David’s HealthCare
Texas Oncology
Austin Regional Clinic
Baylor Scott & White

Rural Texas Medicare Access

Rural Texas Medicare beneficiaries face unique challenges:

Limited provider networks
Longer travel distances to specialists
Fewer Medicare Advantage plan options
Critical Access Hospitals provide essential services

The Texas SHIP program provides additional support for rural Medicare beneficiaries through local counseling services.

Medicare Supplement Insurance (Medigap) in Texas

Medigap policies help pay for costs that Original Medicare doesn’t cover, such as copayments, coinsurance, and deductibles.

Texas Medigap Regulations

Texas follows federal Medigap regulations:

Guaranteed issue rights during open enrollment
Six-month open enrollment period starting when you turn 65 and enroll in Part B
Insurance companies cannot deny coverage or charge higher premiums based on health conditions during open enrollment

Medicare Advantage vs. Original Medicare in Texas

Choosing between Medicare Advantage and Original Medicare is one of the most important decisions Texas Medicare beneficiaries face.

Original Medicare + Medigap

Advantages:

Freedom to see any Medicare provider nationwide
Predictable costs with Medigap
No network restrictions
No prior authorizations typically required

Considerations:

Higher monthly costs (Part B premium + Medigap premium + Part D premium)
Multiple insurance cards and companies
May not include additional benefits

Medicare Advantage

Advantages:

Often $0 monthly premium
May include prescription drug coverage
Additional benefits (dental, vision, hearing aids)
Out-of-pocket maximum protection
One card for all coverage

Considerations:

Network restrictions
Prior authorization requirements
Benefits can change annually
May have higher out-of-pocket costs for frequent healthcare users

Low-Income Medicare Programs in Texas

Several programs help low-income Texas Medicare beneficiaries with costs:

Medicare Savings Programs (MSPs)

Administered by Texas Health and Human Services Commission (HHSC):

Qualified Medicare Beneficiary (QMB):

Income limit: $1,235/month individual, $1,668/month couple (2026)
Pays Medicare premiums, deductibles, and coinsurance

Specified Low-Income Medicare Beneficiary (SLMB):

Income limit: $1,481/month individual, $2,001/month couple
Pays Medicare Part B premium only

Qualified Individual (QI):

Income limit: $1,667/month individual, $2,252/month couple
Pays Medicare Part B premium (limited funding)

Extra Help (Low-Income Subsidy)

Helps with Medicare Part D prescription drug costs:

Income limits higher than MSPs
Automatic qualification for those receiving MSPs, Medicaid, or SSI
Reduces Part D premiums, deductibles, and copays

Texas Medicaid and Medicare

Dual-eligible beneficiaries (qualify for both Medicare and Medicaid) receive coordinated care through:

Medicaid coverage for Medicare premiums and cost-sharing
Additional benefits not covered by Medicare
Prescription drug coverage coordination

For more information, see our comparison of Medicare vs. Medicaid in Texas.

Medicare Resources in Texas

State Health Insurance Assistance Program (SHIP)

Texas SHIP provides free, unbiased Medicare counseling through local offices statewide. Services include:

Medicare education and enrollment assistance
Plan comparison help
Claims and billing assistance
Medicare fraud reporting
Special needs assistance

Contact Texas SHIP:

Phone: 1-800-252-9240
Website: tdi.texas.gov/consumer/hicap
Local offices in all 254 counties

Texas Department of Insurance

Regulates insurance companies operating in Texas and provides consumer assistance:

Insurance company complaints
Medigap shopping guidance
Consumer protection services

Area Agencies on Aging

Texas has 28 Area Agencies on Aging that provide various services to seniors:

Medicare counseling
Benefits enrollment assistance
Long-term care options counseling
Transportation services

Medicare Fraud Prevention in Texas

Medicare fraud costs billions of dollars annually and can affect your benefits. Texas Medicare beneficiaries should be aware of common scams:

Common Medicare Scams in Texas

Free medical equipment offers
Fake COVID-19 treatments or testing
Telemarketing for unnecessary services
Identity theft for Medicare numbers
Fake Medicare cards

Protecting Yourself

Never give your Medicare number to unsolicited callers
Review Medicare Summary Notices carefully
Report suspicious activity to Medicare at 1-800-MEDICARE
Only work with licensed insurance agents

Making Medicare Work for You in Texas

Steps to Choose the Right Medicare Coverage

Assess Your Healthcare Needs
- Current medications
- Preferred doctors and hospitals
- Expected healthcare usage
- Budget for premiums and out-of-pocket costs
Compare Your Options
- Use Medicare.gov plan finder
- Consult with licensed insurance agents
- Attend Medicare education seminars
- Get free counseling from Texas SHIP
Consider Texas-Specific Factors
- Provider networks in your area
- Prescription drug coverage for Texas pharmacies
- Travel needs within and outside Texas
- Climate-related health considerations
Review Annually
- Plans change benefits and costs yearly
- Your health needs may change
- New plans become available

Resources for Houston Residents

For Houston-specific Medicare guidance, see our detailed Houston Medicare guide.

Resources for DFW Residents

Dallas-Fort Worth Medicare beneficiaries can find targeted information in our Dallas-Fort Worth Medicare guide.

Frequently Asked Questions About Medicare in Texas

Is Medicare the same in Texas as other states?

Yes, Medicare is a federal program with the same basic structure nationwide. However, plan availability, costs, and provider networks can vary significantly by location within Texas.

Can I use my Medicare anywhere in Texas?

With Original Medicare, you can see any Medicare provider anywhere in Texas (or the US). With Medicare Advantage, you’re typically limited to the plan’s network, which may be regional within Texas.

What happens if I move within Texas?

If you move to a different county or region within Texas, you may qualify for a Special Enrollment Period to change your Medicare Advantage or Part D plan if your current plan isn’t available in your new location.

How do I find Medicare providers in my Texas area?

Use Medicare.gov’s provider search tool, contact providers directly, or call 1-800-MEDICARE for assistance finding participating providers in your area.

What if I have employer insurance at 65?

You may be able to delay Medicare enrollment without penalty if you have qualifying employer coverage. However, you should understand how your employer plan coordinates with Medicare and consider enrolling in Part A if it’s premium-free.

Can I change my Medicare coverage?

Yes, during the Annual Open Enrollment Period (October 15 - December 7) and sometimes during Special Enrollment Periods if you qualify due to specific circumstances.

What’s the difference between Medicare and Medicaid in Texas?

Medicare is primarily based on age (65+) or disability, while Medicaid is based on income and other factors. Some Texans qualify for both programs. Learn more in our Medicare vs. Medicaid comparison.

How much does Medicare cost in Texas?

Costs vary significantly based on your coverage choices. Original Medicare has standard premiums and deductibles, while Medicare Advantage and supplement plans vary by company and location within Texas.

Contact Us for Personalized Medicare Assistance

Navigating Medicare in Texas doesn’t have to be overwhelming. Our licensed Medicare specialists understand Texas-specific options and can help you find the right coverage for your needs and budget.

Get your free Medicare consultation today:

Compare all available plans in your Texas county
Understand your costs and benefits
Get personalized recommendations based on your healthcare needs
Receive ongoing support throughout the year

Don’t let Medicare confusion prevent you from getting the healthcare coverage you deserve. Contact us today for expert guidance on Medicare in Texas.

Ready to get started? Call us now for a free, no-obligation consultation with a Texas Medicare specialist who can help you navigate your options and make informed decisions about your healthcare coverage.

Medicare in Texas offers many options, and with the right guidance, you can find coverage that provides excellent healthcare access while fitting your budget. Whether you’re in Houston, Dallas, San Antonio, Austin, or anywhere else in Texas, we’re here to help you understand and maximize your Medicare benefits.

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