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Medicare and Medicare Advantage Coverage and Eligibility in Texas

October 19, 2023

Medicare and Medicare Advantage Coverage and Eligibility in Texas

Medicare is a federal health insurance program primarily for those age 65 and older, although some disabled Americans under 65 will qualify. Understanding Medicare requirements, along with what it covers and how to enroll, is vital.

Who qualifies for Medicare? How do I enroll? This page will answer your questions and help you choose the plan that works best for you.

How to Apply for Medicare in Texas

Many Americans will automatically be enrolled in Medicare Part A and Part B. If you’re nearing your 65th birthday and are receiving benefits from Social Security or the Railroad Retirement Board, Original Medicare will automatically start the first day of the month you turn 65.

In some cases, you might need to enroll manually. This could happen if you don’t qualify for premium-free Medicare Part A, or if you are still working when you turn 65. Are you wondering, “How do I enroll in Medicare i?”

To enroll, you can choose from the following options:

  • Contact your local Social Security office
  • Call 1-800-772-1213 to enroll over the phone
  • If you retired from a railroad, call the Railroad Retirement Board at 1-877-772-5772
  • Sign up for Part A online at and Part B using Form CMS-40B

Be sure to enroll during your initial enrollment period, which begins three months before you’re turning 65 and lasts seven months.

How Do I Apply for Medicare Part B?

If you’re enrolled automatically, you’ll get Part A and Part B at the same time. Otherwise, you’ll need to make sure you enroll in Medicare Part B online or over the phone.

Medicare Part B has a monthly premium, but you can’t delay your enrollment unless you are still working and covered by a group health insurance plan. If you don’t enroll when you’re first eligible, you’ll face a late enrollment penalty.

If you don’t want Part B at all, you can submit a signed request to Social Security to drop the coverage. If you don’t have other medical insurance, you may have a gap in coverage if you decide you want Medicare Part B, which could make it more expensive.

Medicare Eligibility

To qualify for Medicare, you must be a U.S. citizen or a permanent resident who has lived in the country for at least five years, along with one of the following:

  • Age 65 or older
  • Younger than 65 but disabled and receiving Social Security Disability payments or payments from the Railroad Retirement Board
  • Have end-stage renal disease (ESRD)
  • Have Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease

What age can you get Medicare i Generally, you have to be 65 years old. However, if you have specific medical conditions, you can qualify for Medicare coverage earlier than that.

Can Retired Texas Teachers Get Medicare?

Retired teachers receive benefits from the Teacher Retirement System of Texas (TRS). Once you reach 65, you can enroll in Original Medicare or choose a Medicare Advantage plan.

TRS offers its own Medicare Advantage plan, h. Keep in mind that you also have other options, from other Medicare Advantage plans to Original Medicare with a Medicare Supplement Plan to keep costs lower.

It’s important to review all of your Medicare options before making a decision on what plan is right for you. If you have retirement benefits, be sure to speak with your employer benefits manager before making decisions.You’ll want to compare monthly premiums, coverage, and out-of-pocket costs before you move forward.

How Does Medicare Work in Texas?

Medicare is a federal program so it works the same way in every state. Medicare has several parts, and each part covers a different part of your medical needs. Medicare Parts A and B together are known as Original Medicare.

The parts of Medicare are:

  • Part A: Hospital coverage
  • Part B: Covers medical appointments and outpatient care
  • Part C: Medicare Advantage: Replaces Original Medicare and can offer additional benefits
  • Part D: Prescription drug coverage

What does Medicare cover? Through Part A, you’ll have coverage for inpatient hospital care, lab tests, surgery, home health care, a skilled nursing facility, and home health care. With Part B, you also have coverage for visits to the doctor, outpatient care, durable medical equipment, home health care, and preventive services.

When you use your Medicare coverage, you will be responsible for some out-of-pocket costs. These include deductibles, copayments, and coinsurance.

If you have Medicare Part C, you’ll have medical coverage for the services covered by Original Medicare, along with additional benefits. For instance, most Medicare Advantage plans include prescription drug coverage, and some also have insurance for vision, dental, hearing, and other needs.

With Medicare Advantage, you’ll need to stay within your insurer’s provider network. Before you enroll, ensure that the doctors and specialists you need are included.

How Much Does Medicare Cost?

For many Texans, Medicare Part A is premium-free. Medicare Part B will have a monthly premium that is updated each year. If you enrolled late or have a high income, you may pay more for Part B.

Does Medicare Cover Dental?

Original Medicare does not include coverage for most dental care. If you want dental insurance, you’ll need a stand-alone dental plan or a Medicare Advantage plan that includes dental care.

Does Medicare Pay for Nursing Homes?

Medicare doesn’t cover custodial care in a nursing home if it’s the only care you need. You can only use Medicare for a nursing home if you medically need to stay there. Most care in a nursing home, such as bathing, dressing, and help with other daily activities, won’t be covered by Medicare.

If you need help paying for long-term care, you will want to get specific long-term care insurance. If you qualify for Medicaid, you may also be able to get assistance through that coverage.

What about a Medicare Supplement Plan in Texas?

Medicare Supplement plans are additional plans you can buy to assist with your out-of-pocket expenses in Original Medicare. They have letters, from A to N, and you buy them through private insurance companies.

Every plan of a specific letter will be the same as other plans with that letter. The only difference is the monthly costs. Be sure to compare the benefits you need to the monthly premium to make the right choice for your needs.

What About Medicare Advantage Plans in Texas?

Medicare Advantage plans are full replacements for Original Medicare and can offer important additional benefits. However, the medical providers that are included may be limited, so be sure that the doctors and specialists you prefer are part of the network.

As you look to see what Medicare Advantage plans are available in Texas, pay attention to the different coverage options and costs.

Some Medicare Advantage plans don’t cost any more than your usual Medicare Part B premium, while others are a bit more expensive. Be sure you compare monthly premiums, out-of-pocket costs, and benefits before you make your final decision.

What is the Medicare Savings Program?

A Medicare Savings Program can help lower-income Medicare recipients afford their out-of-pocket costs. There are four different programs available, and you qualify based on your resources and income. Each program has different requirements.

You apply for Medicare Savings Programs through your local Medicaid office, so be sure to contact the Texas Department of Health and Human Services if you think you might qualify.

Can You Have Medicare and Medicaid in Texas?

You are able to have both Medicare and Medicaid. This is known as being “dual-eligible”, and you may automatically qualify for Medicare Savings Programs as well.

Medicare is generally the first payer for your medical care, but Medicaid can provide coverage for things not covered by Medicare. Medicaid also helps with care coordination. If you have questions about Medicare or Medicaid, be sure to contact the appropriate state or Social Security office.

Find and Compare Medicare Plans in Texas

Still have questions about Medicare in Texas? Are you wondering how to compare plans and choose the right option for you? We can help. Talk to a licensed insurance agent by calling us or visiting our website today.

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