What makes Medicare different in Texas
- Size and distance: Medicare Advantage and Part D plans are offered county by county, and in much of rural Texas the nearest in-network hospital or specialist can be a long drive away.
- State and school retirees: retirees covered through ERS and TRS-Care have their own Medicare rules and plan options.
- Military retirees: TRICARE For Life requires Medicare Part A and Part B.
- Medicare Supplement access under 65: Texas requires insurers to offer people under 65 with End-Stage Renal Disease or ALS the same Medicare Supplement coverage offered to people 65 and older.
- Winter Texans and the border: seasonal residents and people who cross into Mexico for care need to understand how their coverage works away from home.
Medicare Advantage in Texas
Medicare Advantage plans in Texas include HMO and PPO options, and what's available depends on your county. Large metro areas generally have more plan choices than rural counties, and a plan offered in Harris County may not be available a few counties away.
Networks matter too. Texas has several large health systems, such as Baylor Scott & White and Texas Health Resources in North Texas, Memorial Hermann and Houston Methodist in the Houston area, and CHRISTUS Health across the state. Not every plan includes every system, so confirm that your doctors and hospitals are in network before you enroll. In rural areas, also check how far you'd need to travel for in-network care. Medicare at 65 is not affiliated with these health systems.
If you have both Medicare and Medicaid, your Medicaid coverage is provided through STAR+PLUS, and you can choose Original Medicare, a Medicare Advantage plan, or a Dual Eligible Special Needs Plan (D-SNP). In several of the state's largest counties, Integrated D-SNPs combine Medicare and Medicaid coverage with one ID card and one member handbook. Learn how Medicare Advantage works.
Medicare Supplement (Medigap) in Texas
Medicare Supplement plans in Texas use the same standardized lettered plans found in most states, such as Plan G and Plan N, but premiums vary by insurer. The Texas Department of Insurance publishes a list of companies selling Medicare Supplement insurance in the state.
Your Medicare Supplement open enrollment period lasts six months and begins when you enroll in Medicare Part B. During that window, companies must sell you a policy even if you have health problems. After it ends, you may need to answer health questions unless you have a guaranteed-issue right.
Under 65 and on Medicare?
- End-Stage Renal Disease or ALS: Texas requires insurers to offer you the same Medicare Supplement coverage offered to people 65 and older, at the same rates for some plans and at limited higher rates for others.
- Other disabilities: you have a six-month open enrollment period to buy Plan A.
- Turning 65: you get a new open enrollment period, even if you already have a Medicare Supplement policy.
Other Texas protections to know
- A 30-day review period: you can return a new Medicare Supplement policy within 30 days and get your money back.
- Guaranteed-issue timing: if you lose certain coverage, your right to buy a policy without health questions lasts 63 days from the date that coverage ends.
- How premiums change: attained-age policies increase as you get older, so ask how a policy is priced before you buy.
Learn how Medicare Supplement plans work.
Retiring from a Texas state agency or school district?
- State employee retirees (ERS): once you enroll in Medicare and send your Medicare information to ERS, you're enrolled in the HealthSelect Medicare Advantage PPO plan. If you opt out or don't provide your Medicare information, you're placed in HealthSelect Secondary, which generally costs more. The change can take time, so plan ahead.
- Retired teachers (TRS-Care): Medicare-eligible participants must enroll in Medicare Part B and keep paying for it to keep TRS-Care. If you qualify for premium-free Part A, you must sign up for that too. Coverage for Medicare-eligible participants is provided through TRS-Care Medicare Advantage.
Confirm your situation with ERS or TRS before your retirement date. Retiring from a private employer? See how Special Enrollment Periods work when employer coverage ends.
Military retirees and TRICARE For Life
If you're a military retiree, TRICARE For Life works alongside Medicare rather than replacing it. You must have both Medicare Part A and Part B to get TRICARE For Life, and in most cases you need Part B to keep your TRICARE coverage. TRICARE For Life starts automatically once your Part A and Part B are in effect, so there's no separate enrollment.
Help paying Medicare costs in Texas
Texas Health and Human Services administers the state's Medicare Savings Programs, which can help pay Medicare premiums. The Qualified Medicare Beneficiary (QMB) program also helps with Medicare deductibles and coinsurance. You can apply through Your Texas Benefits or by calling 2-1-1. You may also qualify for federal Extra Help with Part D costs.
Winter Texans, the border, and moving to Texas
- Winter Texans: Medicare Advantage plans are based on your permanent home, and most use local networks. If your plan is from another state, routine care in Texas may cost more or may not be covered, though emergency and urgent care are covered nationwide.
- Care in Mexico: Original Medicare generally doesn't cover care outside the U.S., and Medicare drug plans can't cover prescriptions bought outside the U.S. Some Medicare Supplement plans include foreign travel emergency coverage.
- Moving to Texas permanently: if your Medicare Advantage or Part D plan doesn't serve your new area, you generally get a Special Enrollment Period to choose a Texas plan.
- Updating your address: let Social Security know when you move so your Medicare records stay current.
Weighing your options? Compare Medicare Advantage and Medicare Supplement, or start with our Turning 65 guide.