Medicare basics for Texans

What Medicare is

Medicare is a federal health insurance program. It covers people 65 and older, people under 65 who have received Social Security disability benefits for 24 months, and people with end-stage renal disease (permanent kidney failure) or ALS. The rules, the coverage and the standard costs are the same in Texas as in every other state. What changes from place to place is the private coverage you can add to it, and in a state as big as Texas, that varies a lot from Houston to Alpine.

Two federal agencies handle different jobs. The Social Security Administration signs you up, decides whether you qualify and collects most premiums. The Centers for Medicare & Medicaid Services (CMS) runs the program, sets the rules and approves the private plans sold in each county. A third agency, the Texas Department of Insurance (TDI), licenses insurance agents and regulates Medigap policies sold in Texas.

The four parts of Medicare

Should I choose Original Medicare or Medicare Advantage?

Once you have Parts A and B, you get your benefits one of two ways.

Original Medicare

With Original Medicare you can see any doctor or hospital in the country that accepts Medicare, without referrals. You pay the Part B deductible and generally 20% of the Medicare-approved amount for doctor and outpatient care, and there is no yearly cap on those costs. Most people who choose this path add two things:

• A Medigap (Medicare Supplement) policy to cover some or most of the deductibles and coinsurance. See Medigap in Texas.
• A Part D drug plan, because Original Medicare doesn't cover most outpatient prescriptions. For 2027, CMS lists 10 standalone Part D plans in Texas.

This path suits many Texans who travel, including Winter Texans who split the year between the Rio Grande Valley and a home up north, because Original Medicare and Medigap aren't tied to a local network. See Winter Texans and Medicare.

Medicare Advantage (Part C)

A Medicare Advantage plan replaces Original Medicare as the way you get your Part A and B benefits. Plans use networks (HMO or PPO, mostly), set their own copays and coinsurance, and must cap your in-network out-of-pocket costs for Part A and B services, up to $9,250 in 2026. Most include Part D drug coverage. Medicare Advantage plans may offer extra benefits that Original Medicare doesn't cover, such as dental, vision, hearing, fitness, transportation or telehealth. Extra benefits vary by plan and county, may have limits and costs, and not every plan offers them. Check a plan's Summary of Benefits or Evidence of Coverage.

You can't use a Medigap policy with a Medicare Advantage plan. If you choose Medicare Advantage and later want Original Medicare with Medigap, Medigap insurers can usually review your health once your Medigap open enrollment period has passed, unless you have a guaranteed-issue right. Weigh the two paths on Medicare Advantage vs. Medigap in Texas.

How many plans are there in my Texas county?

Medicare Advantage and special needs plans are approved county by county, so your choices depend on where you live. For 2027 coverage, CMS lists 214 Medicare Advantage plans open to everyone across Texas, from 21 companies. No single county has all of them:

Source: CMS 2027 Medicare Advantage Landscape file. The gap follows where Texas's doctors and hospitals are. Houston, San Antonio, Dallas-Fort Worth and El Paso have deep provider networks; in the Big Bend, the Trans-Pecos and parts of the Panhandle, distances are long and providers few, so companies offer far fewer plans. Many of the plans offered in the most rural counties are regional PPOs, which serve the whole state as one region.

Original Medicare, Medigap and Part D work in every county. If you live where local plans are few, or you drive to San Antonio, Lubbock or Midland for specialty care, check that those doctors and hospitals are in a plan's network before you choose it. Look up your county on Medicare by Texas county (for example, Harris County or El Paso County), or see plans in your ZIP code.

How do Texans get started with Medicare?

1. Check whether you'll be enrolled automatically. If you already get Social Security retirement or disability benefits, you're usually enrolled in Parts A and B and your card arrives in the mail. See Medicare eligibility.
2. If not, sign up with Social Security. Your Initial Enrollment Period is the 7 months around your 65th birthday: the 3 months before, your birthday month and the 3 months after. Apply online at ssa.gov, by phone at 1-800-772-1213 (TTY 1-800-325-0778), or in person. Social Security has field offices across Texas; use the office locator at ssa.gov to find the one that serves your ZIP code and check whether you need an appointment.
3. Decide about Part B if you're still working. If you or your spouse has job-based coverage from a current employer, you may be able to delay Part B without a penalty. See working past 65.
4. Retired from a Texas school or state agency? TRS-Care and the ERS retiree health program both require Medicare Part B once you're eligible. Read TRS-Care, ERS retirees and Medicare before you choose anything else.
5. Choose how you'll get your coverage. Original Medicare with Medigap and Part D, or a Medicare Advantage plan. Know your enrollment periods; for 2027 coverage the Annual Enrollment Period runs October 15 to December 7, 2026.
6. Check whether you can get help with costs. HHSC runs the Medicare Savings Programs that can pay the Part B premium, and Extra Help lowers drug costs. See Medicare costs in 2026.

Where can I get help in Texas?

• Medicare: Medicare.gov or 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048), 24 hours a day, for coverage questions and to see your plan options.
• Social Security: ssa.gov or 1-800-772-1213, for enrolling, your Medicare card, premiums and income-related adjustments.
• Texas Health and Human Services Commission (HHSC): the state agency for Texas Medicaid, STAR+PLUS and the Medicare Savings Programs. Apply at YourTexasBenefits.com. See Texas Medicaid and Medicare.
• Texas Department of Insurance (TDI): the state regulator for Medigap policies and insurance agents. Its Consumer Help Line, 1-800-252-3439, answers insurance questions and takes complaints about insurance companies and agents.
• Area Agencies on Aging: HHSC works with regional Area Agencies on Aging for services such as meals, caregiver support and respite for older Texans and their families. See caregivers.
• A licensed insurance agent: a licensed insurance agent with Benefits Life can explain options from the companies they work with, at no cost to you: (512) 265-6565, TTY 711. You can also find a licensed insurance agent in Texas.

For phone numbers and addresses in one place, see Texas Medicare contacts. Unfamiliar terms are explained in our glossary, and short answers are on Medicare questions.

Sources

• Medicare.gov — Get started with Medicare
• Medicare.gov — Parts of Medicare
• CMS — 2026 Medicare Parts A & B premiums and deductibles
• CMS — CY2027 Medicare Advantage and Part D Landscape files
• Social Security Administration — Medicare
• Social Security Administration — Office locator
• Texas HHSC — Your Texas Benefits
• Texas Department of Insurance — Consumer Help Line
• Teacher Retirement System of Texas — TRS-Care and Medicare Part B

Frequently asked questions

Is Medicare the same as Texas Medicaid?

No. Medicare is the federal health insurance program run by the Centers for Medicare & Medicaid Services, mostly for people 65 and older. Texas Medicaid is run by the Texas Health and Human Services Commission (HHSC) and is based on income, resources and other rules. Some Texans qualify for both. Then Medicare pays first, and Texas Medicaid can help with costs Medicare leaves, including the Part B premium for people who qualify.

Do I have to sign up for Medicare at 65 if I already get Social Security?

No. If you already get Social Security retirement benefits, you are usually enrolled in Parts A and B automatically, and your Medicare card arrives in the mail about three months before your 65th birthday. If you don't get Social Security yet, you sign up yourself at ssa.gov, by phone at 1-800-772-1213, or at a Social Security office in Texas.

What does Original Medicare not cover?

Original Medicare doesn't cover most routine dental care, routine eye exams and glasses, hearing aids, or long-term custodial care, and it has no yearly limit on what you pay out of pocket. It also doesn't include outpatient prescription drugs; for those you add a Part D plan or choose a Medicare Advantage plan that includes drug coverage.

Why do some Texas counties have so few Medicare Advantage plans?

Medicare Advantage plans are approved county by county, and companies decide where to offer them. Most plans depend on local networks of doctors and hospitals, so large metro counties such as Harris, Bexar and Dallas have many more plans than sparsely populated counties in far West Texas and the Panhandle. Original Medicare works the same in all 254 Texas counties.

How much does Medicare cost in 2026?

Most people pay no premium for Part A. The standard Part B premium is $202.90 a month in 2026, with a $283 yearly deductible, and higher-income people pay more. Medigap, Part D and Medicare Advantage plans can have their own premiums.

Medicare in your Texas county

Plans, local agents and help, county by county: Harris · Dallas · Tarrant · Bexar · Travis · Collin · Denton · Fort Bend · Hidalgo · El Paso · Montgomery · Williamson · Cameron · Brazoria · Bell · Galveston · Nueces · Lubbock · Hays · Webb · McLennan · Jefferson · Brazos · Smith · Ellis · Johnson · Comal · Kaufman · Guadalupe · Midland · All 254 counties →