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Medicare in Texas

Medicare is a health insurance program offered to senior citizens in the United States. The federal government manages Medicare, with some benefits offered by the government and some by private insurance companies. Medicare Parts A and B are standardized, as are the Medicare supplement plans, also called Medigap. However, the federal government allows states to regulate some aspects of Medicare Part C and choose which Medicare supplement plans they want to offer. The Texas Department of Insurance and the Department of Aging and Disability Services oversee Medicare in Texas.

  1. Original Medicare

    • Medicare Parts A and B are often called original or traditional Medicare. You may receive Part A free of premiums, but all other parts generally require a monthly payment. Part A mainly covers in-patient hospital care, hospice care and home health care. Part B also adds outpatient care, preventive services, clinical laboratory expenses and ambulance transportation. It is not mandatory that you enroll in both parts, unless you think you may want to purchase a Medicare Advantage plan. You may also need both in order to buy a Medigap policy.

    Medicare Part D

    • Medicare Part D is coverage for prescription drugs. You can buy Part D in addition to Parts A and B, or receive it as part of a Medicare Advantage plan. In Texas, Medicare Part D is called Medicare Rx. Medicare Rx policies in Texas include Health Net Orange Option 1, the HealthSpring Prescription Drug Plan, WellCare Classic, Bravo Rx, CVS Caremark Value, Community Care Rx Basic and the Advantage Star Plan.

    Medicare Advantage

    • Medicare Advantage, also called Medicare Part C, allows you to combine your Medicare Part A and Part B benefits with prescription drug coverage and other services, such as dental and vision. Medicare Advantage is available through private companies that may determine benefits and premiums, although they must offer all the services of original Medicare, save for hospice care. Texas offers Medicare Advantage plans according to where you live, and may limit some plans to specific counties. You can purchase Texas Medicare Advantage programs as health maintenance organization (HMO) plans, preferred provider organization (PPO) plans, special-needs plans tailored to specific diseases, private fee-for-service plans or high-deductible plans for use with medical savings accounts.

    Texas Medigap Plans

    • As of 2010, Texas has ten different Medigap policies: plans A through D, F, G and K through N. All plans offer the basic services of hospitalization benefits from the 61st to the 90th day, Medicare Part A co-payments for hospitalization after the 90th day, an additional year of hospital charges after Medicare stops, Part B Medicare co-insurance and the cost of the first three pints of blood per year. Plans K and L have lower premiums but higher co-insurance and annual out-of-pocket expenses than other plans. All companies in Texas that sell Medigap policies must sell Plan A. If they sell other plans, these must include Plan C or Plan F as well, which can also come as a high-deductible plan. All Medigap policies in Texas are also available as Medicare Select PPO policies.

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