Medicare Part D in Texas

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Texas state

Medicare beneficiaries in the state of Texas may wish to know more about prescription drug coverage. After all, approximately 90 percent of people over the age of 65 take at least one drug every week, yet Original Medicare (Medicare Part A and Part B) does not provide coverage for most prescription medications.1 

Medicare beneficiaries have two primary options for obtaining coverage for prescription drugs. The first is enrolling a Medicare Advantage plan that provides such a benefit. The second option is enrolling in a standalone Medicare Part D plan.

Part D plans are used in conjunction with Original Medicare (and Medicare Advantage plans that don’t provide prescription drug benefits) to provide coverage exclusively for prescription drugs. Because these plans are sold by private insurers, each plan will include its own criteria concerning:

  • Premiums
  • Deductibles
  • Copayments or coinsurance
  • Drug formulary (the list of drugs covered by the plan)

Texas Medicare Part D plans by the numbers

There were 2,839,293 people in the state of Texas enrolled in a Medicare Part D plan as of early 2018. That was the third-highest enrollment total in the U.S., trailing only California and Florida.2

There are 24 Medicare Part D plans available in Texas in 2018, which is three more than were offered in 2017. Each plan is unique in terms of its cost and coverage, so it’s important to find a plan that fits your needs.

The chart below highlights some details about the cost of Part D plans in Texas.

Average plan premium

$51.71 ($0.52 lower than the national average of $52.23)

Lowest premium

$16.70

Highest premium

$197.10

Average deductible

$266.46

No. of plans with a premium under $25

10

No. of plans with a $0 deductible

8

Data reflects Medicare Part D enrollment in the state of Texas as of 2018, as obtained from the Centers of Medicare and Medicaid Services, www.cms.gov.3

Eligibility and Enrollment

If you are enrolled in both Medicare Part A and Part B, you are eligible to enroll in a Part D plan or to enroll in a Medicare Advantage plan with prescription drug coverage. Remember that not all plans are available in each state, so you may only enroll in a plan that is sold in the state in which you reside.

There are only certain times of the year in which you may sign up for a Medicare Part D plan or a Medicare Advantage plan, which are outlined below.

Initial Enrollment Period (IEP)

Your seven-month Initial Enrollment Period (IEP) begins three months before your 65th birthday, includes the month of your birthday and continues for three months after you turn 65. It typically runs concurrently with your Medicare Part B Initial Enrollment Period.

It’s important to consider that there is a Medicare Part D late enrollment penalty. You may incur this penalty if you go at least 63 continuous days without a Part D plan, a Medicare Advantage plan that offers prescription drug coverage or other creditable prescription drug coverage.

Annual Election Period

The Annual Election Period occurs from October 15 to December 7 each year. During this time, you may enroll or disenroll in a Medicare Part D plan or switch from one plan to another.

During this period, you can also enroll in a Medicare Advantage plan with prescription drug coverage, disenroll from a Medicare Advantage plan or switch from one Medicare Advantage plan to another.

Medicare Advantage Disenrollment Period

The Medicare Advantage Disenrollment Period lasts from January 1 to February 14 each year. During this time, you may disenroll from a Medicare Advantage plan and enroll in a Part D plan.

Special Enrollment Period

A Special Enrollment Period may be granted under certain circumstances under which you can enroll in a Medicare Part D plan or in a Medicare Advantage plan. These specific circumstances can include but are not limited to: moving out of your current plan’s service area, losing your current coverage or moving into a long-term care facility.

5-Star Special Enrollment Period

There is also a 5-Star Special Enrollment Period, which runs from December 8 to November 30 each year. If you are enrolled in a Part D plan or a Medicare Advantage plan that does not have a 5-star rating, you can use this time to switch to one that does, as long as one is available in your area.4

The Health Information Counseling & Advocacy Program of Texas (HICAP)

The Health Information Counseling & Advocacy Program of Texas provides benefits counseling to the state’s seniors to help them gain a deeper understanding of their Medicare benefits and rights. The assistance is provided by trained volunteers, and all information given is free and unbiased. The program may be reached at 800-252-9240.    

You can also explore more information about the insurance industry in Texas by visiting the state’s Department of Insurance website.

 

1 Ruscin, Mark and Linnebur, Sunny. Aging and Drugs. Merck Manual. Retrieved from https://www.merckmanuals.com/home/older-people%E2%80%99s-health-issues/aging-and-drugs/aging-and-drugs.
2 Cubanski, Juliette; Damico, Anthony and Neuman, Tricia. Medicare Part D in 2018: The Latest on Enrollment, Premiums and Cost Sharing. May 17, 2018. Kaiser Family Foundation. Retrieved from https://www.kff.org/report-section/medicare-part-d-in-2018-the-latest-on-enrollment-premiums-and-cost-sharing-tables.
3 MedicareAdvantage.com’s internal analysis of CMS 2018 Prescription Drug Plan (PDP) Landscape Source Files. May 2018.
4 Medicare evaluates plans based on a 5-star rating system. Star Ratings are calculated each year and may change from one year to the next.

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This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums, and/or copayments/coinsurance may change on January 1 of each year.

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