Medicare Advantage in Texas

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Texas state

Information about Medicare Advantage Plans in Texas

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There are 221 different Texas Medicare Advantage (Medicare Part C) plans in 2022.1 Not every plan may be available where you live in Texas, as plan availability, benefits and costs can vary.

Read below to learn more about Medicare in your state.

Average costs of Medicare Advantage in Texas

The average premium for a 2022 Medicare Advantage plan in Texas is $73.30 per month, though you may find plans where you live that feature $0 premiums.

  • Average in-network out-of-pocket spending limit: $5,810.15
  • Average drug deductible for Medicare Advantage Prescription Drug plans (weighted): $272.852

It's important to note that Medicare Advantage plan premiums, deductibles and out-of-pocket costs may vary greatly depending on where you live and the plan you have.

Further below in this guide, you can also explore the average 2022 Medicare Advantage plan costs in Texas by county.

A licensed insurance agent can help you compare Medicare Advantage plan costs in your area.

Compare Texas Medicare Advantage plan costs

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TX Medicare Eligibility & Enrollment

In order to sign up for a Medicare Advantage plan in Texas, you must enroll in Original Medicare (Part A and Part B).

To be eligible for Original Medicare at age 65, you must meet the following requirements:

  • You must be a U.S. citizen or permanent legal resident who has lived in the U.S. for five continuous years.

  • You or your spouse must be eligible to receive Social Security or Railroad Retirement benefits.

  • You or your spouse must be government employees or retirees who have not paid into Social Security, but you've paid Medicare payroll taxes.

You could potentially be eligible for Medicare under 65 if:

  • You receive Social Security disability benefits or certain Railroad Retirement Board disability benefits for at least 24 months.

  • You have ALS (amyotrophic lateral sclerosis, also called Lou Gehrig's disease).

  • You have End-Stage Renal Disease (ESRD), and you or your spouse have paid Social Security taxes for the required period of time.

If you have ESRD, you may be able to sign up for a Medicare Advantage plan or a Texas Medicare Special Needs Plan (SNP) that is specifically designed to help meet your health care needs.

How to sign up for a Medicare Advantage Plan in Texas

The first time most Medicare beneficiaries can enroll in a Texas Medicare Part C plan is during their Medicare Initial Enrollment Period (IEP).

Medicare Initial Enrollment Period graphic

Your Initial Enrollment Period beings three months before your 65th birthday, includes the month of your 65th birthday and continues for another three months after your birth month.

You may also be able to enroll in Medicare Advantagae (or switch your Medicare plan) during other Medicare enrollment periods, which include:

Medicare Advantage Open Enrollment Period graphic

Medicare Advantage Open Enrollment Period: January 1 – March 31

If you're already enrolled in a Part C plan, you may switch Medicare Advantage plans or drop your Medicare Advantage plan and return to Original Medicare from January 1 to March 31 each year.

If you switch to Original Medicare during this period, you'll also have a chance to sign up for a Medicare standalone prescription drug plan (Medicare Part D).

Medicare AEP graphic

Medicare Annual Enrollment Period (AEP): October 15 – December 7

You may enroll in a Medicare Advantage plan or switch from one Medicare Advantage plan to another during Medicare AEP, which lasts from Oct. 15 to Dec. 7 every year.

You may also drop your existing Medicare Advantage plan and return to Original Medicare.

You may also join, switch or drop a Medicare Part D plan during AEP. This period is also sometimes called the Annual Election Period.

Medicare Special Enrollment Periods (SEP)

Depending on your circumstances, you may be granted a Medicare Special Enrollment Period (SEP) at any time throughout the year.

Find out if you qualify for a Medicare Special Enrollment Period by calling to speak to a licensed insurance agent.

Find a $0 premium Texas Medicare Advantage plan today

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Or call TTY Users: 711 to speak with a licensed insurance agent. We accept calls 24/7!

Top-rated Medicare Advantage Plans in Texas 2022

The Centers for Medicare & Medicaid Services (CMS) issues star ratings for all Medicare Advantage plans every year, using a system of one to five stars.3

If a Medicare Advantage plan is awarded four or more stars out of five stars, it is considered a top-rated plan.

32.6% of all 2022 Medicare Advantage plans in Texas are rated four stars or higher.

Medicare Star Ratings
Star Ratings

★★★★★

Excellent

★★★★

Above Average

★★★

Average

★★

Below Average

Poor

Medicare Advantage plans are rated in the following five categories:

  • Preventive care and health maintenance (screenings, tests, vaccines, etc.)
  • Management of chronic conditions
  • Member experiences and ratings of the plan
  • Member complaints, problems receiving services and member retention
  • Customer service

The CMS bases its Star Ratings on several pieces of information, including Medicare’s regular monitoring activities as well as member surveys.

List of Medicare Advantage Plans Available in Texas in 2022

To view a list of plans offered in your area of Texas, use our plan comparison tool.

Find a $0 premium Texas Medicare Advantage plan today

Compare Plans

Or call TTY Users: 711 to speak with a licensed insurance agent. We accept calls 24/7!

Private insurance companies offer Medicare Advantage plans in Texas

Several insurance companies may offer Medicare Advantage plans in Texas, but local availability depends on where you live.

Private insurance companies offer Medicare Advantage plans that could potentially be unique to the plan area they serve.

A licensed insurance agent can help you compare the Medicare Advantage plans that are sold by insurance companies in your area of Texas.

When you’re shopping for Medicare Advantage plans in Texas, you can compare plans from several different carriers.

You can use some of the following information sources to help you compare companies and plans:

  • Agencies like A.M. Best, Moody’s and Standard & Poor’s can provide information about an insurance company’s credit rating and financial standing.

  • The Medicare Star Ratings can give you an idea of a plan’s overall quality.

  • You can read through Medicare Advantage plan reviews and testimonials from customers

  • Websites such as the Better Business Bureau and Consumer Reports can teach you about a company’s reputation among its customers.

Texas Medicare Advantage plans by county

Learn more about Medicare Advantage plans in some of the most populous counties in Texas.

TX Medicare Advantage plans by plan type

The major types of Medicare Advantage plans include:

  • HMO
    If you have a Texas Health Maintenance Organization (HMO) plan, you'll typically be required to visit doctors, hospitals and pharmacies that are part of your plan’s network (except in the case of emergencies).

    An HMO plan will also typically require you to get a referral from your primary care physician (PCP) in order to see a specialist.

  • PPO
    If you have a Medicare Preferred Provider Organization (PPO) plan, you may be able to see providers outside of your plan’s network, but you'll typically pay higher out-of-pocket costs for going outside of the plan network.

    You'll typically pay less out of pocket if you seek medical services from providers within your plan’s network.

    PPO plans typically do not require you to get a referral before you can see a specialist.

  • PFFS
    A Private Fee-For-Service (PFFS) plan will typically determine how much you are required to pay for health care services at the point when care is received.

    With a PFFS plan, you can typically receive care from any doctor, hospital or health care provider that accepts Medicare as well as your plan’s terms. Not all providers will accept these terms, however.

  • SNP
    A Special Needs Plan (SNP) is a type of Medicare Advantage plan that is limited to people with certain chronic health conditions and other specific characteristics.

    SNP plans are required to provide prescription drug coverage.

Not all of these types of plans may be available in your area. A licensed insurance agent can help you compare the types of 2022 Texas Medicare Advantage plans that are available where you live.

Local health insurance resources in Texas

  • 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.

  • Texas Prescription Drug Assistance Programs
    The state of Texas has a number of programs designed to help with the cost of prescription drugs. There are programs for both Medicare beneficiaries and non-Medicare beneficiaries alike that can cover the cost of premiums and cost-sharing or even lower the cost of the drugs themselves.

 

1 Freed M. et al. (Nov. 2, 2021). Medicare Advantage 2022 Spotlight: First Look. Kaiser Family Foundation. Retrieved from www.kff.org/issue-brief/medicare-advantage-2022-spotlight-first-look.

2 MedicareAdvantage.com's The Best States for Medicare report.

3 Medicare evaluates plans based on a 5-star rating system.