About Medicare in Texas

Welcome! We Know Medicare is Confusing! Let Us Help! Ashford Insurance is an independent insurance agency specializing in the Medicare market. As an independent agency, we have the freedom to offer any Supplement or Medicare Prescription Drug product from any company. After reviewing all of your doctors and prescriptions, we can give you a true and unbiased opinion.

Are you close to turning 65?  If you or your family is hitting this milestone age soon, then it’s time to take a look at Medicare.   Do you know what it covers?  Where the gaps in coverage are?  When you are eligible to sign up?  Enrolling in Medicare can be an overwhelming and confusing experience.  Benefits may differ from those you had while under a private policy.

About Medicare in Texas

Beneficiaries in Texas can receive coverage through Original Medicare, Part A, and Part B, and then add prescription drug coverage and/or a Medicare Supplement insurance policy for more comprehensive health insurance. Or they can join a private Medicare Advantage plan, also called Medicare Part C. These plans offer at least the same amount of coverage as Medicare Part A and Part B (except for hospice care), but may include other benefits, such as routine vision and dental, hearing, or prescription drug coverage.

Medicare in Texas comes from the United States federal health insurance program enacted in 1966 to cover hospital (Part A) and medical (Part B) expenses for beneficiaries. Over time, Medicare has expanded its program to offer even wider coverage, often referred to as Medicare Part C and Medicare Part D coverage. Also, Medicare coverage is delivered not only by the federal government but also by private insurance companies that are contracted by Medicare to provide benefits to beneficiaries. With so many connecting pieces and providers of coverage, deciding on your Medicare coverage may seem like an exhausting task. To help you, here are some facts about the parts of Medicare and how they can work together in Texas to help you evaluate which Medicare coverage options might be best for you.

Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD). If you or your spouse have worked full-time for 10 or more years over a lifetime, you are probably eligible to receive Medicare Part A for free. If you have to buy Part A, you’ll pay up to $413 each month.

Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. What Medicare covers is based upon, Federal and state laws, National coverage decisions made by Medicare about whether something is covered, and local coverage decisions made by companies in each state that process claims for Medicare. These companies decide whether something is medically necessary and should be covered in their area.

Medicare Part B is available at a monthly rate set annually by Congress ($134 in 2017 for incomes $85000.00 or less for an individual). Part B covers certain doctor’s services, outpatient care, medical supplies, and preventive services. Some seniors are eligible to receive the medical insurance portion (Part B) free as well, depending on their income and asset levels. For more information, inquire about the Qualified Medicare Beneficiary (QMB), Special Low Income Medicare Beneficiary (SLMB), and Qualifying Individual programs through your county social services office.

Remember, in most cases, if you don’t sign up for Part B when you are first eligible, you will have to pay a late enrollment penalty for as long as you have Part B. Your monthly premium for Part B may go up 10% for each full 12-month period that you could have had Part B, but didn’t sign up for it. Also, you may have to wait until the General Enrollment Period (from January 1 to March 31) to enroll in Part B, and coverage will start on July 1 of that year. Usually, you don’t pay a late enrollment penalty if you meet certain conditions that allow you to sign up for Part B during a Special Enrollment Period.

Medicare Part C (Medicare Advantage Plans) is a type of Medicare health plan offered by a private insurance company that contracts with Medicare to provide you with all your Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-for-Service Plans (PFFS), Special Needs Plans (SNP’s), and Medicare Medical Savings Account Plans (MSA’s). If you’re enrolled in a Medicare Advantage Plan, most Medicare services are covered through the plan and are not paid for under Original Medicare. Most Medicare Advantage Plans have prescription drug coverage included.

Medicare Part D (prescription drug coverage) adds prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private-Fee-for-Service Plans, and Medicare Medical Savings Account Plans. These plans are offered by insurance companies and other private companies approved by Medicare.

Medicare Advantage Plans may also offer prescription drug coverage that follows the same rules as Medicare Prescription Drug Plans. Keep in mind, that you may owe a late enrollment penalty if you go without a Medicare Prescription Drug Plan (Part D), or without a Medicare Advantage Plan (Part C) (like an HMO or PPO) or other Medicare health plan that offers Medicare prescription drug coverage, or without creditable prescription drug coverage for any continuous period of 63 days or more after your Initial Enrollment Period is over.

How to apply for Medicare in Texas

The process for applying for Medicare in Texas is the same as in any other state. To qualify for Medicare, you must be either a United States citizen or a legal permanent resident of at least five continuous years. Enrolling manually may be done by visiting your local Social Security Administration (SSA) office. Visit SSA.gov for office hours and to find the closest location to you.

It can also be done online at the Social Security website or over the phone.

Call Social Security at 1-800-772-1213 (TTY users should call 1-800-325-0778), Monday through Friday, 7 AM to 7 PM.
If you worked for a railroad, call the Railroad Retirement Board to apply at 1-877-772-5772 (TTY users call 312-751-4701), Monday through Friday, 9 AM to 3:30 PM.

Confused?  Many People Are. It can seem overwhelming when trying to plan your future coverage and sort through the many options, especially since the choices you make can have a significant effect on your health care and your financial well-being.

Whether an “all-in-one” Medicare Advantage plan or a standalone Part D plan suits you, Ashford Insurance can help. Get a quote for prescription drug plans online now at no cost to you. Or, let one of our licensed agents review your options and find the best drug insurance plan for your unique needs. Just give us a call today at 817-952-3153.

Next, learn: How Medicare Works