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Ashford Insurance

Eligibility For Medicare In Texas

Picture of Sonia Ashford

Sonia Ashford

Sonia Ashford is the owner of Ashford Insurance, an independent health insurance agency specializing in Texas Medicare insurance.

Medicare can seem confusing and convoluted to most intelligent folks. However, it doesn’t have to be that way. Ashford Insurance has the essential info you need to know about Medicare in Texas.

Eligibility For Medicare in Texas

Medicare can seem confusing and convoluted to most intelligent folks. However, it doesn’t have to be that way. Ashford Insurance has the essential info you need to know about Medicare in Texas.

When Will I Be Eligible for Medicare in Texas?

You’ll normally become eligible for Texas Medicare when you near your sixty-fifth birthday. The Initial Enrollment Period begins three months before your sixty-fifth birthday month and ends three months after the end of your birthday month.

Individuals younger than this can still enroll if they have Amyotrophic Lateral Sclerosis (ALS) or End Stage Renal Disease (ESRD) or have been receiving Social Security Disability Benefits (SSDI) for 24 months. To see if you’re eligible and/or what you can expect to pay for coverage, Medicare has online tools to check eligibility and premium.

How To Apply for Medicare in Texas

Qualifying for Medicare typically means you’re either a US citizen or you’ve been a legal permanent resident of the US for a minimum of five consecutive years.

Texas residents can enroll in Medicare about three months before their sixty-fifth birthday month. To apply for Medicare coverage, you can visit your local SSA office, enroll over the phone, or sign up online.

  • Locate your local SSA office so you can schedule an appointment and visit them.
  • Call Social Security at 1-800-772-1213 (TTY users can call 1-800-325-0778), Monday through Friday, from 7 a.m. to 7 p.m.
  • Apply online if you meet all of the following requirements:
    • You’re at least sixty-four years and nine months old.
    • You don’t currently have any Medicare insurance.
    • You don’t want to start receiving Social Security benefits now.
    • You aren’t currently receiving Social Security retirement, disability, or survivor benefits.

If you have already received benefits from the Social Security Administration (SSA) or the Railroad Retirement Board (RRB) for more than twenty-four consecutive months, you will usually be enrolled in Medicare automatically.

 Original Medicare, Medicare Parts A&B

 Commonly known as Original Medicare, Parts A and B are the most essential parts of Medicare insurance. Part A refers to hospital insurance that can help pay for inpatient hospital care and follow-up services, while Part B refers to medical insurance that can help pay for outpatient hospital care, doctors’ services, and necessary medical equipment.

Be sure to check out our Medicare Education page for more specifics on Original Medicare.

Parts A and B are the most common parts of Medicare coverage in Texas and throughout the US. It is important to remember that Original Medicare has no yearly Maximum Out of Pocket amount.

Medicare Advantage (Part C)

 Medicare Part C, also known as a Medicare Advantage Plan, is for individuals who carry Parts A and B but want more coverage. An Advantage Plan allows policyholders to choose a private, Medicare-approved insurance provider to get all their healthcare-related services. It sometimes requires premium payments on top of what you already pay for Part B.

Medicare Advantage, Part C typically includes added benefits that aren’t covered by Original Medicare (Parts A and B), such as vision, dental, and hearing coverage, chiropractic care, and prescription drug coverage. Some even have gym memberships at no additional cost.

A significant difference between Original Medicare and Medicare Advantage is Medicare Advantage does have a yearly Maximum Out of Packet amount, so you know the maximum amount you might have to spend on your medical health. This yearly Maximum Out of Pocket does not apply to your prescriptions.

Texas Medigap Plans

 Medicare Supplement Insurance, also known as Medigap, helps pay for out-of-pocket health-related costs that aren’t covered by Original Medicare Parts A and B, like copayments, deductibles, and medical care when traveling outside the US. While Parts A and B typically pay for 80% of medical expenses, Medigap coverage is designed to cover the remaining 20%. Medigap plans are available only with Original Medicare (Parts A and B), but not Part C.

With a Texas Medigap plan, you will have a monthly premium that will increase over time which you will pay whether you use it or not.

Texas Medicare Resources

 While most Medicare programs, resources, and laws are the same across states, Texas does have a few varied factors that are worth consideration:

  • Texas Health Information, Counseling, and Advocacy Program: Formed as a partnership between the Texas Health and Human Services system, the Texas Legal Services Center, and the Area Agencies on Aging, this program offers Medicare counseling and information services to those eligible for Medicare.
  • The Low-Income Subsidy: Also known as “Extra Help,” this service is provided through Medicare Prescription Drug (Part D) coverage. The Low-Income Subsidy can help individuals with limited incomes and assets to pay their prescription drug costs.
  • The Texas Dual Eligible Integrated Care Demonstration Project: In 2014, the Centers for Medicare & Medicaid Services (CMS) announced that the State of Texas was partnering with CMS to “contract with Medicare-Medicaid plans to coordinate the delivery of and be accountable for covered Medicare and Medicaid services for participating Medicare-Medicaid enrollees.”

Last Thoughts: Texas Medicare Doesn’t Have to be a Hassle

The world of Medicare (and health insurance in general) is complex and can be quite confusing for many. But don’t worry—Ashford Insurance has plenty of licensed, experienced Medicare sales agents in Texas to help answer any questions you may have and help you pin down a Medicare plan that feels best for you. Schedule a consultation with an Ashford Insurance Medicare agent in your area to see how simple the process can be.

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Picture of Sonia Ashford

Sonia Ashford

Sonia Ashford, “The Medicare Insurance Lady”, has been helping Medicare eligibles in Texas with their Medicare Insurance since 2005.