How to Qualify for Medicare Part D Texas

When you are approaching Medicare age you will be filled with questions. One of those will be about prescription benefits because you probably heard that Original Medicare does not cover the list of medications you are now taking. There is an answer, Medicare Part D. Through this article we hope to clarify and ease your mind about your medical needs and how to qualify for Medicare Part D Texas.

What is Medicare?

As you get older, you may no longer need to buy health insurance Texas through the Affordable Care Act. Medicare is a health insurance program for those 65 or older, those 65 and younger with a qualified disability, and those with End Stage Renal Disease. You enroll in Medicare during a seven-month window surrounding your 65th birthday: three months prior, the month of, and three months after. Your window can also be triggered by a disability diagnosis.

Medicare is split into three parts, Part A, Part B, and Part D. Each covers a different medical need. There is a Part C, which is a combination of Parts A, B, and D, and is commonly known as Medicare Advantage.

Medicare Part A – Hospital Insurance

Once an individual turns 65, they are eligible for Medicare Part A. Medicare Part A is hospital insurance and covers hospital care:

  • Inpatient hospital care
  • Skilled Nursing Facility
  • Hospice
  • Surgery
  • Lab Testing
  • Home Health Care

As long as you have paid into the system for 10 years, 40 quarters, it is free, otherwise, there will be a premium when you enroll. For 2024, Medicare Part A premium is $505 for those with fewer than 30 quarters, for those with 30 to 39 quarters this premium is reduced to $278.

Keep in mind that you must enroll in Part A when you first become eligible or face a penalty. This penalty increases each year you go without enrolling in your Medicare policy. The good news is that if you have contributed to Medicare through payroll deductions, you may automatically be enrolled in Medicare, otherwise you will have the seven-month window to enroll.

Medicare Part B – Medical Insurance

Medicare Part B is available to those who are covered under Part A. Here, regardless of your Part A status, you will pay a monthly premium. For 2024, the standard premium for Part B is $174.70. Part B will cover medically necessary doctor services:

  • Doctor’s Visits
  • Outpatient Care
  • Durable Medical Equipment
  • Home Health Care
  • Mental Health
  • Preventive and Screening Services

While Medicare Part B does not cover prescription drugs, it has limited prescription drug coverage. Alzheimer’s drugs are part of this. This can include flu and pneumonia shots, including COVID-19.

Just like Part A, if you fail to enroll when you first become eligible, you must pay a penalty when you finally do enroll. However, unlike Part A’s penalty which is just double the time you went without enrolling, Part B’s penalty is lifetime.

Medicare Part C – Medicare Advantage

Medicare Part C, better known as Medicare Advantage, is Medicare insurance purchased through a private insurance company. It takes Medicare Part A, Part B, and Part D, then adds benefits that the others lack, such as Dental and Vision.

What is Medicare Part D?

Medicare Part D is Medicare’s prescription drug program. One can apply for Medicare Part D during Open Enrollment which is between October 15th and December 7th of each year. Of the over 67 million enrolled in Medicare, 80 percent have Part D coverage. After joining Medicare Part A, you have the option of signing up for Part B. Just like you do not have to sign up for Part B, you have the option whether or not you want to enroll in Medicare Part D. However, just like Part B, the longer you wait, the more you will have to pay due to penalties.

To join Medicare Part D, you need to sign up for Medicare Part A or Part B and pay the premium. The cost can vary by plan provider. Texas has up to 22 Plan D offerings, depending on the area you live in. The average premium for Part D in 2024 is $34.70.

What does Medicare Part D Cover?

Medicare Part D pays for your medications, generally on a tier platform, this can differ, depending on the insurance company you sign up with.

  • Tier 1 – lowest copay: generic drugs
  • Tier 2 – medium copay; preferred brand-name drugs
  • Tier 3 – higher copay; non-preferred name brand-named
  • Tier 4 – highest copay; specialty drugs with highest cost drugs

Original Medicare does cover some medications such as Insulin under its Durable Medical Benefit, but this exemption is limited.

Medicare Deductibles:

Medicare’s deductible is $545 for 2024, the initial coverage limit is $5030 at 75 percent. Then a covered person reaches the coverage gap phase, sometimes called the donut hole. Part D enrollees pay 25 percent while 70 percent is covered by drug manufacturers and the plan itself covers 5 percent.

Medicare Part D will undergo major changes in 2025. The long-lived coverage gap is being eliminated. This will impact the Catastrophic Phase by lowering it from $3300 to $2000. Once you reach your $545 deductible, you pay your 75/25 portion until you reach $2000, then you are paid in full for the year. Medicare will begin to pick up that tab for the remainder of the year.

How Do I Get Medicare Part D?

There are two ways to qualify for Medicare Part D.

  1. When you first become eligible for Medicare.

This begins the month after the date of your enrolment. If you plan for your benefits to begin the day you turn 65, you should enroll the month prior.

  • If you become eligible for Medicare due to a disability.

You can enroll three months before the 25th month of your disability. Benefits will begin on the first day of the 25th month. If you enroll later, up to the 28th month, your coverage will begin the first of the month after you enroll.

These rules are the same whether you are choosing a standalone Part D plan or Medicare Advantage.

Are There Alternatives to Medicare Part D?

Medicare Advantage has grown in popularity over the years. More than 32.5 million Medicare beneficiaries are enrolled in Medicare Advantage as of 2023. This is nearly half of those enrolled in the Medicare program. This will be welcome to those who have high prescription costs.

If one desires to purchase Medicare Parts A, B, and D, they can look into a Medicare Advantage Plan. Not only would this save money, but it would also extend to you additional benefits that Original Medicare does not offer.

Medicare Advantage plans are required to cover all services covered by Medicare Part A and Medicare Part B. Then you receive your prescription coverage through Part D. In addition, you will receive dental and vision coverage, a benefit that is unavailable with Medicare Part A or Medicare Part B.

Who has the best Medicare Advantage coverage?

UnitedHealthcare has the best Medicare Advantage plan offering in Texas, having coverage for 79 percent of Texans.

Blue Cross Blue Shield of Texas comes in at a close second. They offer 2466 county plans nationwide with up to 18 different Medicare Advantage options depending on which county you live in.


Medicare Part D is an important part of your Medicare package, especially if you take maintenance medication. If you have questions on how to qualify for Medicare Part D Texas or need assistance with signing up for Medicare, contact CoverMile today. Our experienced agents can help you buy health insurance Texas today.

Frequently Asked Questions

  1. Is Medicare Part D Texas expensive?

    The average cost for Medicare Part D in 2024 is $34.70. Keep in mind that this is a base cost. Since most Medicare Part D Texas plans are sold through private carriers, prices are subject to change. Low-income subsidies are available for those who qualify. In 2023, 13.4 million Part D recipients received premium and cost-sharing assistance. This can help enrollees when they buy health insurance Texas pay as little as zero dollars for their plan.

  2. Can I apply for Medicare Part D before I am eligible for Medicare?

    In most cases you will need to wait until you are 65 years old to apply for Medicare Part D. However, you may apply for Medicare Part D if you are diagnosed with a qualifying disability such as Lou Gehrig’s Disease or End-Stage Renal Failure. With these two illnesses, you can receive immediate Medicare Part D Texas benefits. Other illnesses could qualify, but you would need to wait 25 months to receive MPD benefits.

  3. What is Medigap Insurance?

    Under Medicare, there are additional plans that you can add for coverage. Plan A – N. These Medigap plans assist with paying coinsurance, copayments, and other medical expenses such as hospice care and skilled nursing facility care.  Some plans will also pay Part A and Part B deductibles.

  4. Does Medicare Part D cover weight loss drugs like Ozempic?

    If a physician prescribes Ozempic to a patient for type 2 diabetes Medicare Part D will cover the prescription. However, Part D will not cover Ozempic for weight loss because it is considered off-label use.

  5. Do I need both Medicare Part A and B to get Medicare Part D?

    No. Medicare Part D can be added to Part A, Part B, or both. However, Part D cannot be purchased as a stand-alone plan by itself.