Medicare health insurance can be just as costly as Affordable Care Act insurance. Especially when one does not qualify for free Medicare Part A. When one lives on a fixed income, it can mean the difference between carrying insurance and going without. If you do carry free Part A, there is a way to receive assistance with Part B. At CoverMile we aim to help those with Medicare questions in Texas make the transition from traditional health insurance. If you have difficulty with finances, we encourage you to read on.
What is Medicare?
Medicare is a health insurance program for:
One can enroll in Medicare during a seven-month window surrounding your 65th birthday: three months prior, the month of, and three months after. Those with a medical condition can apply upon diagnosis.
Medicare has three parts: Part A, Part B, (also known as Original Medicare), and Part D. Each covers a separate medical need. There is also Medicare Part C. This is a combination of Parts A, B, and D; it is commonly known as Medicare Advantage.
Medicare Part A – Hospital Insurance
Medicare Part A is hospital insurance and covers hospital care. If you have paid Medicare taxes for 10 years, or 40 quarters, it is free. You can also be married and still qualify based on your spouse’s paid status.
If you have between 30 and 39 quarters paid of Medicare taxes, your premium would be $278 for 2024. If your contribution is less than 30 quarters, then your Medicare Part A premium would be $505.
You must enroll in Part A when you are first eligible or face a penalty. This penalty increases each year you do not enroll in Medicare. If you are receiving Social Security, you will automatically be enrolled in Medicare.
Medicare Part B – Medical Insurance
Medicare Part B is the doctor visit portion of Medicare and is optional. You will pay a monthly premium for Part B, For 2024, recipients pay $174.70. One can also sign up for Part B alone without Part A when they must pay a premium for Part A.
Part B covers medically necessary services:
Medicare Part B does not cover prescription drugs. However, it has limited prescription coverage. Alzheimer’s drugs, flu and pneumonia shots, as well as COVID-19 shots, are included.
Like Part A, if you fail to enroll when first eligible, you must pay a penalty when enrolling. However, unlike Part A’s penalty which is double the time you went without enrolling, Part B’s penalty is lifetime.
Medicare Part C – Medicare Advantage
Medicare Part C is also known as Medicare Advantage. Medicare Advantage can be purchased through private insurance companies such as Humana Medicare and UnitedHealthcare Medicare. However, you must first enroll in Medicare Part A, then you can select an Advantage plan.
A Medicare Advantage plan takes Medicare Part A, Part B, as well as Part D, and rolls it into one package, adding benefits such as Dental and Vision. Many insurance companies sell MA plans; thus, premiums can vary. Medicare insurance agents in Austin, San Antonio, and Houston can assist you in finding the best Advantage plan at the lowest cost. Contact CoverMile today to help you find the best plan for your situation.
Medicare Part D – Prescription Coverage
Medicare Part D is the prescription portion of Medicare, as Original Medicare does not include prescription benefits. Unlike Medicare A and B, it is not a plan you can purchase by itself, you must purchase either Part A or B, or both to enroll in Part D.
Medicare Part D will undergo major changes in 2025. The 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 will be paid in full for the year. Medicare will pick up that tab for the remainder of the year.
Insurance companies such as Blue Cross Blue Shield of Texas, Humana Medicare, and UnitedHealthcare offer Medicare Advantage plans, Each has similar Medicare qualifications in Texas beginning in 2025.
If you have questions, contact our Medicare agents in Austin Texas and we can assist you with signing up for Medicare and Medicare Advantage plans.
Qualifying for Medicare in Texas
Medicare Open Enrollment is between October 15th and December 7th of each year. One can enroll or make changes to their current Medicare coverage. Any changes made take effect on January 1st of the following year.
An individual first becomes eligible for Medicare because of their age.
Your initial Medicare eligibility period begins three months before the month you turn 65. This includes the month of your birthday and continues for three months thereafter.
You can qualify for a Special Event Period to enroll in Medicare.
A Special Event Period applies if you had a job that provided benefits and are leaving that job. After your job ends you have an eight-month window to apply for Medicare without penalty. Coverage starts the month after the day you apply.
You can also qualify for Medicare in Texas due to a disability.
You can enroll in Medicare 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.
You can also enroll during the annual Medicare Advantage Enrollment Period. If you are currently enrolled in a Medicare Advantage plan, you have the opportunity to make changes to your current plan from January 1st through March 31st. Your new plan will take effect the month following your change.
If you delay enrolling in Medicare, there are premium penalties for both Part A and Part B.
Part A – If you must pay a monthly premium, you will pay up to 10 percent twice the number of years you did not sign up. Meaning if you did not sign up for two years, you will pay the additional premium amount for four years.
Part B – Your monthly premium is $174.70 for 2024. You will pay an extra ten percent for each year you do not sign up. This is accumulative and it will be permanent. Keep in mind that each year Part B’s premium is recalculated, so this number can change.
Medicare also has supplement Plans F through N that can cover deductibles, coinsurance, and copays. These are purchased through insurance companies such as Humana Medicare, the same as Medicare Advantage. You can enroll at the same time you enroll in Medicare. Contact our Medicare insurance agents in Austin, Houston, or Corpus Christi if you have any questions. We can assist you with your Medicare qualifications in Texas.
Medicare Savings Programs in Texas
Just as it can be difficult to afford health insurance before you retire, Medicare can be equally tough. Medicare has created savings programs that assist those below certain income levels to afford their Medicare Part B premiums and other Part A costs such as copays.
Medicare Savings Program (MSP)
Medicare Savings Programs are for those who have limited income. They are federally funded programs administered by each state’s Medicaid program to assist individuals with affording premium Medicare Part A, Part B, and Medicare Advantage. Federal Poverty Level (FPL) limits apply. There are four MSP programs.
Qualified Medicare Beneficiary (QMB): QMB is for those entitled to Medicare Part A with incomes less than 100 percent FPL. It will help cover Medicare premiums, deductibles, copays, and coinsurance.
| Income Limit (monthly) | Resource Limit | |
| Individual | $1275 | $9430 |
| Married | $1724 | $14,130 |
Specified Low-Income Beneficiary (SLMB): SLMB provides Seniors and adults with disabilities between 100 percent and 120 percent FPL coverage for their Part B premiums. One must be receiving Medicare Part A to qualify.
Qualifying Individual (QI): QI is limited and on a first-come, first-served basis for those with Medicare in Texas. Incomes must fall between 120 and 135 percent FPL. QI covers Medicare Part B premiums. You must be receiving Medicare Part A and cannot be receiving Medicaid to qualify.
| Income Limit (monthly) | Resource Limit | |
| Individual | $1715 | $9430 |
| Married | $2320 | $14,130 |
Qualified Disabled Working Individuals Program (QDWI): This program is for those 64 and younger and not receiving Medicaid or Medicare Part A due to a disability, but still in the workforce. You must also have had to lose your SSI and premium-free Part A because you returned to work. This benefit will pay for your Part A premiums.
| Income Limit (monthly) | Resource Limit | |
| Individual | $5105 | $4000 |
| Married | $6899 | $6000 |
Many of these programs include a low-income subsidy called “Extra Help.” This subsidy assists those with limited means with the cost of prescriptions. The QI, QMB, and SLMB include Extra Help as part of their program offering covered prescriptions for no more than $11.20 per month.
Summary
If you qualify for Medicare Part A but are having trouble with affording Part B and prescription coverage for Part D, Medicare Savings Programs in Texas can assist you with lowering your out-of-pocket costs. Contact CoverMile today. Our experienced Medicare agents in Bastrop and surrounding Texas counties can help you find Medicare coverage today.
Frequently Asked Questions
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Is Medicare in Texas expensive?
If you have to pay a premium for Medicare Part A in 2024, it will be between $278 and $505 depending on how long you or your spouse paid Medicare taxes. For most, it will be free. For Medicare Part B, all will have a premium. Medicare Part B has a premium of $174.70 in 2024. You can also choose a Medicare Advantage plan which will include Medicare Part D prescription coverage, your premium will vary because it is sold through individual insurance companies.
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Are there financial or asset limits on Medicare Savings Programs?
Yes, there are both federal financial and asset limits with all Medicare Savings Programs. Each state can set its own limits. This is one of the Medicare qualifications in Texas. Each program has its own bracket and coverage level.
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Can I get a Medicare Savings Program through Blue Cross Blue Shield of Texas?
No. Medicare Savings Programs are a state assistance program that helps you pay Part A and Part B premiums; they are not insurance. If you have questions about enrollment, contact one of our Medicare insurance agents in Austin, Texas today.
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Do Medicare Savings Programs in Texas pay for Medicare Part D?
No. Medicare Savings Programs only assist with Medicare Part A and Part B premiums, and in some cases Part A copays and coinsurances. However, with these two covered you would have enough funds available to pay for a Part D premium and medications.
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Which Medicare Savings Program pays for Medicare Part A?
Qualified Member Beneficiary is the Medicare Savings Program (MSP) that pays for Medicare Part A premiums, deductibles, copays, and coinsurance. This program is based on income levels: $1275 for an individual and $1724 for married people. All other MSPs cover Part B premiums up to their monthly limits.
