Who is Eligible for Medicare in Texas?

When you have health insurance, one main concern is which insurance company you will select for your coverage? As you approach Medicare eligibility in Texas, age becomes a factor, there is a benchmark you are aiming for; 65. Then what is Medicare all about, and what is with all the letters? To help you understand these important questions we at CoverMile want to take you through Medicare basics, beginning with who is eligible for Medicare. We will also explain some of the alphabet soup that goes along with this major change in your life.

What is Medicare?

Medicare is broken down into four parts: Part A and Part B, (also known as Original Medicare), and Part D. Each covers a separate medical need. There is also a Part C, which is a combination of Parts A, B, and D; it is commonly known as Medicare Advantage.

Let’s take a brief look at each program.

Medicare Part A – Hospital Insurance

Medicare Part A is hospital insurance and covers medical care. Most people receive this portion free as long as they or a spouse has paid Medicare taxes for 10 years. This payment is usually through employment payroll deductions.

Medicare Part A covers:

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

If you have not met Medicare tax requirements you will be required to pay a premium. 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 per month.

In addition, you must enroll in Part A when you first become eligible, otherwise, you will face a penalty which is a percentage fee for double the time you went without enrolling.

Medicare Part B – Medical Insurance

Medicare Part B is the doctor visit portion of Medicare. You can purchase it regardless of your Part A status. For this portion of Medicare, you will pay a monthly premium. In 2024, the standard premium for Part B is $174.70 per month.

Part B covers medically necessary services:

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

Medicare Part B has limited prescription coverage. This includes Alzheimer’s drugs, flu and pneumonia shots, in addition to COVID-19 immunizations.

Like Part A, if you fail to enroll when first eligible, you will pay a penalty when enrolling. However, unlike Part A’s penalty, Part B’s penalty is lifetime.

Medicare Part C – Medicare Advantage

Medicare Part C is also known as Medicare Advantage. This insurance is purchased through private insurance companies. One must enroll in Medicare first, then you can select an Advantage plan.

A Medicare Advantage plan takes Medicare Part A, Part B, and adds Medicare Part D. One can also add benefits such as Dental and Vision. Many insurance companies such as Blue Cross Blue Shield of Texas and UnitedHealthcare Medicare sell MA plans; thus, the cost of these plans can vary.

Medicare Part D – Prescription Coverage

Medicare Part D is the prescription portion of Medicare as Part A and Part B do not include medication benefits. Unlike 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. You can also obtain it when you enroll in Medicare Part C plan.

Part D plans have what is known as the ‘donut hole’ where prescription coverage is reduced. The coverage for the donut hole period in 2024 is, the manufacturer and insurance company pays 75 percent and the insured will pay 25 percent. One reaches the donut hole when they and the insurance company spend $5030 on prescription drugs. You remain in this hole for another $2970 in spending ($8000 accumulative), then you will pay nothing for the remainder of the year.

Am I Eligible for Medicare in Texas?

The next question is who can enroll. Medicare is primarily age-driven. It surrounds an individual’s 65th birthday. There are also medical reasons such as being diagnosed with End Stage Renal Failure or ALS (Lou Gerig’s Disease). One can then receive Medicare when one is younger than 65.

When it comes down to it, who is eligible for Medicare in Texas provides five eligibility opportunities.  

  1. The first is when you become eligible for Medicare in Texas because of age.

Your initial Medicare eligibility period begins three months before the month you turn 65. It includes the month of your birthday and continues for three months thereafter.

  • You are eligible for Medicare by qualifying for a Special Enrollment Period.

After reaching Medicare age, you may continue with health benefits through a job or a spouse’s employer. A Special Event Period is triggered when that health insurance source ends. You have an eight-month window to apply for Medicare without penalty. Coverage begins the month after the day you apply.

  • You are also eligible for Medicare in Texas due to a disability.

You can enroll in Medicare three months before the 25th month of diagnosis of your disability. Benefits 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 be eligible for Medicare in Texas:

  • During the Medicare Open Enrollment period of each year.

Medicare Open Enrollment is between October 15th and December 7th of each year. You can enroll or make changes to your current Medicare coverage. Any such changes will go into effect on January 1st of the following year.

  • During your 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.

Keep in mind that if you delay enrolling in Medicare, there are penalties for both Part A and Part B.

Part AIf you must pay a premium, it can be an additional 10 percent for twice the number of years you did not sign up. For example, if you did not sign up for two years, you will pay the additional premium for four years.

Part BFor 2024, your monthly premium is $174.70. You will pay an extra ten percent for each year you did not sign up. Keep in mind that each year the Part B premium is recalculated, so this number can change.

Medicare also has supplement plans that can cover deductibles, coinsurance, and copays. These are purchased through insurance companies such as Humana Medicare, the same as Part C (Medicare Advantage). Medicare recipients are eligible to enroll at the same time they join Medicare. Contact a CoverMile consultant if you have any questions. We can assist you when you become eligible for Medicare in Texas.

CoverMile are the Medicare Insurance Agents Near Me

If you have questions about who is eligible for Medicare in Texas, our experienced Medicare insurance agents in Austin, Dallas, El Paso, and Houston, Texas can assist you in finding coverage. At CoverMile we are here to help you make the health insurance transition worry-free. Contact us today.

Frequently Asked Questions

  1. Is Medicare in Texas expensive?

    For 2024, Part A will be free for most. If you have to pay a premium, it will be between $278 and $505 depending on how long you or your spouse paid Medicare taxes. For Medicare Part B, all who are eligible for Medicare in Texas will have a premium. For 2024, Medicare Part B has a premium of $174.70. This amount is reviewed and changes annually. You can also select a Medicare Advantage plan which will include Part D prescription coverage. Part D premium varies as it is sold through individual insurance companies.

  2. Am I eligible to sign up for Medicare when I turn 65?

    Normally you will sign up for Medicare during the seven months surrounding your 65th birthday. However, if you have health insurance through an employer or a spouse’s employer, you may wait to sign up until that coverage ends. You will have eight months after that coverage ends to sign up without penalty.

  3. Who is not eligible for Medicare in Texas?

    If you did not have a job that you contributed to Social Security or Medicare taxes and do not have 40 quarters (ten years) of employment contribution history. This can also apply to a spouse whether current, former, or deceased.

  4. Can I become not eligible for Medicare in Texas?

    One can become ineligible for Medicare if they fail to pay their premiums; commit fraud by lying on their application or allowing someone else to use Medicare benefits; or if one recovers from their medical diagnosed condition that allowed them to receive underage Medicare.

  5. Can I get Medicare through Blue Cross Blue Shield of Texas?

    Blue Cross Blue Shield of Texas offers Medicare Advantage plans that offer Medicare Part A, Medicare Part B, and Medicare Part D. They can be either an HMO or a PPO. Unlike their health insurance, you must live within certain counties to be eligible for Medicare Advantage in Texas. Extra financial help and low-income subsidies are available for those who qualify for Medicare in Texas. You can also find Medicare coverage through insurance companies such as UnitedHealthcare Medicare and Humana Medicare.