Home Health & Wellness Here’s Everything You Should Know About Medicare in Texas

Here’s Everything You Should Know About Medicare in Texas

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Confused about Medicare and when you should enrol? Here’s an easy-to-follow breakdown of everything to know if you live in Texas and might be eligible for Medicare.

Texans aged 65 and older, along with those who are under age 65 and have certain disabilities or diseases, are eligible to apply for medical coverage through Medicare. Medicare is a federal programme that includes Medicare, Medicare Advantage plans, and Medigap.

Here’s a brief summary of each option:

Medicare Part A

In general, Medicare Part A helps cover inpatient care in hospitals, critical access hospitals, and skilled nursing facilities. For most beneficiaries, they don’t have to pay a monthly premium if they are:

  • Age 65 or older and have paid at least 40 quarters of Medicare taxes in their lifetime. f their spouse worked and paid taxes, this could count toward Medicare eligibility.
  • Age 65 and younger and have received benefits from Social Security or the Railroad Retirement Board for at least 24 consecutive months
  • Stricken with end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS)

If you don’t meet one or several of these conditions, you can still receive Medicare Part A benefits after turning 65 if you pay a monthly premium.

Medicare Part B

This option provides medical coverage to anyone who’s eligible for Part A. However, Medicare Part B includes a monthly premium, which is significantly lower than the cost of private insurance. The premium is determined after considering the income history of you and your spouse. Like other types of insurance, you typically have to meet a deductible with Medicare Part B. Your monthly premium will change based on your chosen deductible and could be higher if your income exceeds a certain threshold.

Medicare Part C (Medicare Advantage)

This part is only available through Medicare-approved private insurers and is accessible to anyone who meets traditional Medicare eligibility. If you want to take advantage of these plans in Texas, you must first participate in open enrollment in Medicare. Premiums and co-pay rates differ in Texas compared to other locales, but they should be similar to those provided in other states. Medicare Advantage plans in Texas tend to vary in cost and covered services. For example, some offer prescription drug coverage in addition to vision and dental coverage, which are not covered by basic Medicare.

Medicare Part D

If you need prescription drug coverage and don’t have a Medicare Advantage plan that provides it, Medicare Part D is available to cover the cost of medicines. It’s important to remember to enrol in Medicare Part D as soon as you become eligible. Failure to do so could result in a late enrollment penalty.

When is Medicare Open Enrollment in Texas?

The federal government sets Medicare enrollment periods and deadlines. These are the same regardless of the state you live in. Here are four enrollment dates of which you should be aware:

  • Initial enrollment period. Each individual gets only one initial enrollment period for Medicare. If you’re applying for Medicare because you’re almost 65, your initial enrollment period begins three months before your birthday and ends three months afterwards.
  • 25th disability benefit. If you qualify for Medicare due to a disability and are younger than age 65, Part C enrollment will be based on the date of your 25th disability payment. You’ll have three months before that 25th payment and three months after it to enrol.
  • General enrolment. From January 1 to March 31 of each year, you can enrol to receive Medicare. 
  • Open enrolment. Medicare’s open enrollment occurs each year from October 15 to December 7. You’ll be able to add or drop services, change plans, or amend your current plan.

Write down your enrolment period date

The ins and outs of Medicare can get confusing, especially if you miss the right enrollment period. Your first priority should be to know your exact initial enrollment period and write it down in a calendar or wherever you organise your notes. Once you enrol, you’ll be given easy-to-follow instructions on how to start receiving payments, along with detailed information concerning the benefits available in your Medicare plan.

Ellen Diamond did her degree in psychology at the University of Hertfordshire. She is interested in mental health, wellness, and lifestyle.

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