Medicare offers healthcare coverage to Texas residents age 65 or older, or to Texans that suffer from certain medical disabilities. In 2016, 3,620,000 people are enrolled in Medicare in Texas, accounting for 13.2% of the population in Texas. In 2009 about $11,479 was spent per Medicare enrollee in Texas, approximately 10.75% higher than the national average of $10,365. Between 2015 to 2030 the number of seniors in Texas is expected to rise by an estimated 66.6% according to calculations based off of the 2000 Census. Therefore the number of eligible Medicare beneficiaries in Texas is also projected to increase.
In Texas older and disabled residents and their caregivers can receive free, comprehensive, one-on-one, and unbiased health insurance counseling from the Health Information Counseling and Advocacy Program of Texas (HICAP), a part of a national network of State Health Insurance Assistance Programs (SHIP). Additionally, the state has a Senior Medicare Patrol (SMP) program which is dedicated to educating individuals on how to identify, avoid, and report instances of Medicare fraud, errors, and/or abuse.
Individuals that qualify for Medicare can sign up for Medicare Part A (hospital services) and Part B (medical services) through the Federal government. Part A is generally paid for by paycheck deductions from their working years (or their spouse's) but most Medicare beneficiaries pay for Part B through monthly premiums unless they qualify for financial assistance. If you are eligible for Original Medicare (Parts A & B) or if you are already enrolled in it, you also have the option to enroll in a Medicare Advantage plan (Part C) instead of Original Medicare or add a standalone prescription drug plan (Part D) to your current Original Medicare coverage. Original Medicare offers its beneficiaries flexibility in choosing their providers and you are not limited to a network. However, there is no limit on out-of-pocket medical expenses and you must always pay 20% coinsurance for medical service costs. Medicare Advantage and Medicare Part D insurance plans are sold by private insurance companies that have a contract with Medicare. Many Medicare beneficiaries will elect to enroll in a Medicare Advantage plan that includes prescription drug coverage or purchase a standalone prescription drug plan to go with their Original Medicare coverage. Medicare Advantage plans require you to stay in network but some plans will also cover out-of-network care at a higher cost. Additional benefits of Medicare Advantage plans such as dental, vision, or hearing coverage can help reduce out-of-pocket expenses for seniors with certain medical needs.
Using CMS data HealthPocket found that:
- The average total monthly premium for a 2017 Medicare Advantage plan in Texas is $71.11, 13.81% greater than the national average of $62.48. 26.53% of 2017 Medicare Part C insurance plans in Texas have a $0 monthly premium.
- The maximum possible annual drug deductible in any 2017 Medicare Advantage plan with a drug component is $400, but in Texas the average annual drug deductible for Medicare Part C insurance plans with drug components is $173.32. 20.21% of 2017 Medicare Part C insurance plans with a drug component in Texas have a $0 annual drug deductible.
- The average total monthly premium for a 2017 Medicare Advantage plan without a drug component in Texas is $42.68. 58.63% of 2017 Medicare Part C insurance plans without a drug component in Texas have a $0 monthly premium.
- The average medical out-of-pocket limit for 2017 Medicare Part C insurance plans in Texas is $5,324.43. 25.66% of 2017 Medicare Advantage plans in Texas had a medical out-of-pocket limit of $3,400 or less.
To assist seniors in choosing Medicare plans, CMS assigns star ratings to Medicare Part C and Part D plans each year based on preventive care, chronic condition management, customer service, member satisfaction, and drug pricing. Ratings range from 1 star (a poor plan) to 5 stars (an excellent plan).
- The average overall CMS star rating assigned to Medicare Part C insurance plans in Texas was 3.7 stars in 2017.
- Among Texas's 2017 Medicare Advantage plans with CMS star ratings:
- 1.97% earned a score of 5 stars
- 35.09% earned a score of 4 or 4.5 stars
- 59.61% earned a score of 3 or 3.5 stars
- 3.33% of plans are “Not enough data available” or “Too new to be measured”.
Data on Medicare eligibility, enrollment, and spending by state from Kaiser Family Foundation