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Texas Medicare Insurance

Medicare in Texas

Medicare offers healthcare coverage to Texas residents age 65 or older, or to Texans that suffer from certain medical disabilities. In 2015, 3,633,78 people are enrolled in Medicare in Texas, accounting for 13% 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.

Local Medicare Resources

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.

Types of Medicare Coverage

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.

Texas 2017 Medicare Advantage Plans at a glance

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”.

Sources:

Data on Medicare eligibility, enrollment, and spending by state from Kaiser Family Foundation

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Texas Medicare Insurance Companies

There are 31 Medicare insurance providers that offer affordable and comprehensive Medicare insurance in Texas. Of these, the companies that offer the largest variety of plans to choose from are UnitedHealthcare, Humana, and Aetna. In Texas,. The following are all medicare insurance providers in Texas:

Humana

16 Plans

Aetna

9 Plans

Baylor Scott & White Health Plan

7 Plans

WellCare

5 Plans

Care Ní Care Insurance Company

3 Plans

Blue Cross Blue Shield of New Mexico

3 Plans

Universal American, A WellCare Company

2 Plans

CHRISTUS Health Plan Generations

2 Plans

Amerigroup

2 Plans

Superior HealthPlan

1 Plans

Magellan Rx Medicare

1 Plans

Cigna-HealthSpring CarePlan

1 Plans

CareNCare

1 Plans

CLOVER HEALTH

1 Plans

Baylor Scott & White Health Plan

1 Plans

Baylor Scott & White Health Plan

1 Plans

Baylor Scott & White Health Plan

1 Plans

Amerigroup STAR+PLUS MMP

1 Plans

Allwell

1 Plans

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2018 Best Medicare Plans in Texas

There are 103 medicare plans in Texas. The following are the 10 highest rated medicare plans in Texas based on their CMS rating for the plan's overall quality.

Monthly CostPlan NameCMS Rating
from $0KelseyCare Advantage - KelseyCare Advantage Rx (HMO) - Fort Bend County
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from $73KelseyCare Advantage - KelseyCare Advantage Rx+Choice (HMO-POS) - Fort Bend County
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from $0UnitedHealthcare - AARP MedicareComplete Focus (HMO) - Aransas County
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from $0UnitedHealthcare - AARP MedicareComplete Plan 1 (HMO) - Austin County
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from $0UnitedHealthcare - AARP MedicareComplete (HMO) - Angelina County
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from $0UnitedHealthcare - AARP MedicareComplete SecureHorizons (HMO) - Nueces County
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from $0UnitedHealthcare - AARP MedicareComplete SecureHorizons Plan 1 (HMO) - Collin County
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from $22UnitedHealthcare - AARP MedicareComplete SecureHorizons Plan 2 (HMO) - Collin County
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from $36UnitedHealthcare - Erickson Advantage Freedom (HMO-POS) - Collin County
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from $43UnitedHealthcare - Erickson Advantage Signature with Drugs (HMO-POS) - Collin County
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Best Texas Medicare Plans for Managing High Blood Pressure

The following are the 5 highest rated medicare plans in Texas based on their CMS rating for the plan's ability for controlling high blood pressure.

Monthly CostPlan NameCMS Rating
from $34Humana - HumanaChoice R4182-003 (Regional PPO)
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from $24Humana - HumanaChoice R4182-004 (Regional PPO)
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from $43UnitedHealthcare - Erickson Advantage Signature with Drugs (HMO-POS) - Collin County
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from $36UnitedHealthcare - Erickson Advantage Freedom (HMO-POS) - Collin County
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from $0UnitedHealthcare - AARP MedicareComplete Plan 1 (HMO) - Austin County
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Best Texas Medicare Plans for Managing Diabetes

The following are the 5 highest rated medicare plans in Texas based on their CMS rating for the plan's ability for diabetes care including: eye exam, kidney disease monitoring, blood sugar controlled and cholesterol controlled.

Monthly CostPlan NameCMS Rating
from $123Baylor Scott & White Health Plan - SeniorCare Premium - Enhanced Rx (Cost) - Anderson County
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from $123Baylor Scott & White Health Plan - SeniorCare VIP - Enhanced Rx (Cost) - Anderson County
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from $123Baylor Scott & White Health Plan - SeniorCare Preferred - Enhanced Rx (Cost) - Anderson County
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from $76Baylor Scott & White Health Plan - SeniorCare Premium - Basic Rx (Cost) - Anderson County
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from $76Baylor Scott & White Health Plan - SeniorCare VIP - Basic Rx (Cost) - Anderson County
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Best Texas Medicare Plans for Managing Rheumatoid Arthritis

The following are the 5 highest rated medicare plans in Texas based on their CMS rating for the plan's ability for rheumatoid arthritis management.

Monthly CostPlan NameCMS Rating
from $13BlueCross BlueShield of Texas - Blue Cross Medicare Advantage Premier (HMO) - El Paso County
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from $0BlueCross BlueShield of Texas - Blue Cross Medicare Advantage Basic Plus (HMO-POS) - Cameron County
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from $0BlueCross BlueShield of Texas - Blue Cross Medicare Advantage Basic (HMO) - El Paso County
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from $21BlueCross BlueShield of Texas - Blue Cross Medicare Advantage Select (HMO) - Atascosa County
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from $0BlueCross BlueShield of Texas - Blue Cross Medicare Advantage Value (HMO) - Atascosa County
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Best Texas Medicare Plans for Managing Osteoporosis

The following are the 5 highest rated medicare plans in Texas based on their CMS rating for the plan's ability for osteoporosis management.

Monthly CostPlan NameCMS Rating
from $35Cigna-HealthSpring - Cigna-HealthSpring Preferred (PPO) - Collin County
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from $0CLOVER HEALTH - Clover Health TX Green (PPO) - Bexar County
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from $119Care Ní Care Insurance Company - Care N' Care Choice Premium (PPO) - Collin County
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from $49Care Ní Care Insurance Company - Care N' Care Choice Plus (PPO) - Collin County
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from $34Humana - HumanaChoice R4182-003 (Regional PPO)
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Most Popular Medicare Doctors in Texas

The following are the most popular medicare doctors in Texas based on the provider utilization and payment data published by the U.S. Department of Health & Human Services.

NameSpecialtyLocation
SurgerySAN ANTONIO, TX
SurgeryGARLAND, TX
SurgeryDALLAS, TX
SurgeryDALLAS, TX
SurgerySAN ANTONIO, TX
SurgeryDALLAS, TX
SurgeryHOUSTON, TX
Internal MedicineAMARILLO, TX
Internal MedicineSAN ANTONIO, TX
SurgerySAN ANTONIO, TX
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Browse Medicare Plans by Cities

  1. Houston, TX
  2. San Antonio, TX
  3. Dallas, TX
  4. Austin, TX
  5. Fort Worth, TX
  6. El Paso, TX
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