Texas Medicare beneficiaries have access to a range of coverage options, state-specific protections, and free counseling services. This comprehensive Texas Medicare guide covers your SHIP office contacts, Medigap plan availability, birthday rule protections, Medicare Savings Program eligibility, Medicare Advantage options, and how to compare plans. Whether you are turning 65, helping a parent navigate Medicare, or re-evaluating your coverage, understanding Texas Medicare rules is essential for making informed decisions.
All information in this guide has been verified against official state sources, CMS data, and NAIC reports as of April 2026.
In This Texas Medicare Guide:
Texas SHIP — Free Medicare Counseling
Every state has a State Health Insurance Assistance Program (SHIP) that provides free, unbiased Medicare counseling. Texas’s SHIP program can help you understand your coverage options, compare plans, resolve billing issues, and navigate enrollment periods at no cost.
| SHIP Program | HICAP (Health Insurance Counseling and Advocacy Program), operated by Texas Legal Services Center in partnership with Area Agencies on Aging and the Health and Human Services Commission |
| Phone | 1-800-252-9240 |
| Website | https://www.tdi.texas.gov/consumer/hicap/ |
SHIP counselors are trained volunteers and staff who are not affiliated with any insurance company. They do not sell plans. Contact your Texas SHIP office before making any major Medicare decisions.
Texas Medigap (Medicare Supplement) Plans
Medigap plans in Texas help cover out-of-pocket costs not paid by Original Medicare, including the Part A deductible, Part B coinsurance, and skilled nursing facility copays. Medigap plans are standardized by federal law, meaning Plan G from one carrier covers the same benefits as Plan G from another carrier. The difference is premium cost.
Plans available in Texas: A, B, C, D, F, G, K, L, M, N
Most popular plan: Plan G (approximately 54 percent of Texas Medigap enrollees) is the most popular Medigap plan in Texas. Plan G covers all gaps in Original Medicare except the annual Part B deductible ($240 in 2026). Plan N is the most popular lower-premium alternative, with small copays for some doctor visits and ER visits.
Pricing method: Texas uses attained-age-rated Medigap pricing. Premiums increase as you age, which means your costs will rise over time. Buying earlier locks in lower starting premiums.
The average monthly Plan G premium for a 65-year-old in Texas is approximately $163. Plan N averages approximately $112 per month. Actual premiums vary by carrier, age, gender, tobacco use, and zip code. Always compare quotes from at least three carriers.
Texas Medigap Switching Rights
Texas does not have a Medigap birthday rule. Your primary opportunity to buy or switch Medigap plans without medical underwriting is during your initial Medigap Open Enrollment Period, which lasts 6 months starting when you first enroll in Medicare Part B at age 65 or older.
After your initial OEP closes, you may face medical underwriting if you apply for a new Medigap policy. However, federal law provides guaranteed issue rights in specific situations, such as losing employer coverage or leaving a Medicare Advantage plan during your first year.
Texas guaranteed issue protections: Texas requires Medigap insurers to offer at least Plan A to disabled Medicare beneficiaries under age 65 during their 6-month Part B open enrollment period, with a second 6-month enrollment period when they turn 65. Legislation enacted in 2025 requires all Medigap plans to be guaranteed-issue for people under 65 with ESRD or ALS, with premium caps. Beneficiaries who lose Medicaid due to a change in financial situation have a 63-day guaranteed issue right to purchase a Medigap policy.
Texas Medicare Advantage (Part C)
Approximately Approximately 4.4 million people in Texas are enrolled in Medicare.
Medicare Advantage plans in Texas are offered by private insurers as an alternative to Original Medicare. Most MA plans include prescription drug coverage (Part D) and often add dental, vision, and hearing benefits. However, MA plans use provider networks, which can limit your choice of doctors and hospitals.
Key Medicare Advantage considerations in Texas:
- Networks matter: HMO plans require you to use in-network providers except in emergencies. PPO plans allow out-of-network care at higher cost.
- $0 premium plans: Many Texas MA plans have $0 monthly premiums (you still pay your Part B premium).
- Maximum Out-of-Pocket (MOOP): MA plans cap your annual spending, unlike Original Medicare which has no cap.
- Star ratings: CMS rates MA plans 1-5 stars. Higher-rated plans often have lower costs and better coverage.
Top Medicare Advantage carriers in Texas by enrollment:
- UnitedHealthcare
- Humana
- Blue Cross Blue Shield of Texas
- Aetna
- Cigna
Texas Medicare Financial Help Programs
Texas offers Medicare Savings Programs (MSPs) that help low-income Medicare beneficiaries pay for premiums, deductibles, and copays. The four programs are:
- QMB (Qualified Medicare Beneficiary): Pays Part A and Part B premiums, deductibles, coinsurance, and copays.
- SLMB (Specified Low-Income Medicare Beneficiary): Pays Part B premiums only.
- QI (Qualifying Individual): Pays Part B premiums (limited funding, first-come first-served).
- QDWI (Qualified Disabled Working Individual): Pays Part A premiums for disabled workers.
Texas MSP eligibility: QMB: individual 1330/month, couple 1804/month (100 percent FPL). SLMB: individual 1596/month, couple 2164/month (120 percent FPL). QI: individual 1796/month, couple 2435/month (135 percent FPL). Resource limits: individual 9430, couple 14130. Income limits do not include the 20 dollar general income disregard.
Apply through your local SHIP office or your state Medicaid agency for free help determining eligibility.
Top Medicare Insurance Companies in Texas
Top Medigap carriers in Texas:
- AARP/UnitedHealthcare
- Mutual of Omaha
- Cigna
- Blue Cross Blue Shield of Texas
- Aetna
When comparing carriers, focus on premium cost (for identical standardized Medigap plans, benefits are the same — only price differs), financial strength ratings from AM Best (A or higher), customer satisfaction ratings, and claims processing speed.
Texas Medicare Enrollment Periods
Understanding Medicare enrollment deadlines prevents costly late enrollment penalties:
- Initial Enrollment Period (IEP): 7-month window around your 65th birthday (3 months before, birthday month, 3 months after). Enroll in Parts A and B during this period.
- Medigap Open Enrollment: Standard federal 6-month Medigap Open Enrollment Period beginning the first day of the month the beneficiary is both 65 or older and enrolled in Part B. Texas does not extend this period beyond the federal standard.. During this period, insurance companies cannot deny you Medigap coverage or charge higher premiums based on health conditions.
- Annual Enrollment Period (AEP): October 15 through December 7 each year. Switch between Original Medicare and Medicare Advantage, change MA plans, or add/change Part D drug plans.
- Medicare Advantage Open Enrollment Period (OEP): January 1 through March 31. Switch MA plans or return to Original Medicare (and add a Medigap plan, subject to underwriting).
- Special Enrollment Periods (SEP): Available when you lose employer coverage, move, or qualify for other life events.
Additional Texas Medicare protections: 30-day free-look period on all Medigap policies allowing return for full refund. Under-65 disabled beneficiaries guaranteed access to at least Plan A during Part B OEP. 2025 legislation requires guaranteed-issue access to all Medigap plans for under-65 beneficiaries with ESRD or ALS, with premium caps. 63-day guaranteed issue right for beneficiaries who lose Medicaid coverage.
Compare Texas Medicare Plans
Ready to compare Medicare options in Texas? Use the official Medicare Plan Finder or contact your local SHIP counselor for free, unbiased help.
Official Sources & Resources
- Medicare.gov: medicare.gov
- Texas Department of Insurance: https://www.tdi.texas.gov
- HICAP (Health Insurance Counseling and Advocacy Program), operated by Texas Legal Services Center in partnership with Area Agencies on Aging and the Health and Human Services Commission: https://www.tdi.texas.gov/consumer/hicap/
- CMS.gov: cms.gov
- NAIC: naic.org
This Texas Medicare guide was last verified against official sources in April 2026. If you notice outdated information, please contact us.