Medicare in Texas: Your Local Options and Resources
Written by My65 Playbook Editorial Team
Texas is one of the largest Medicare markets in the country, with over 4.5 million beneficiaries. That means a lot of plan options — but also a lot of complexity. Whether you're just turning 65, moving to Texas, or reviewing your coverage for the first time, here's a practical guide to Medicare as a Texan.
Medicare Is Federal, But Your Options Are Local
Original Medicare — Parts A and B — works the same in Texas as anywhere else in the country. Your eligibility, premiums, and benefits are federally determined. But the Medicare Advantage and Part D plans available to you depend entirely on where you live. Plan availability, premiums, networks, and formularies vary by county.
Someone in Houston (Harris County) may have access to 40 or more Medicare Advantage plans. Someone in a rural West Texas county may have far fewer options. This geographic variation is one reason it's important to evaluate plans based on your specific ZIP code — not on what a plan advertises nationally.
Plan Availability in Texas
Texas's major metro areas — Houston, Dallas-Fort Worth, San Antonio, and Austin — are among the most competitive Medicare Advantage markets in the country. Residents in these areas typically have access to:
- A wide range of HMO and PPO Medicare Advantage plans
- Multiple standalone Part D plans
- Significant variation in premiums, copays, and included extra benefits
In these markets, $0-premium Medicare Advantage plans are common, and plans often compete on extras like dental allowances, over-the-counter benefits, and transportation services.
In rural areas of Texas, plan availability may be more limited. People in less-populated counties may find that Original Medicare with a Medigap supplement offers more consistent access to providers than a network-based Medicare Advantage plan.
How to check your options: Go to medicare.gov and use the Plan Finder tool. Enter your ZIP code to see all plans available in your area, along with premiums, estimated drug costs (if you enter your medications), and quality ratings.
Texas Medicaid and Dual Eligible Programs
Texas has a Medicaid program administered by the Texas Health and Human Services Commission (HHSC). For Medicare beneficiaries with low income and limited resources, Texas Medicaid can work alongside Medicare to reduce or eliminate out-of-pocket costs.
Medicare Savings Programs (MSPs)
Texas offers four Medicare Savings Programs that help pay Medicare costs for people who meet income and asset limits:
Qualified Medicare Beneficiary (QMB): Helps pay Medicare Part A and Part B premiums, deductibles, coinsurance, and copays. Enrollees pay little or nothing out of pocket for Medicare-covered services when they see a provider who accepts Medicaid.
Specified Low-Income Medicare Beneficiary (SLMB): Helps pay the Part B premium only. Income limit is slightly higher than QMB.
Qualifying Individual (QI): Also pays the Part B premium. Available to people with income up to 135% of the federal poverty level. Slots are limited and filled on a first-come, first-served basis.
Qualified Disabled and Working Individuals (QDWI): For people under 65 who have Medicare due to disability and are working, it helps pay the Part A premium.
To apply for any Texas Medicare Savings Program, contact Texas Health and Human Services at 2-1-1 (dialing 2-1-1 from any Texas phone connects you to a benefits navigator) or visit your local HHSC benefits office.
Full Dual Eligibility in Texas
People who qualify for both Medicare and full Medicaid are called "dual eligible" beneficiaries. Texas Medicaid covers many services Medicare doesn't — including some long-term care services and supports.
Dual-eligible Texans may be eligible for Dual Eligible Special Needs Plans (D-SNPs), a type of Medicare Advantage plan specifically designed to coordinate Medicare and Medicaid benefits. D-SNPs often provide extra care coordination, transportation, and benefits for people with complex health needs.
If you think you may qualify for both Medicare and Medicaid in Texas, speaking with a SHIP counselor or calling Texas 2-1-1 is a good first step.
Texas SHIP: Free Local Help
The State Health Insurance Assistance Program (SHIP) provides free, unbiased Medicare counseling from trained volunteers and staff. In Texas, SHIP is called Texas SHIP and is administered by the Texas Department on Aging and Disability Services.
Texas SHIP counselors can help you:
- Understand your Medicare options
- Compare Medicare Advantage and Part D plans
- Apply for Medicare Savings Programs
- Understand Medicare Supplement (Medigap) options
- File Medicare appeals
- Identify Extra Help eligibility
To reach Texas SHIP: Call 1-800-252-9240 or visit hhs.texas.gov and search for "SHIP." Counseling is available by phone and in person at local Area Agencies on Aging locations across the state.
SHIP counselors are not insurance agents and do not sell any products. Their advice is completely independent.
Texas Area Agencies on Aging
Texas is served by 28 Area Agencies on Aging (AAAs), which coordinate services for older Texans at the regional level. In addition to SHIP counseling, AAAs can connect you to:
- Caregiver support services
- Transportation assistance
- Meals and nutrition programs
- Legal aid for seniors
- Long-term care ombudsman services
To find your local AAA in Texas, visit eldercare.acl.gov or call the Eldercare Locator at 1-800-677-1116.
Texas Key Medicare Resources at a Glance
| Resource | Contact |
|---|---|
| Texas SHIP (free counseling) | 1-800-252-9240 |
| Texas HHS Benefits (Medicaid, MSPs) | 2-1-1 |
| Eldercare Locator / Local AAA | 1-800-677-1116 |
| Medicare Plan Finder | medicare.gov/plan-compare |
| 1-800-MEDICARE | 1-800-633-4227 |
| Social Security (Medicare enrollment) | 1-800-772-1213 or ssa.gov |
A Note for New Texas Residents
If you've recently moved to Texas from another state, you'll want to review your Medicare coverage. If you had a Medicare Advantage plan, moving may take you out of the plan's service area, triggering a Special Enrollment Period. You should also evaluate whether Medigap plans available in Texas differ from your previous state.
Texas does not have "birthday rule" protections for Medigap like some other states (California has this; Texas does not). Once your Medigap Open Enrollment Period closes, switching plans in Texas typically requires medical underwriting.
If you're new to Texas and have Medicare questions, contacting Texas SHIP is a solid first step.
Have questions? Call 1-877-443-3251 for free, no-obligation help from a licensed agent.
This is an educational website and is not affiliated with or endorsed by Medicare or any government agency. We connect consumers with licensed insurance agents who can help with Medicare enrollment. Not all plans or options are available in all areas. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare Disclaimer
This is an educational website and is not affiliated with or endorsed by Medicare or any government agency. We connect consumers with licensed insurance agents who can help with Medicare enrollment. Not all plans or options are available in all areas. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
Frequently asked questions
How many Medicare plans are available in Texas?
Plan availability in Texas varies by county. Major metro areas like Houston, Dallas-Fort Worth, San Antonio, and Austin typically have 30–50 or more Medicare Advantage plan options plus multiple Part D plans. Rural counties may have fewer choices. Check medicare.gov/plan-compare and enter your specific ZIP code for accurate results.
What is Texas SHIP and how can it help me?
Texas SHIP (State Health Insurance Assistance Program) provides free, unbiased Medicare counseling from trained volunteers and staff. They can help you compare plans, apply for Medicare Savings Programs, understand Medigap options, and file Medicare appeals. Call 1-800-252-9240 to reach Texas SHIP. They do not sell insurance.
Can Texas Medicaid help pay my Medicare costs?
Yes. Texas offers Medicare Savings Programs (MSPs) that can help pay Medicare Part A and B premiums, deductibles, and cost-sharing for people who meet income and asset limits. Programs include QMB, SLMB, and QI. Contact Texas Health and Human Services by dialing 2-1-1 to learn more or apply.
