Medicare is a federal program, so the basics are the same whether you live in Houston, Lubbock, or a small town in the Hill Country. What changes is the layer of private plans on top: Medicare Advantage, Part D drug plans, and Medigap policies are offered county by county, and Texas has 254 counties. This guide explains how Medicare works for Texans, what is specific to Texas, where to get free help, and when a licensed agent is worth a call.
Key takeaways
- Original Medicare (Parts A and B) works the same everywhere. Private plan choices depend on your county.
- Your Medigap open enrollment window is six months from the month you turn 65 and have Part B. Texas has no birthday rule, so that window matters.
- Texas requires Medigap companies to offer Plan A to people under 65 on Medicare because of a disability during a six-month window.
- Free, unbiased counseling is available through Texas's State Health Insurance Assistance Program and 1-800-MEDICARE.
- A licensed agent can compare plans across carriers at no cost to you, but you can also do it yourself on Medicare.gov.
Medicare is federal; your choices are local
Medicare has four parts. Part A covers hospital care, Part B covers doctor visits and outpatient care, Part C is Medicare Advantage, and Part D is prescription drug coverage. Parts A and B are run by the federal government. Parts C and D, along with Medigap, are sold by private insurance companies under federal and state rules.
Those private companies decide which counties they will serve and file their plans for approval each year. That is why the Medicare Plan Finder on Medicare.gov asks for your ZIP code before it shows you anything. A plan available in Dallas County may not exist in a county 50 miles away, and a rural county may have only a handful of options.
For Texans, that means two things. First, the advice you get from a relative in another state may not apply to you. Second, if you move within Texas, your plan may not move with you, and you will usually get a Special Enrollment Period to pick a new one.
Enrollment windows that matter
| Window | When | What you can do |
|---|---|---|
| Initial Enrollment Period | 7 months: the 3 months before your 65th birthday month, that month, and the 3 months after | Enroll in Parts A and B, and pick Medicare Advantage or Part D |
| Medigap open enrollment | 6 months starting the first day of the month you are 65 or older and enrolled in Part B | Buy any Medigap plan sold in Texas with no health questions |
| General Enrollment Period | January 1 to March 31 | Sign up for Part B if you missed your initial window |
| Annual Enrollment Period | October 15 to December 7 | Join, switch, or drop Medicare Advantage and Part D plans for the next year |
| Medicare Advantage Open Enrollment | January 1 to March 31 | If you are in Medicare Advantage, switch plans once or return to Original Medicare |
| Special Enrollment Periods | Triggered by events such as moving or losing employer coverage | Change plans outside the normal windows |
If you are still working past 65 with employer coverage, you may be able to delay Part B without a penalty. That decision has consequences for your Medigap window, so review it before your birthday. Our turning 65 Medicare checklist walks through the timeline.
Your two main paths
Most Texans end up on one of two paths:
- Original Medicare plus a Medigap policy and a standalone Part D plan. You can see any provider in the country who accepts Medicare. Medigap pays some or most of what Original Medicare does not. You pay a Medigap premium on top of Part B.
- A Medicare Advantage plan. A private plan bundles Parts A and B, usually Part D, and often extras like dental or vision. You typically use a network, and your costs depend on how much care you use.
Neither is right for everyone. The trade-offs are covered in Medicare Advantage vs. Medigap. The important Texas-specific point is that switching from Medicare Advantage back to Medigap later may require health underwriting, which brings us to the next section.
Medigap in Texas
Texas follows the federal standardized Medigap plans, labeled by letter (Plan A, Plan G, Plan N, and so on). A Plan G from one company covers the same things as a Plan G from another; only the price and the company's service differ. People who became eligible for Medicare on or after January 1, 2020 cannot buy Plans C or F, which cover the Part B deductible.
Your six-month window
Federal law gives you a six-month Medigap open enrollment period that starts the first day of the month you are 65 or older and enrolled in Part B. During that window, any company selling Medigap in Texas must sell you any plan it offers, regardless of your health. After the window closes, there is no federal guarantee. Companies can ask health questions, charge more, or decline you.
No birthday rule in Texas
Several states have a "birthday rule" or an anniversary rule that lets you switch to an equal or lesser Medigap plan each year without health questions. Texas does not have one. If someone tells you that you can freely switch Medigap plans every year in Texas, they are mistaken or describing another state's law. Shop carefully during your window, because it is the one time you are guaranteed your pick.
Guaranteed-issue situations
Outside the window, you still have a guaranteed right to buy certain Medigap plans in specific situations. Common examples include:
- Your Medicare Advantage plan leaves Medicare or stops serving your county, or you move out of its service area
- Your employer or union retiree coverage that paid after Medicare ends
- You joined Medicare Advantage when you first became eligible at 65 and want to leave within the first year (the "trial right")
- Your Medigap company goes bankrupt or misled you
These rights are time-limited, typically 63 days from when the old coverage ends, and they apply to specific plan letters rather than every plan. The Texas Department of Insurance publishes a Medicare supplement guide that lists the situations and the plans they apply to.
Under 65 in Texas
Federal law does not require companies to sell Medigap to people under 65. Texas law does add a protection: people on Medicare because of a disability get a six-month open enrollment period starting when they enroll in Part B, but it applies only to Plan A. If you are under 65, ask an agent or SHIP counselor about Plan A pricing and whether a Medicare Advantage plan might fit better in the meantime.
Medicare Advantage and Part D in Texas
Texas is one of the largest Medicare Advantage markets in the country, and the big metros have crowded lineups. In Houston, Dallas-Fort Worth, San Antonio, and Austin you will often find dozens of plans, including HMOs, PPOs, and Special Needs Plans for people who also have Medicaid or a chronic condition. Rural counties have fewer choices, and networks can be thin, so checking that your hospital and doctors participate is essential. Our guide to Medicare Advantage in Texas goes county by county on what to check.
Standalone Part D plans are offered by region rather than county, so Texans across the state see a similar list. What differs is which plan covers your specific prescriptions at the lowest total cost, which is why a drug-by-drug comparison matters. See how to compare Medicare Part D plans.
Free, unbiased help in Texas
You never have to pay for Medicare advice. Texas offers several free options:
- Texas's State Health Insurance Assistance Program (SHIP). Trained benefits counselors at local Area Agencies on Aging help you compare plans, apply for savings programs, and sort out billing problems. They do not sell anything. Medicare.gov's contact page links to the SHIP locator.
- 1-800-MEDICARE. Available around the clock for questions about coverage, enrollment, and reporting problems.
- Medicare Plan Finder. The official comparison tool at Medicare.gov shows every Medicare Advantage and Part D plan in your ZIP code with estimated drug costs.
- Texas Department of Insurance. TDI's consumer help line can answer questions about Medigap rules and take complaints about agents or companies.
If your income is limited, ask a SHIP counselor about Medicare Savings Programs, which are run through Texas Health and Human Services, and about Extra Help for prescription costs through Social Security.
When a licensed agent helps
Free counseling is excellent for understanding your options. A licensed agent adds something different: they can enroll you, compare specific plans across the carriers they represent, and stay with you during the year if a claim or a network issue comes up. An agent is especially useful if:
- You take several prescriptions and want someone to run the drug comparison with you
- You want to compare Medigap premiums across companies during your six-month window
- You live in a metro with dozens of Medicare Advantage plans and want them narrowed to the ones that include your doctors
- You are leaving employer coverage and need to line up Part B, Medigap, and Part D at the same time
Agents are paid by the carriers, so their help does not add to your premium. Before you work with one, verify their Texas license and ask which carriers they are appointed with in your county. You can browse Medicare agents in Texas, including agents in Houston, San Antonio, Dallas, Austin, Fort Worth, and El Paso.
Talk to a licensed agent for free
Medicare agents are paid by the insurance carriers whose plans they sell, so you pay nothing extra for their time, and your premium is the same either way. A licensed Texas agent can compare Medigap, Medicare Advantage, and Part D plans in your county, check your doctors and prescriptions, and help you enroll before the deadline. When you are ready, you can find a licensed health insurance agent near you and get connected at no cost.
Frequently asked questions
Is Medicare different in Texas than in other states?
Original Medicare (Parts A and B) is a federal program and works the same in every state. What differs is the lineup of private plans: Medicare Advantage, Part D, and Medigap policies are approved and priced by county or ZIP code, so your options in Harris County can look very different from options in a rural county.
Does Texas have a Medigap birthday rule?
No. Some states let you switch Medigap plans around your birthday without health questions, but Texas does not. Outside your six-month Medigap open enrollment window, Texas insurers can generally ask health questions unless you have a guaranteed-issue right.
When is my Medigap open enrollment period in Texas?
It is the six-month period that starts the first day of the month you are 65 or older and enrolled in Part B. During that window, companies must sell you any Medigap plan they offer without medical underwriting. Texas also gives people under 65 on Medicare because of a disability a six-month window to buy Plan A.
Where can Texans get free, unbiased Medicare help?
Texas's State Health Insurance Assistance Program offers free counseling through benefits counselors at local Area Agencies on Aging. You can also call 1-800-MEDICARE, use the Plan Finder on Medicare.gov, or call the Texas Department of Insurance consumer help line.
Do I need an agent to enroll in Medicare?
No. You can enroll in Parts A and B through Social Security and pick plans on Medicare.gov yourself. An agent is useful when you want someone to compare plans across carriers, check your doctors and prescriptions, and handle paperwork. Their help is free to you because carriers pay them.
Sources
- Medicare.gov: Get started with Medicare
- Medicare.gov: When can I buy a Medigap policy?
- Texas Department of Insurance: Medicare supplement insurance guide
- Medicare.gov: Medicare Plan Finder
- Medicare.gov: Contact Medicare and find free counseling
Read how we research and update articles in our editorial policy.