Texas residents have access to the federal Medicare program. Traditional Medicare refers to Part A and B of Medicare. While Medicare provides basic healthcare benefits, it does not cover 100% of charges. There are supplemental insurance plans designed to help you fill in the “gaps” and we will discuss those options later on in this article. Medicare Part A comes free as long as you have worked at least a total of 10 years (40 quarters). If you do not have 10 full years work experience/tax filing, you may be required to pay a premium for Medicare Part A. In addition, if you wish to obtain Medicare Part B, you must pay an additional monthly premium; click here to see Part B premium costs. To learn more about Medicare Part A or B premium costs, you can contact your local Social Security office. Below is a helpful chart summarizing the features of the 4 basic parts to Medicare coverage.

Coverage and Benefits

Medicare Part A (Hospital Coverage)

  • Inpatient care in hospitals
  • Skilled nursing facility care
  • Hospice care
  • Home health care
Medicare Part B (Medical Insurance)

  • Services from doctors and health providers
  • Outpatient care
  • Home health care
  • Durable medical equipment
  • Some preventive services
Medicare Part C (Medicare Advantage)

  • Includes all benefits and services covered under Part A and Part B
  • Usually includes Medicare prescription drug coverage (Part D) as part of the plan
  • Offered by Medicare-approved private insurance companies
  • May include extra benefits and services for an extra cost
Medicare Part D (Drug Coverage)

  • Helps cover the cost of prescription drugs
  • Run by Medicare-approved private insurance companies
  • May help lower your prescription drug costs and help protect against higher costs in the future

Introduction to Medicare Insurance Programs Available in Texas:

In Texas alone, there are about 3,187,332 Medicare beneficiaries. Of those, 29% or 924,326 are enrolled into a Medicare Advantage Plan, and about 18% or 566,289 are enrolled into a Medicare Supplement (aka Medigap) Plan. This leaves the remaining 1,696,717 individuals to be either covered by an alternative individual healthcare plan, employer-sponsored group or retiree plan, or without additional coverage other than basic Medicare benefits.

It is important to understand that supplemental Medicare plans cannot be purchased if you are not currently enrolled in Medicare. For more information on Medicare enrollment, go ahead and click that link.

Why Purchase Additional Coverage To Supplement Basic Medicare?

Medicare only covers a small portion of your total healthcare costs. There are a few things that Medicare may not cover at all (like elective cosmetic surgery), however there are many things that are approved by Medicare, but are only partially covered. For example; if you need any Medicare Part A (Hospital) services, you are required to pay the Part A annual deductible first before Medicare would cover anything.

Medicare Part A Costs in 2022 Medicare Part B Costs in 2022
  • Part A is premium-free for most
  • Part A deductible is $1,556 per benefit period
  • Inpatient hospital stay days 61-90 is $389
  • The standard Part B premium is $170.10
  • The annual deductible for Part B is $233
  • Medicare pays 80%, you pay 20% out-of-pocket

Likewise, if you needed any Medicare Part B (Medical) coverage, you would not only be required to meet the Part B annual deductible, but you would also need to pay the 80/20 co-insurance portion of the costs. This means that Medicare pays 80% of the costs for Part B benefits, and you have to pay the remaining 20%. By now, I think you can see the shortcomings of Medicare benefits alone, and why it is extremely important to consider purchasing additional insurance, like Medicare Supplement Plans or Medicare Advantage Plans, to help pay these out-of-pocket costs.

Coverage Choice #1: Medicare Supplement Plans

Medicare Supplement Plans are also knows as Medigap Plans. Medigap plans are designed to fill in the “gaps” left by Medicare (hence the word MediGAP). Currently, there are 10 different Medigap plans on the market, and all plans are designed and regulated by the federal government. The ten plans are organized in a letter system, and they consist of: Plan A, B, C, D, F, G, K, L, M, and N. Plans E, H, I, and J were eliminated on June 1st, 2010 due to the Medicare modernization act which was meant to streamline the policies on the market and bring the core benefits up-to-date. All 10 plans currently sold today must offer the same benefits and coverage (regardless of company), meaning price is the only difference. This makes the shopping process easy on the consumer knowing they are comparing apples to apples.

Below is a Medigap policy comparison chart showing what each plan covers:

Top Medicare Supplement Plans in the Area

Type Starting From Part A Deductible Part B Deductible Excess Nursing Travel
F $91 $0 $0 100% Covered 100% Covered 100% Covered Request Info
C $95 $0 $0 Not Covered 100% Covered 100% Covered Request Info
G $95 $0 $147 100% Covered 100% Covered 100% Covered Request Info
B $87 $0 $147 Not Covered Not Covered Not Covered Request Info
N $71 $0 $147 Not Covered 100% Covered 100% Covered Request Info
D $85 $0 $147 Not Covered 100% Covered 100% Covered Request Info
A $69 $1 $147 Not Covered Not Covered Not Covered Request Info
L $76 $304 $147 Not Covered 75% Covered Not Covered Request Info
K $51 $608 $147 Not Covered 50% Covered Not Covered Request Info
M $84 $608 $147 Not Covered 100% Covered 100% Covered Request Info

Coverage Choice #2: Medicare Advantage Plans

Medicare Advantage Plans are also known as Medicare Part C, or Medicare Replacement Policies. There is a lot of confusion regarding these types of policies and how they work. We will try to eliminate that confusion here. Medicare Advantage plans are a “replacement” of Medicare, and if selected—although you will technically still have your Medicare Parts A & B coverage activated, Medicare will no longer be the one paying your claims. Rather, your new Medicare Advantage Plan will be your primary health insurance provider. Medicare Advantage is a specific type of insurance plan that has been approved by Medicare to offer “equal or greater benefits” comparable to what Medicare provides. Individuals that elect this option will be required to follow the rules and regulations of the specific company they choose, since that plan now stands in place of Medicare.

Medicare Advantage plans can combine many benefits into one policy, such as drug coverage, vision & dental, etc. This tends to be a main reason why many individuals like this type of coverage. The only downfall with Medicare Advantage plans is that you are required to stay within the network of providers that your company offers.

If you have an HMO (Health Maintenance Organization) type policy, your network may be more restricted—whereas if you have a PPO (Preferred Provider Organization) type policy, you may have more flexibility to see the doctors and providers that you choose. However, in either plan type, you are still required to stay within the company’s network and cannot simply choose any provider at your free will.

Useful Medicare Contacts:

Below is our directory search tool with helpful Medicare-related contacts. This tool will help you locate contacts for agencies like Medicare, Social Security, the State Health Insurance Assistance Program, and more.

Useful Contacts

Choose at least one topic area you are interested in: Select All

Help with my Medicare options & issues
Other insurance programs
Complaints about my care or services
General health & health conditions
Claims & billing
Health care facilities & services in your area

Helpful Medicare-Related Healthcare Definitions:

  • HMO: Health Maintenance Organization, this refers to a network of doctors and hospitals with a plans’ network.
  • PPO: Preferred Provider Organization, this refers to a network of doctors and hospitals with a plans’ network.
  • Co-Pay: Amount of money charged per visit to doctor, specialist, etc.
  • Co-Insurance: A percentage required by the policyholder to pay out-of-pocket. For example, 80/20 coinsurance means the insurance company will cover 80% of the charges, and the policyholder pays the remaining 20% of the charges.
  • Deductible: This is the amount of money required out-of-pocket by the policyholder before the insurance will kick-in and pay for any remaining charges. For example, a policy with a $1,000 deductible means that you must pay full healthcare costs out-of-pocket up to $1,000 before the plan will start coverage.
by Lindsay Malzone, Lindsay Malzone is the Medicare expert for Medigap.com. She's been contributing to many well-known publications as an industry expert since 2017. Her passion is educating Medicare beneficiaries on all their supplemental Medicare options so they can make an informed decision on their healthcare coverage.