Medicare in Texas
Medicare in Texas — What You Need to Know
Texas is the second-largest state in the country — and one of the most complex for Medicare. Plan availability, provider networks, and costs can change dramatically from one county to the next.
Whether you’re in Houston, the Hill Country, or a small town in West Texas — understanding how Medicare works in your area matters.
No pressure. Just clear, Texas-specific guidance.
Why Medicare in Texas Is Different
Texas isn’t just big — it’s one of the most varied Medicare markets in the country. What works in Dallas may not even be available in Lubbock.
Medicare beneficiaries in Texas
Counties — each with different plan options
Largest Medicare population in the U.S.
Medicare Supplement (Medigap) Rules in Texas
Unlike some states, Texas follows federal Medigap rules without additional state-level protections. That makes your initial enrollment window critical.
Your Medigap Open Enrollment Period
You have a one-time, 6-month window starting when you are 65 or older and enrolled in Part B. During this time:
After This Window Closes
In Texas, the decision about whether to enroll in a Supplement plan — and when — is one of the most consequential Medicare decisions you’ll make.
Urban vs. Rural: Two Very Different Medicare Experiences
Texas has some of the most populated metro areas in the U.S. — and some of the most remote. Your Medicare experience depends heavily on where you live.
Urban & Suburban Texas
Houston • DFW • San Antonio • AustinRural & Small-Town Texas
West Texas • Panhandle • East Texas • Hill CountryIn rural Texas, Original Medicare with a Supplement plan often provides the most reliable coverage — because it works with any Medicare-accepting doctor without network restrictions.
Medicare Advantage in Texas
Texas is one of the top Medicare Advantage markets in the country — but plan quality and availability depend entirely on your ZIP code.
In Major Metros
Residents of Houston, DFW, San Antonio, Austin, and El Paso often have access to 30–60+ Advantage plans, including HMO, PPO, HMO-POS, and Special Needs Plans. Many include dental, vision, hearing, fitness benefits, and Part B Givebacks.
Outside Major Metros
Plan availability drops significantly in rural counties. Network limitations become real — your closest in-network specialist may be hours away. For many rural Texans, Original Medicare with a Supplement plan offers more practical, reliable access to care.
Important for All Texas Residents
Texas-Specific Enrollment Considerations
Retiring in Texas
Many people relocate to Texas for retirement, attracted by no state income tax and lower cost of living. If you’re moving from another state, you’ll trigger a Special Enrollment Period. Plan options in your new Texas ZIP code will likely be completely different from your previous state — review them carefully.
➡ Turning 65 GuideTexas Oil & Gas / Energy Retirees
Many Texas retirees come from energy companies that offer retiree health benefits. This coverage is not the same as active employer coverage — it typically expects Medicare to be your primary payer. Delaying Part B enrollment because you have retiree benefits can result in permanent penalties.
Rural Hospital Access
Texas has experienced more rural hospital closures than almost any other state. If you live in a rural area, your Advantage plan’s network matters even more — if the nearest in-network hospital closes or isn’t nearby, you may face longer drives and higher out-of-network costs. Original Medicare with a Supplement has no network restrictions.
Part D in Texas
Prescription drug costs and coverage vary by county. A Part D plan that’s cost-effective in El Paso may not be available in Beaumont. Always compare formularies, drug tiers, and preferred pharmacies specific to your ZIP code — especially if you take specialty medications.
➡ Learn About Part DWinter Texans & Seasonal Visitors
Texas — particularly the Rio Grande Valley — attracts seasonal residents from northern states. If you spend part of the year in Texas, your Medicare plan must work in both locations. Advantage plans are ZIP code-specific; Original Medicare with a Supplement works nationwide.
Annual Enrollment Period
During AEP (October 15 – December 7), Texas residents face heavy marketing from insurance carriers. With so many plans available in metro areas, comparing based on total yearly cost, doctor networks, and drug formularies is critical — not just TV ad promises.
➡ Annual Review GuideCommon Texas Medicare Mistakes
Most of these mistakes are preventable with a proper review before enrollment.
➡ Read About All Common Medicare MistakesHow We Help Texas Medicare Beneficiaries
During your free Medicare review, we:
Compare all available plans in your Texas ZIP code
Verify your doctors and specialists are in-network
Check prescription costs across plan formularies
Evaluate Supplement timing — especially critical in Texas where there’s no birthday rule
Assess whether Advantage or Supplement fits your region and travel patterns
Calculate total yearly out-of-pocket cost — not just premiums
Coordinate enrollment timing for new Texas residents and retirees
We work as independent advisors — not captive agents for a single carrier.
If a plan improves your situation, you’ll understand why. If staying put is smarter, we’ll tell you that too.
Texas Medicare — Frequently Asked Questions
Does Texas have a birthday rule for Medicare Supplements?
No. Unlike states like Florida, Texas does not have a birthday rule or annual open enrollment for Medigap plans. Once your initial 6-month Medigap Open Enrollment window closes, you may face medical underwriting if you want to purchase or switch a Supplement plan. This makes timing your initial decision even more important.
Are there more Advantage plans in Texas cities than rural areas?
Yes, significantly. Major metro areas like Houston, DFW, San Antonio, and Austin typically have 30–60+ Advantage plans available, while rural counties may only have 5–10. Provider networks in rural areas are also smaller, which can limit your access to specialists.
I’m retiring from an oil and gas company with retiree benefits. Do I still need Medicare?
Almost certainly yes. Retiree health benefits are not the same as active employer coverage. Most retiree plans expect Medicare to be your primary payer. Delaying Part B enrollment because you have retiree benefits can result in permanent penalties and coverage gaps. Review your specific situation before making assumptions.
I’m moving from another state to Texas. Do I need to change my Medicare plan?
If you have a Medicare Advantage or Part D plan, yes — these plans are ZIP code-specific and your current plan likely won’t work in your new Texas county. Moving triggers a Special Enrollment Period. If you have Original Medicare with a Supplement, your coverage travels with you, but it’s worth comparing rates from Texas-based carriers.
I live in rural Texas. Is Supplement or Advantage better for me?
For many rural Texans, Original Medicare with a Supplement plan provides more practical coverage. It works with any Medicare-accepting doctor — no network restrictions, no referrals, no prior authorization. This is especially important in areas with limited provider networks and rural hospital closures. Compare both options here.
Does Texas have any extra Medicare assistance programs?
Texas participates in federal programs like Extra Help (Low-Income Subsidy) for Part D costs and Medicare Savings Programs that help pay Part B premiums. The Texas Health and Human Services Commission manages enrollment for these programs. Qualifying can also trigger Special Enrollment Periods.
What if I need to switch plans after moving within Texas?
If you move to a new Texas county, your Medicare Advantage or Part D plan may no longer be available. You qualify for a Special Enrollment Period to switch plans. Review all options in your new ZIP code — don’t simply re-enroll in the same carrier without comparing. See how location affects your Medicare options.
Am I eligible for Medicare if I’m still working in Texas?
Yes — you’re eligible for Medicare at 65 regardless of employment status. Whether you must enroll depends on your employer size. If your employer has 20+ employees, you can delay Part B. If fewer than 20, Medicare becomes primary and you should enroll to avoid permanent penalties.
Explore More Medicare Resources
Supplement Plans
Understand Medigap coverage, costs, and enrollment.
Advantage Plans
Learn how Advantage plans work and what to watch for.
Enrollment Deadlines
Every enrollment period with dates and rules.
Medicare Penalties
Understand penalty rules and how to prevent them.
How to Switch Plans
Switch safely without coverage gaps or penalties.
Medicare Glossary
Every Medicare term explained in plain language.
Need Help Navigating Medicare in Texas?
Let’s review your options and find the right coverage for your ZIP code, doctors, and budget.
Licensed independent Medicare advisor. Reviews provided at no cost to you.