How Does Medicare Work in Texas?
Because Medicare is a federal health insurance program, eligibility requirements are the same in every U.S. state. If you live in Texas, you can enroll in Medicare if you meet one of the following requirements:
- You are 65 years or older and are a U.S. citizen, or you’ve been a permanent legal resident for five continuous years. You qualify for premium-free Medicare Part A benefits if you or your spouse have paid Medicare taxes for the minimum time requirement (40 quarters or 10 years).
- You are younger than 65 but have a qualifying disability and have been receiving Social Security or Railroad Retirement Board disability benefits for at least 24 months.
- You are on dialysis for end-stage renal disease or need a kidney transplant.
If you meet Medicare’s requirements while living in Texas, you can enroll in one of the available Medicare options. This includes Original Medicare Part A (hospital insurance) and/or Part B (medical insurance). If you sign up to get your benefits through Original Medicare, you may consider enrolling in a Prescription Drug Plan as well. You may also purchase Medigap plan to supplement your Original Medicare benefits. As an alternative to Original Medicare, you may choose to enroll in a Medicare Advantage (Part C) plan. Medicare Advantage plans will include your Part A and Part B benefits, but most plans include additional cove rage.
How does Medicare work in Texas?
The Texas Health, Information, Counseling, and Advocacy Program has specially trained benefit counselors available to help you. Along with your basic Medicare coverage, here’s a look at some of the additional Medicare programs you can apply for in Texas:
Medicare Savings Programs
Enrolling in a Medicare Savings program can help you pay for your monthly Medicare premiums, copayments, and deductibles. Depending on your level of income and resources, you can qualify for different benefit levels in this program.
Qualified Medicare Beneficiaryeligibility requires that you are entitled to Medicare Part A, have a maximum gross monthly income of $1133 as an individual or $1526 as a couple, and have resources worth no more than $7970 as an individual or $11960 as a couple.
Specified Low-Income Medicare Beneficiary eligibility requires that you are entitled to Medicare Part A, have a monthly gross income of no more than $1359 as an individual or $1831 as a couple, and have the same resource level as the previous bracket above.
To be eligible for the Qualifying Individuals Program (QI-1)you much be entitled to Medicare Part A benefits, not enrolled in Medicaid, and have an individual monthly income of less than $1529, or $2060 as a couple. Resource limits are the same as the other benefit levels.
Qualified Disabled and Working Individuals Program (QDWI)
To enroll in this program, you must be entitled to Medicare Part A, be younger than 65, and not enrolled in Medicaid. Your gross monthly income as an individual can’t exceed $2265 and the resource limit is $4000. If you’re married, your gross monthly income can’t exceed $3052, and the resource limit is $6000.
Low-Income Subsidy program
This program, available in Texas, is also known as Medicare Extra Help. You can get it through your Medicare prescription drug (Part D) plan if you qualify according to your income level and resource limit.
How can the Texas Health, Information, Counseling and Advocacy Program help?
If you need assistance signing up for these programs, or you’d like more information about them, you can call or visit the official website of the Texas Health, Information, Counseling, and Advocacy Program.
If you are a resident of Texas when you become eligible for Medicare, or you move to Texas as a Medicare enrollee from another state, you are eligible for access to the Texas Health, Information, Counseling, and Advocacy Program. This program provides information and counseling concerning Medicare programs available in your Texas service area and can assist you in enrolling in one that suits your health care needs and budget best.
Medicare enrollees can receive information and education about Medicare and Medicaid, but the Texas Health, Information, Counseling, and Advocacy Program also provides the following services:
- Assistance with complaints, rights, and claims’ appeals regarding Medicare and Medicaid coverage
- Information about Medicare Supplement (Medigap) insurance regarding benefits and available plans
- Information and education about Medicare Advantage (Part C) plans regarding comparable plans, enrollment, and how to switch plans
- Information and education about Medicare prescription drug (Part D) coverage regarding comparable plans and help with prescriptions
- Information regarding long-term care insurance