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Texas Medicare Plans

Medicare Supplement Insurance (Medigap) Policies

Texas is a state that requires insurers to sell Medicare Supplement Insurance policies to people under the age of 65.

High-Risk Pool

Coverage in the Texas Health Insurance Pool, which was the high-risk pool for individuals in the state who were unable to obtain insurance coverage because of a pre-existing condition, expired on March 31, 2014. Individuals who were covered under the Texas Health Insurance Pool were eligible to apply for coverage under the Health Insurance Marketplace operated via Coverage under the pool was deemed minimum essential coverage in accordance with the provisions of the Affordable Care Act.

Mini-COBRA Policies (Small Group)

The state of Texas mandates insurance continuation coverage for small employers of less than 20 employees.

Texas has four Medicare Savings Programs:

  • Qualified Medicare Beneficiaries (QMBs) - MC-QMB: For individuals with a monthly income under $973 and couples with a monthly income under $1,311, the state pays all premiums for Medicare Part B and all copays and deductibles for Medicare Parts A and B.
  • Specified Low-Income Medicare Beneficiaries (SLMBs) - MC-SLMB: For individuals with monthly income greater than $973 butless than $1,167 or couples with income greater than $1,311 but less than $1,573 per month, the state pays premiums for Medicare Part B.
  • Qualified Individuals (QIs): For individuals with income greater than $1,167 butless than $1,313 a month or couples with monthly income greater than $1,573 but less than $1,770, the state pays premiums for Medicare Part B.
  • Qualified Disabled and Working Individuals (QDWIs) - MC-QWDI: For individuals with income under $1,945 a month and couples with monthly income under $2,622, the state pays premiums for Medicare Part A.

Health Information Counseling and Advocacy Program of Texas (HICAP)

Your local Texas HICAP service exists to help you understand your Medicare benefits. Texas HICAP provides confidential and one-on-one Medicare beneficiary counseling for residents in the state.

Texas HICAP provides eligibility, program benefit, and appeals rights information concerning:

  • Medicare Parts A and B
  • Medicare Part C - Medicare Advantage Plans
  • Medicare Part D - Prescription Drug Plans
  • Medicare Supplement Insurance (Medigap)
  • Long-term care insurance options
  • Healthcare rights and protections
  • Low-income assistance programs

Texas HICAP volunteers and staff are committed to work with you to provide assistance in meeting your Medicare needs through any one of 28 Area Agency on Aging offices throughout the state. Texas HICAP is partially funded by a grant from the Centers for Medicare and Medicaid Services (CMS).

Low-Income Subsidy (Extra Help) for Prescription Drugs

The low-income subsidy in the state of Texas for Extra Help with prescription drugs for 2015 is $27.30.

Texas residents seeking assistance with their health benefits should consult with one of our insurance specialists. A knowledgeable professional can help you by comparing plans available in your area and assist you in finding the Medicare insurance benefits that are right for your needs.