Medicare in Texas: Plans and Coverage (2026)

Taking Medicare in Texas runs on federal rules, but the state adds its own free HICAP counseling and routes the programs that help pay for it through Texas Health and Human Services. This guide covers Medicare in Texas for 2026: how each part works, what it costs this year, the plan choices you'll see, and the programs that lower the bill. The standard Part B premium for 2026 is $202.90 a month, and the Part D donut hole is gone for good.1,2

It walks through every part of Medicare for Texas residents, what each one costs, the plan options specific to the state, and the help available if you're on a fixed income.

In This Guide

• Key Takeaways
• Original Medicare: Parts A and B
• Medicare Advantage in Texas (Part C)
• Medicare Part D: Prescription Drugs
• Medigap in Texas
• Help Paying for Medicare in Texas
• Medicare Enrollment Periods
• Free Medicare Help: Texas HICAP
• Frequently Asked Questions

About these numbers: The premiums and deductibles below come from CMS for calendar year 2026, effective January 1. Medicare costs change every year. For the most current figures, check Medicare's own cost pages or call Texas HICAP at 1-800-252-9240 for free help reading them.6

Original Medicare: Parts A and B

Original Medicare is run directly by the federal government and comes in two parts. The mechanics and costs are identical in Texas and every other state.

Part A (Hospital Insurance)

Part A covers inpatient hospital stays, limited skilled nursing facility care, hospice, and some home health care.1

The hospital deductible rose $60 from 2025, to $1,736 per benefit period.1 A benefit period starts the day you're admitted and ends once you have gone 60 days in a row without inpatient hospital care or skilled care in a SNF. Get readmitted after that, and the deductible applies again.

Part B (Medical Insurance)

Part B covers doctor visits, outpatient care, preventive services, durable medical equipment, and mental health care. Part B doesn't cover routine dental, vision, or hearing.7 Most Medicare Advantage plans offer routine dental, vision, and hearing benefits instead, so check what a specific plan actually covers before you count on it.8

• Monthly premium: $202.90 (higher if your 2024 income was above $109,000 single or $218,000 married, under the income-related adjustment)1
• Annual deductible: $2831
• After the deductible: you pay 20% of the Medicare-approved amount for most services1

Part B is technically optional, but nearly everyone signs up. Delay past your enrollment window without qualifying for a Special Enrollment Period or a Medicare Savings Program and you'll owe a late penalty of 10% for every 12 months you could have had it, for as long as you keep Part B.9

Medicare Advantage in Texas (Part C)

Medicare Advantage plans are an alternative to Original Medicare, sold by private insurers. They cover everything Parts A and B do, except hospice, which Original Medicare keeps covering. Most bundle in Part D drug coverage along with extras like dental, vision, and hearing.8

Texas residents in the big metros, Houston, Dallas-Fort Worth, San Antonio, and Austin, generally see the widest choice of plans, while rural counties in West Texas and the Panhandle tend to have fewer. Plan options, networks, and prices change every year and differ by county, so compare what's actually available at your address before you decide.

How These Plans Work

• You keep paying your Part B premium ($202.90) on top of any plan premium, though CMS says some plans may help pay all or part of it. The CMS estimate for the average Medicare Advantage premium in 2026 is about $14 a month, and many plans charge $0 extra.1,8
• Plans run on networks (HMO or PPO). Confirm your doctors and hospitals are in-network before you enroll. Emergency care, out-of-area urgent care, and temporary out-of-area dialysis are covered whether you get them in or out of the plan's network.8
• Plans usually require prior authorization for certain services, which Original Medicare generally does not.8
• Every plan caps your annual in-network out-of-pocket spending (federally limited to $9,250 in 2026; many plans set it lower). Original Medicare has no such cap. CMS puts it this way: there is no yearly limit on what you pay out of pocket unless you have supplemental coverage like Medigap, Medicaid, employer, retiree, or union coverage. With none of those, your exposure is open-ended.8

Use the Medicare Plan Finder at medicare.gov to compare plans by ZIP code. Enter your doctors and prescriptions and it shows which plans cover them and your estimated cost. If you want help reading the results, a Texas HICAP counselor will go through them with you for free.

Medicare Part D: Prescription Drugs

Part D covers outpatient prescription drugs. You can get it as a standalone plan paired with Original Medicare, or built into a Medicare Advantage plan.

The Inflation Reduction Act eliminated the old coverage gap, the donut hole, so that higher-cost middle stage is gone.2 Part D now moves through three phases:

1. Deductible: you pay full price until you meet your plan's deductible (up to $615 in 2026).10
2. Initial coverage: you pay copays or coinsurance while your plan and drug makers cover the rest.
3. Catastrophic: once your out-of-pocket spending reaches $2,100, you pay $0 for covered drugs the rest of the year.2

That $2,100 cap is the number that matters most in Part D. It was $2,000 in 2025 and rises with drug-spending growth.2 The 2026 national base beneficiary premium is $38.99 a month, though actual standalone-plan premiums vary widely.11 Every plan also has to offer the Medicare Prescription Payment Plan, which lets you spread your out-of-pocket drug costs into capped monthly payments across the year instead of paying in full at the pharmacy.2 People who qualify for Extra Help often pay much less, sometimes nothing.

Medigap in Texas

Medigap policies are sold by private insurers to fill the gaps in Original Medicare: the deductibles, coinsurance, and copays. They pair with Original Medicare, not with Medicare Advantage: a Medigap policy can't pay an Advantage plan's copayments, coinsurance, deductibles, or premiums.8

Texas offers the federally standardized plans, labeled A-D, F, G, and K-N. Every policy with the same letter carries the same basic benefits, no matter which insurer sells it. Plans E, H, I, and J are no longer sold, though anyone who already holds one can generally keep it.12 Plans C and F are closed to anyone who first became Medicare-eligible on or after January 1, 2020.4 Plan G is the popular choice for people newly eligible: it covers the Part A deductible ($1,736), Part A and Part B coinsurance, and skilled nursing coinsurance, leaving only the $283 Part B deductible on you.3,1

When to Buy Medigap

Your strongest opening is the federal Medigap Open Enrollment Period, the six months that begin when you're 65 and enrolled in Part B. During that window an insurer must sell you any plan at the standard rate regardless of your health.3 Outside it, Texas insurers may use medical underwriting, meaning they can review your health, charge more, or decline you.

Medigap or Medicare Advantage?

Pairing them doesn't work, and while you're in an Advantage plan it's illegal for anyone to sell you a Medigap policy unless you're switching back to Original Medicare. That isn't permanent: if this is your first Advantage plan, a federal trial right lets you return to Original Medicare within 12 months and buy a Medigap policy.8 Choose Medigap and you stay on Original Medicare with the freedom to see any provider who takes Medicare nationwide, at a higher monthly premium. Choose Medicare Advantage and you trade some of that freedom for a network and a lower upfront cost. Talk it through with a Texas HICAP counselor before you commit.

Help Paying for Medicare in Texas

If you're on a fixed income, two programs can cut your Medicare costs sharply.

Medicare Savings Programs (MSPs)

Texas runs its Medicare Savings Programs through the Texas Health and Human Services Commission (HHSC), the state Medicaid agency. They pay some or all of your Medicare premiums and cost-sharing based on income, and Texas uses the standard federal income tiers and resource limits.5 One wrinkle matters if you are checking your own paycheck against a chart: HHSC's own handbook prints QMB as a maximum gross monthly income of $1,330 for one person and $1,804 for a couple, effective March 1, 2026, and says those amounts do not include the $20 general income disregard. The figures below are those same Texas standards with the $20 added back, which is how Social Security and medicare.gov publish them.13

QMB is the most generous, covering your Part B premium ($202.90 a month) plus your deductibles and coinsurance, and federal law bars providers from billing a QMB enrollee for that cost-sharing.5,1 For all three programs the 2026 limit is $9,950 for one person and $14,910 for a couple in countable resources, not a cap on everything you own: Texas excludes the homestead you live in as your principal residence, a car, burial spaces, life insurance with a face value of $1,500 or less, and $1,500 in separately identifiable burial funds. A home and a car therefore do not count toward the $9,950.13 Those are the federal standards rather than absolute cutoffs: states can effectively raise both the income and the resource limits by disregarding certain income and resources, so apply rather than rule yourself out. QI has to be reapplied for every year; being selected one year does not entitle you to it the next.5 Apply through your local HHSC benefits office, and enrolling in QMB, SLMB, or QI automatically qualifies you for Extra Help; QDWI, the fourth savings program, does not.5

Extra Help for Part D

Extra Help, also called the Low-Income Subsidy, pays Part D premiums, deductibles, and copays for people with limited income and resources.14 Since 2024 the partial-subsidy tier is gone, so everyone who qualifies now gets the full subsidy.

• Income limit (2026): up to about $1,995 a month for an individual, $2,705 for a couple, the figures for the 48 contiguous states and DC (Alaska and Hawaii are higher)14
• Resource limits: $16,590 for an individual, $33,100 for a married couple, rising to $18,090 and $36,100 if you tell Social Security you expect to use some of your resources for burial expenses14
• Maximum copay: no more than $12.65 per covered brand-name drug and $5.10 per generic with full Extra Help, and that is the ceiling: full-benefit dual eligibles at or below 100% of the poverty level pay $4.90 and $1.60, or $0 if they are institutionalized or receiving home and community-based services14
• If you qualify for QMB, SLMB, or QI, you're enrolled in Extra Help automatically5

Apply through the Social Security Administration (SSA) at ssa.gov or call 1-800-772-1213.14

Medicare Enrollment Periods

Miss a deadline and you can face coverage gaps or permanent penalties. These dates are federal and the same in Texas as everywhere else.15

Changes you make during Annual Open Enrollment take effect the following January 1.15 If you're already getting Social Security before 65, you're enrolled in Parts A and B automatically; if not, you sign up yourself through Social Security. If you're still working past 65 with group health coverage based on that current employment, you can delay Part B without penalty and use an eight-month Special Enrollment Period to sign up, counted from the month that job or coverage ends, whichever comes first; miss it and you wait for the General Enrollment Period (January 1 to March 31) and may owe a late penalty. COBRA and retiree coverage do not count as coverage based on current employment, and if you're self-employed or your plan isn't available to everyone at the company, ask your insurer whether it qualifies before you delay; if it doesn't, sign up at 65. This Special Enrollment Period does not apply if you're eligible for Medicare based on End-Stage Renal Disease (ESRD).16

Free Medicare Help: Texas HICAP

You don't have to figure this out alone, and you don't have to pay a broker. Texas runs the State Health Insurance Assistance Program as HICAP, the Health Information, Counseling, and Advocacy Program. It's a partnership of the Texas Area Agencies on Aging, the Health and Human Services Commission, and the Texas Legal Services Center, and its counselors give free, unbiased help without selling insurance. The statewide line is 1-800-252-9240, and counseling is available by phone or in person through your local Area Agency on Aging.6

A Texas HICAP counselor can help you:

• Understand your Medicare options and what each part covers
• Compare Medicare Advantage, Part D, and Medigap plans side by side
• Apply for the Medicare Savings Programs and Extra Help
• Sort out billing problems, denials, and appeals
• See how Medicare works with Texas Medicaid if you're dual-eligible

Key Texas Medicare Contacts

Learn More

Find personalized help understanding your Medicare options in Texas at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.