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 Texas Health and Human Services publishes the income limits for the Medicare Savings Programs.1,2 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.3,4

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.1

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.8

The hospital deductible rose $60 from 2025, to $1,736 per benefit period.3 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.9 Part B doesn't cover routine dental, vision, or hearing.10 Some Medicare Advantage plans add routine dental, vision, or hearing benefits, but those extras aren't universal, so check what a specific plan actually covers before you count on it.10,11

• Monthly premium: $202.90 (higher if your 2024 income was above $109,000 single or $218,000 on a joint return, under the income-related adjustment)3
• Annual deductible: $2833
• After the deductible: you pay 20% of the Medicare-approved amount for most services3

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.12

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.11

The plans you can join depend on where you live in Texas: you need both Part A and Part B, and a plan can only enroll you if you live in its service area.13 Plans can change from one year to the next, so read your plan's Annual Notice of Change and compare the plans offered in your area side by side in Medicare Plan Finder before you decide.14

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.3,11
• 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.11
• Plans may require prior authorization for certain services, which Original Medicare generally does not.11
• 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.11

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 can help you compare plans for free.1

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.4 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).15
2. Initial coverage: under the standard benefit you pay 25% coinsurance on covered drugs until your out-of-pocket spending reaches the yearly cap.4
3. Catastrophic: once your out-of-pocket spending reaches $2,100, you pay $0 for covered drugs the rest of the year.4

That $2,100 cap is the number that matters most in Part D. It was $2,000 in 2025, and payments made on your behalf, such as through Extra Help, count toward it.4 The 2026 national base beneficiary premium is $38.99 a month, but you pay your plan's own premium: standalone drug plan premiums are set by private carriers and vary by plan.16,3 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.4 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.11

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.17 Plans C and F can't be sold to people new to Medicare on or after January 1, 2020, and that's a two-part test: you count as new only if you turned 65 on or after that date and also got Part A on or after it.6 So if you had Medicare before 65 because of a disability or End-Stage Renal Disease (ESRD) before 2020, or you were eligible before 2020 but haven't enrolled yet, you may still be able to buy Plan C or Plan F.17,6 People who are new to Medicare can buy Plan G instead: 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.5,3

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 can't refuse to sell you any Medigap policy it offers, can't use medical underwriting, and can't charge you more because of your health. It can still make you wait up to six months for coverage of a pre-existing condition, unless you had at least six months of continuous prior creditable coverage.5 Outside that one-time window, those protections no longer apply unless you have a separate guaranteed issue right, so apply inside it if you can.5

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.11 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.7,2 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 federal figures below, from Social Security and medicare.gov, are $20 higher at each tier ($1,350 rather than $1,330 for one person at QMB), so compare your income to one table or the other, not to a mix of the two.2

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.7,3 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 $9,950.2 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.7 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.7

Extra Help for Part D

Extra Help, also called the Low-Income Subsidy, lowers Part D premiums, deductibles, and copays for people with limited income and resources. Your plan deductible drops to $0, and your premium is covered up to a regional benchmark, so if you pick a pricier plan you pay the difference.18 Since 2024 the partial-subsidy tier is gone, so everyone who qualifies now gets the full subsidy.18

• Income limit (2026): about $1,995 a month for an individual and $2,705 for a married couple in the 48 contiguous states and DC (Alaska and Hawaii are higher). Those are the one- and two-person figures, not a ceiling on everyone: the limit is higher if you support family members who live with you, and Social Security doesn't count all income (all interest and dividends are excluded, for example), so apply rather than screen yourself out18
• Resource limits: $18,090 for an individual and $36,100 for a married couple living together. The lower $16,590 and $33,100 limits apply only if you tell Social Security that none of your resources will go toward funeral or burial expenses. Your home, car, and personal possessions don't count18
• 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 services18
• If you qualify for QMB, SLMB, or QI, you're enrolled in Extra Help automatically7

Apply through the Social Security Administration (SSA) at ssa.gov or call 1-800-772-1213.18

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.19

Changes you make during Annual Open Enrollment take effect the following January 1.19 If you start getting Social Security or Railroad Retirement Board benefits at least four months before you turn 65, you're enrolled in Parts A and B automatically; if not, you sign up yourself through Social Security.19 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. Missing it isn't automatically a dead end: check first whether another Special Enrollment Period fits, such as the one for people whose employer or health plan gave them wrong information about enrolling on or after January 1, 2023, and only if none does do you wait for the General Enrollment Period (January 1 to March 31) and possibly owe a late penalty. COBRA and retiree coverage do not count as coverage based on current employment, though group coverage based on severance or retirement pay can still qualify if the job it's based on ended in the last eight months. 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).20

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 Texas HHSC presents it as free benefits counseling from a trusted and unbiased source. Call 1-800-252-9240 or use the HHSC directory to find an office near you; counselors help by phone and in person.1

A Texas HICAP counselor can help you:

• Understand your Medicare options and what each part covers1
• Compare Medicare Advantage, Part D, and Medigap plans side by side1
• Apply for the Medicare Savings Programs and Extra Help if your income is limited1
• Sort out billing problems, complaints, and appeals1,21
• See how Medicare works with Texas Medicaid if you're dual-eligible21

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.