Medicare Plans and Coverage in Texas

If you're turning 65 or helping a parent sort out Medicare in Texas, you're dealing with four parts, dozens of plan options, and annual costs that change every January. Here's what you actually need to know. The standard Part B premium for 2026 is $202.90 per month, and the big news is that the Part D donut hole is gone for good.

This guide walks through every piece of Medicare as it applies to Texas seniors in 2026, from what Original Medicare covers to how to get help paying for it.

By Brevy Care Team · Reviewed by Nicolette · Last verified March 31, 2026

In This Guide

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

Key Takeaways

• Part B premium for 2026 is $202.90/month with a $283 annual deductible. Most people pay $0 for Part A.
• The Part D donut hole is eliminated starting in 2025. Your out-of-pocket drug costs are capped at $2,100 per year.
• Texas seniors average 32+ Medicare Advantage plans to choose from, offered by about 8 different insurers.
• Medicare Savings Programs can pay your Part B premium (and more) if your income is under $1,761/month.
• Texas HICAP provides free, unbiased Medicare counseling. Call 1-877-839-2675.

Important: The premiums and deductibles in this guide are from CMS.gov for calendar year 2026, effective January 1, 2026. Medicare costs change annually. Contact Medicare at 1-800-633-4227 (1-800-MEDICARE) or Texas HICAP at 1-877-839-2675 for the most current information.

Original Medicare: Parts A and B

Original Medicare is the federal program run directly by the government. It has two parts.

Part A (Hospital Insurance)

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

2026 Part A costs:

The hospital deductible increased $60 from 2025. A "benefit period" starts when you're admitted and ends 60 days after you leave. If you're readmitted after 60 days, you pay the deductible again.

Part B (Medical Insurance)

Part B covers doctor visits, outpatient care, preventive services, durable medical equipment, and mental health services. It doesn't cover routine dental, vision, or hearing.

2026 Part B costs:

• Monthly premium: $202.90 (higher if your income exceeds $106,000 individual / $212,000 married)
• Annual deductible: $283
• After deductible: You pay 20% coinsurance for most services

Part B is optional but almost everyone enrolls. If you delay enrollment past your Initial Enrollment Period without other creditable coverage, you'll pay a late enrollment penalty of 10% for each 12-month period you were eligible but not enrolled. That penalty lasts as long as you have Part B.

Medicare Advantage in Texas (Part C)

Medicare Advantage (MA) plans are an alternative to Original Medicare offered by private insurers. They cover everything Parts A and B cover, and most include Part D drug coverage and extras like dental, vision, and hearing.

In 2026, the average Medicare beneficiary nationally can choose from about 32 Medicare Advantage plans with drug coverage. Texas seniors typically have even more options, averaging around 40+ plans in major metro areas like Houston, Dallas, and San Antonio.

Major Insurers in Texas

The biggest Medicare Advantage insurers nationally are UnitedHealthcare and Humana, which together hold about 46% of all MA enrollment. Other major players in Texas include Aetna, Blue Cross Blue Shield of Texas, Cigna, Wellpoint (formerly Amerigroup), and Molina Healthcare.

How MA Plans Work

• You must keep paying your Part B premium ($202.90/month) in addition to any MA plan premium
• Many MA plans charge $0 in additional premiums
• Plans use provider networks (HMO, PPO, or HMO-POS). Check that your doctors are in-network before enrolling
• MA plans set an annual out-of-pocket maximum. Original Medicare has no OOP cap.
• Extra benefits vary widely. Compare dental coverage, fitness programs, over-the-counter allowances, and transportation benefits

Comparing Plans

Use the Medicare Plan Finder at medicare.gov to compare MA plans by zip code. Enter your doctors and prescriptions to see which plans cover them and what your estimated costs would be.

For 2026, note that UnitedHealthcare and Humana are both exiting some counties across the country. If your current plan is leaving your area, you'll get a Special Enrollment Period to choose a new plan.

Medicare Part D: Prescription Drugs

Part D covers outpatient prescription drugs. You can get Part D through a standalone prescription drug plan (PDP) paired with Original Medicare, or through a Medicare Advantage plan that includes drug coverage (MA-PD).

The Big Change: No More Donut Hole

The Inflation Reduction Act eliminated the coverage gap (donut hole) starting in 2025. Previously, you'd hit a gap in coverage after spending a certain amount where you paid a higher share. That's gone. Now Part D has three simpler phases:

1. Deductible phase: You pay full price until you meet your plan's deductible (varies by plan, max $590 in 2026)
2. Initial coverage phase: You pay copays/coinsurance. Your plan and drug manufacturers share the rest
3. Catastrophic phase: Once your out-of-pocket spending hits $2,100, you pay $0 for covered drugs for the rest of the year

That $2,100 annual cap is the most important number in Part D. It was $2,000 in 2025 and is adjusted for inflation going forward.

Part D Costs

• Base beneficiary premium: $38.99/month (actual plan premiums vary, many are higher, some are $0 for low-income beneficiaries)
• Premium increase cap: 6% per year through 2029 (IRA provision)
• Maximum out-of-pocket: $2,100/year

Medicare Supplement (Medigap) Plans in Texas

Medigap policies are sold by private insurers to fill gaps in Original Medicare coverage (deductibles, coinsurance, copays). They only work with Original Medicare, not with Medicare Advantage.

Texas offers standardized Medigap plans labeled A, B, C, D, F, G, K, L, M, and N. Plans C and F are only available to people who became eligible for Medicare before January 1, 2020.

Plan G is the most popular Medigap plan for people newly eligible. It covers the Part A deductible ($1,736), Part A coinsurance, Part B coinsurance (the 20% after your deductible), and skilled nursing facility coinsurance. The only gap Plan G doesn't cover is the Part B deductible ($283/year).

When to Buy Medigap

Your best opportunity is during Medigap Open Enrollment, which starts the month you turn 65 and are enrolled in Part B. For 6 months, insurers must sell you any Medigap policy at the standard rate regardless of health conditions. After that window, insurers in Texas can deny you or charge more based on health status.

Medigap vs. Medicare Advantage

You can't have both. If you choose a Medigap policy, you stay on Original Medicare. If you choose Medicare Advantage, you don't need (and can't use) Medigap. The main trade-off: Medigap gives you freedom to see any provider who accepts Medicare, while MA plans cost less upfront but restrict you to a network.

Help Paying for Medicare in Texas

If you're on a fixed income, several programs can reduce or eliminate your Medicare costs.

Medicare Savings Programs (MSPs)

Texas offers three MSPs that pay some or all of your Medicare costs based on income:

Resource limits for all three programs: $9,430 for individuals, $14,130 for couples. These limits include a $20 general income disregard.

QMB is the most generous. It pays your Part A premium (if you have one), your Part B premium ($202.90/month), and covers deductibles and coinsurance. That can save over $5,000 per year.

Apply through your local HHSC office or call 1-800-252-8263.

Extra Help (Low-Income Subsidy) for Part D

Extra Help pays Part D premiums, deductibles, and copays for people with limited income and resources.

• Resource limits: $16,590 individual / $33,100 married
• Maximum copay: $12.65 per drug with full Extra Help
• Auto-enrollment: If you qualify for QMB, SLMB, or QI, you automatically get Extra Help

Apply at ssa.gov/extrahelp or call Social Security at 1-800-772-1213.

Medicare Enrollment Periods

Missing an enrollment deadline can mean gaps in coverage or permanent late penalties. Here are the key dates:

Changes made during Annual Open Enrollment (Oct 15 - Dec 7) take effect January 1 of the following year. This is when most people review and switch plans.

Free Medicare Help: Texas SHIP/HICAP

You don't have to figure this out alone. Texas HICAP (Health Insurance Counseling and Advocacy Program) provides free, unbiased Medicare counseling through a partnership of Area Agencies on Aging, HHSC, and the Texas Legal Services Center.

HICAP counselors can help you:

• Understand your Medicare benefits and coverage options
• Compare Medicare Advantage, Part D, and Medigap plans
• Apply for Medicare Savings Programs and Extra Help
• Resolve billing problems and appeals
• Understand how Medicare works with Medicaid if you're dual-eligible

Contact HICAP: Visit shiphelp.org to find your local counselor, email info@shiphelp.org, or call 1-877-839-2675.

What does Medicare cost in Texas in 2026?

Most people pay $0 for Part A. The standard Part B premium is $202.90/month with a $283 annual deductible. Part D premiums vary by plan (base is $38.99/month). Medicare Advantage plans often have $0 additional premiums. Total costs depend on the plan you choose and the services you use.

Is there a donut hole in Medicare Part D in 2026?

No. The Inflation Reduction Act eliminated the donut hole starting in 2025. Your out-of-pocket drug costs are now capped at $2,100 per year. Once you hit that cap, you pay $0 for the rest of the year.

How do I get help paying for Medicare in Texas?

Apply for Medicare Savings Programs (QMB, SLMB, QI) through HHSC at 1-800-252-8263. QMB covers all your Medicare premiums and cost-sharing if your income is under $1,305/month. Also apply for Extra Help with Part D costs at ssa.gov/extrahelp.

Should I choose Medicare Advantage or Original Medicare with Medigap?

It depends on your priorities. Medicare Advantage costs less upfront and includes extras like dental and vision, but limits you to a provider network. Original Medicare with Medigap lets you see any Medicare provider nationwide with predictable out-of-pocket costs, but premiums are higher. Talk to a HICAP counselor (1-877-839-2675) for free, unbiased advice specific to your situation.

Next Steps

• If you're turning 65 soon, start researching plans 3 months before your birthday. Use Medicare Plan Finder to compare options in your area.
• If you need help paying Medicare costs, apply for Medicare Savings Programs through HHSC (1-800-252-8263) and Extra Help through Social Security (1-800-772-1213). See our guide to paying for senior care in Texas for the full picture.
• If your loved one is a veteran, VA Aid and Attendance can supplement Medicare with up to $2,424/month.
• If you're confused about your options, call Texas HICAP at 1-877-839-2675 for free counseling.
• If you also have Medicaid, see our guides to Texas Medicaid programs and STAR+PLUS to understand how your benefits work together.

Find personalized help understanding your Medicare options 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. Medicaid rules vary by state and change frequently. Always verify eligibility and benefits with your state Medicaid agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.