How to Apply for Medicare in Texas

Over 4.4 million Texans currently enroll in Medicare, the federal health insurance program designed for people 65 or over. People younger than 65 with qualifying disabilities such as end-stage renal disease or amyotrophic lateral sclerosis may also qualify.

Original Medicare provides several choices for coverage options, from Parts A through D to Medicare Advantage plans administered by private insurers that combine coverages into packages administered by them. There are also optional plans available such as Medicare Advantage Prescription Drug plans and Medicare Supplements as supplementary options.

Eligibility

Over 4.4 million Texans currently benefit from Medicare, the federal health insurance program. Medicare covers medically necessary services for Americans 65 or older with qualifying disabilities such as end-stage renal disease or amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease). Residents in Texas may enroll in original Medicare Part A and B as well as Medicare Advantage plans or Supplement insurance options that offer additional benefits at different costs with associated deductibles and copayments; there are specific open enrollment periods each year during which individuals can sign up for coverage.

Individuals can enroll in Medicare Part A and Part B during their Initial Enrollment Period, typically starting the month they turn 65 (or sooner if receiving Social Security disability payments or Railroad Retirement Board disability payments for 24 months).

People typically can avoid late enrollment penalties by enrolling during their Initial Enrollment Period (IEP), though in certain situations people may qualify to enroll outside this window – for instance if someone did not sign up for Part B when first eligible due to having creditable group health plan coverage or TRICARE Prime they can sign up during a Special Enrollment Period.

Texas offers four Medicare Savings Programs that can assist those needing help paying their Medicare premiums, deductibles and copayments. Administered by the Texas Health and Human Services Commission, eligibility requirements differ among them but all have limits on the total accessible financial assets that individuals may own.

Anyone wishing to enroll in a Medicare Advantage plan during Texas’ open enrollment period of October 15 through December 7 can do so during this open enrollment period, from October 15 until December 7. Over 300 plans are available, typically offering lower monthly premiums than Original Medicare while providing extra benefits like vision care and dental coverage as well as prescription drug coverage. Although restrictions do apply when enrolling, such as living within its service area and meeting any minimum health requirements.

Open Enrollment

As soon as you become eligible for Medicare in Texas, there will be several coverage options to consider when selecting coverage. There is Original Medicare (the public option), Medicare Advantage plans with various cost sharing arrangements, Medicare Supplement plans or both. It is crucial that any plan selected be enrolled during its open enrollment period to avoid penalties or gaps in coverage.

READ ALSO: Medicare Open Enrollment Guide

If it’s your first time signing up for Medicare Part B, an Initial Enrollment Period (IEP) offers you the best opportunity. This window begins three months prior to your birthday month and continues through your birth month until three months post. If you miss this window and choose later enrollment instead of enrolling within this window, penalties will apply when enrolling later on.

Special Enrollment Periods (SEP) allow Medicare plan changes without incurring extra fees, should certain qualifying life events arise, such as moving states or getting married. You can take advantage of one if these circumstances apply; these windows of time provide an opportunity to switch plans without incurring penalties.

Discover more about Special Enrollment Plans (SEPs) by contacting the Medicare helpline or visiting their website, and there are also local advocacy organizations specializing in helping people make decisions regarding Medicare; these groups can also guide you through the registration process for Medicare.

Medicare assistance organizations also provide additional resources and financial support for your expenses. The Texas Health and Human Services Commission can be an excellent source for finding Medicare Savings programs which may provide financial help with Medicare deductibles, premiums and coinsurance costs.

As another option for those who missed their Initial Enrollment Period (IEP), Special Enrollment Periods (SEPs) provide individuals who did not enroll in Part B of Medicare during their Initial Enrollment Period due to misrepresentation or reliance on information from employers, GHPs, agents or brokers of health plans or anyone authorized to act on their behalf during that IEP window. It also applies when volunteers were performing service abroad with tax-exempt organizations that provided them health insurance while abroad.

Enrollment Options

Texas Medicare participants have several choices when enrolling, from Original Medicare (the public option) or private plans offering Parts A and B coverage bundled together through private insurers regulated by CMS; Medicare Advantage provides cost caps; enrollees should sign up during either their Initial Enrollment Period, General Enrollment Period or Special Enrollment Period to ensure coverage.

Individuals who missed their Initial Enrollment Period due to an emergency or disaster can use this Special Enrollment Period (SEP) as a second chance to enroll in Medicare Parts B and premium Part A without incurring penalties. Individuals must provide documentation or written attestation that circumstances beyond their control prevented them from enrolling when first eligible; it cannot be used to avoid paying late enrollment penalties due to ignorance, forgetfulness or nonpayment of premiums.

Not only can Medicare beneficiaries change or discontinue coverage during the Special Election Period (SEP), but other opportunities also exist to make necessary adjustments or drop coverage altogether. Open enrollment period takes place annually between October 15 and December 7; individuals can join or switch Medicare Advantage or Prescription Drug plans; they can also purchase Medigap policies approved by Medicare; they could even get Medigap coverage with private insurers approved by Medicare.

Individuals attempting to enroll in Medicare Advantage plans or Medigap policies outside their designated enrollment periods may be subject to medical underwriting, a process intended to determine whether an insurance company accepts their application and what amount will be charged for coverage.

Individuals ineligible for Medicare Advantage or supplement policies can apply for one of four Texas Medicare Savings Programs that help people pay their premiums and cost-sharing payments. Furthermore, Texas provides numerous resources that assist senior Texans and caregivers, including nonprofit organizations, Area Agencies on Aging (AAoA), and local public health agencies.

Plan Choices

Once eligible, Texans have a variety of Medicare options to select. Original Medicare provides hospital and medical coverage through Part A and B respectively; but as this doesn’t cover all costs, most opt for Medicare Advantage or Supplement plans instead.

Medicare Advantage plans from private companies provide an appealing alternative to Original Medicare with additional benefits such as dental, hearing and vision coverage. Medicare Advantage is ideal for people looking for one plan covering primary care provider visits, referrals to specialists as well as prescription drug coverage – these supplemental plans vary in cost and coverage depending on where you live.

Medicare Advantage plans provide Texas residents who want to remain close to home and remain within reach of their preferred doctors and facilities with access to local networks of providers that best suit them. It’s essential that they find one that complements both current healthcare providers and medical needs, so find one that matches up.

Texas Medicare Advantage Plans, also known as Medicare Part C, are the ideal choice for many residents who appreciate having easy access to a primary care physician and referrals or prior authorization for certain treatments. Many Medicare Advantage plans also come equipped with prescription drug plans which may save you money on medications.

Medicare Advantage plans differ from Medicare Supplement in that their prices and terms can differ considerably, making comparisons challenging. When shopping for an Advantage plan, keep your monthly premiums and total annual out-of-pocket costs in mind when making your selection; generally speaking, younger enrollees will typically pay less since their premium is determined based on age.

As with any major purchase, Medicare Advantage plans should be purchased during your six-month open enrollment window. Otherwise, medical underwriting could become necessary and you could end up answering health-related questions and potentially be denied coverage due to preexisting conditions or paying higher premiums than necessary.

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What is Original Medicare?

Original Medicare (or Parts A and B) is a fee-for-service program which offers hospital and medical coverage respectively (Part A) with ambulance and essential health services being covered through Part B coverage as well as durable medical equipment, mental healthcare services and ambulance transportation being included through Part D coverage.

Original Medicare isn’t enough, which is why some people opt to purchase additional private health insurance coverage known as Medigap to cover Medicare’s deductibles, copayments and coinsurance costs.

People not eligible for social security or railroad retirement board benefits may purchase a Medicare Advantage Plan, which acts similar to group health insurance provided by employers. Sold by private companies that must follow Medicare regulations, Medicare Advantage plans offer extra benefits such as vision and dental coverage, gym memberships and healthy lifestyle programs compared with original Medicare. They may also differ in costs and provider networks so if someone wants to keep their current health coverage without risking losing it all they could benefit from opting for one of these plans instead of losing it completely they might be the ideal solution!
How do I enroll in Original Medicare?

Initial Enrollment Period is your ideal opportunity to enroll in Original Medicare, starting three months before your 65th birthday (or when it actually happens) and lasting for seven months after. If you miss this window, General Enrollment Periods become available and late enrollment penalties could apply;

Medicare Advantage plans offered by private insurance companies provide additional benefits beyond Original Medicare such as dental, vision and prescription drug coverage. You can switch between plans during the Annual Enrollment Period (Read our Medicare Open Enrollment Guide) which runs between October 15th and December 7th every year.

Special enrollment periods provide you with an opportunity to enroll for Medicare Part B (and premium Part A if applicable) without incurring a late enrollment penalty. In such instances, circumstances beyond your control caused you to miss your IEP but no other window exists for enrolling for Medicare coverage.
How do I enroll in a Medicare Advantage Plan?

Medicare Advantage plans are private health insurance options that cover the same basic Medicare benefits, with different rules and costs, yet typically offer greater flexibility. They typically also include Part D coverage for prescription drugs.

Seniors eligible for Medicare have seven months from their 65th birthday, when they become eligible, to sign up or switch plans during an Initial Enrollment Period or ICEP that starts three months before and ends one month post.

If they miss this window and still wish to switch or modify their Medicare Advantage Plan, they must do so during the annual Open Enrollment Period which occurs each fall from October 15 through December 7 and allows one MA plan change per year, with any modifications taking effect in January.

Special Enrollment Periods (SEPs) allow seniors to make Medicare Advantage changes outside of ICEP and annual Open Enrollment periods, such as for people who lose COBRA coverage but fail to sign up for Part B during its Special Enrollment Periods (SEPS). One such SEP occurs for people who failed to take action before their COBRA coverage expired and did not sign up during that SEP’s Part B Special Enrollment Periods.
How do I enroll in Medigap?

Medicare Supplement policies, also commonly referred to as Medigap policies, provide optional additional coverage that helps pay your share of Original Medicare’s deductibles and copayments. Most individuals can participate in one Medigap Open Enrollment Period during which time they can purchase any plan lettered policy without answering health-related questions.

Within this six month window, insurers cannot deny your application or charge more based on preexisting conditions. Now is an opportune time to compare plans offered by different insurance providers to find one that best meets your needs.

Insurance companies use medical underwriting to refuse you a policy or charge higher rates than other Medicare beneficiaries enrolled outside their Medigap Open Enrollment Period, sometimes even making you wait six months before your Medicare supplement covers any preexisting conditions. Some states offer laws protecting residents so it’s wise to inquire with your state insurance department to see if there are protections in place that might help your situation; that’s why it’s critical that you take full advantage of your Medigap Open Enrollment period.
How do I apply for Medicare?

Most applicants can easily apply for Medicare online in under 10 to 30 minutes, typically using the Social Security Administration website to verify your income and provide basic identifying data; additionally, your income verification may require further submission if it qualifies you for premium support from the government.

Your Initial Enrollment Period for Medicare enrollment runs for seven months before, during, and after your birthday month – three months prior, during, and three months postnatal to your birthday month. If you fail to register during this window of opportunity, permanent penalties could increase both Part A and B premiums significantly.

Certain individuals qualify for a Special Enrollment Period to sign up for Medicare without incurring penalties, such as those still working and providing credible coverage through their employer group health plan. People continuing their careers post age 65 could even qualify if they plan to do so for at least another seven years and maintain the same health plan coverage.

John Claeys is the Founder of Claeys Group Insurance Services, as well as a frequent contributor to the Medicare Blog. John lives with his wife of 30 years in Tyler, Texas. Unsure about Medicare coverage options in East Texas? Contact John for guidance and help navigating the Medicare coverage process.

John Claeys