Navigating Medicare coverage in Texas can be complex, especially with recent changes affecting beneficiaries in 2025. This guide provides an overview of Medicare basics in Texas, highlights recent updates, offers tips on selecting the best plan, and advises when to consult our Medicare advisors for help. Whether you’re new to Medicare or exploring options through the health insurance marketplace, understanding your choices is essential.
What You Need to Know About Medicare Basics in Texas
Medicare is a federal health insurance program primarily for individuals aged 65 and older, as well as certain younger individuals with disabilities. It comprises several parts:
- Part A (Hospital Insurance): Covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.
- Part B (Medical Insurance): Covers outpatient care, preventive services, and medical supplies.
- Part C (Medicare Advantage): An alternative to Original Medicare, offered by private insurers, often including additional benefits like vision, dental, and prescription drug coverage.
- Part D (Prescription Drug Coverage): Helps cover the cost of prescription medications.
In Texas, beneficiaries have access to a variety of Medicare Advantage and Part D plans. For 2025, there are 373 Medicare Advantage plans available in the state, with an average monthly premium of $6.81, down from $9.15 in 2024.
Recent Changes to Medicare in Texas for 2025
Several significant changes to Medicare are taking effect in 2025:
- $2,000 Annual Cap on Out-of-Pocket Prescription Drug Costs: Medicare Part D plans now have a $2,000 annual limit on out-of-pocket expenses for prescription drugs, replacing the previous coverage phases, including the “donut hole.”
- Increased Part B Premiums and Deductibles: The standard monthly premium for Medicare Part B has increased to $185.00 in 2025, up from $174.70 in 2024. The annual deductible has also risen to $257, an increase from $240 in 2024.
- Expanded Access to Mental Health Services: Medicare now covers services provided by marriage and family therapists and mental health counselors, as well as intensive outpatient program services in certain locations.
Midyear Coverage Notices: Medicare Advantage plans are required to send midyear notifications to beneficiaries about unused supplemental benefits, helping enrollees maximize their plan offerings.
How to Select the Best Medicare Plan in Texas for Your Needs
Choosing the right Medicare plan involves careful consideration of your healthcare needs and financial situation.
- Assess Your Healthcare Needs
Consider your current health status, such as any chronic conditions, required medications, and preferred healthcare providers. You’ll want to ensure they are included in the plan’s network.
- Compare Plan Options
You can use the “Medicare Plan Finder” tool, which allows you to compare plans, benefits, and costs. You can also enter your prescriptions to see how costs vary by plan. Pay close attention to copayments and deductibles. Some plans will also offer extra services like dental, vision or wellness programs.
- Consider Costs
There are a few costs to consider, such as:
- Premiums: The monthly cost of the plan.
- Deductibles: The amount you pay out-of-pocket before coverage begins.
- Copayments and Coinsurance: Your share of costs for services after meeting the deductible.
- Out-of-Pocket Maximums: The maximum you’ll pay in a year before the plan covers 100% of costs.
- Review Plan Ratings
You can check out the Centers for Medicare & Medicaid Services (CMS) rates plans based on quality and performance. Higher-rated plans may offer better services.
- Check for Plan Changes
The Annual Notice of Change (ANOC) allows you to review any changes to your current plan’s costs, or network providers so you can plan accordingly for the future.
When to Seek Help From Our Medicare Advisors
Navigating Medicare options can be overwhelming. Consider consulting our certified Medicare advisors if you find yourself in the following situations:
- You have complex healthcare needs: If you have multiple chronic conditions or require specialized care.
- You have financial concerns: To explore programs that assist with Medicare costs, such as Medicare Savings Programs or Extra Help for prescription drugs.
- You don’t understand plan differences: To get clarity on the differences between Medicare Advantage, Medigap, and Part D plans.
- You need enrollment assistance: For help with the enrollment process or to understand enrollment periods.
Our Medicare advisors here at Wise Insurance can help you stay informed about any Medicare changes and help you carefully evaluate your options to select the best coverage to meet your healthcare needs in Texas. With over 15 years of experience, our team provides personalized guidance to ensure you receive coverage tailored to your specific needs and budget. We can also simplify the enrollment process for you and conduct annual plan reviews to ensure your coverage remains optimal as your healthcare needs evolve.
We look forward to helping you make informed decisions about your healthcare coverage.
Emily Trevino, Senior Managing Partner at Wise Insurance, leverages her extensive background in biology and business finance to master Medicare, health insurance, and retirement planning. With over a decade in the field, Emily has co-authored “Medicare Breakdown – The Alphabet Soup of Medicare,” marking her as a pivotal figure in insurance education. Her commitment extends through active participation in the National Association of Benefits and Insurance Professionals (NABIP) and speaking at major industry events. Emily’s drive for community service and personal resilience shines through her adventurous pursuits and dedication to societal well-being. Connect with Emily on LinkedIn to explore the future of informed insurance decisions.
