Medicare

Medicare is a federal health insurance program designed for:

• Adults age 65 and older
• Younger individuals with qualifying disabilities
• People with End-Stage Renal Disease (ESRD)

Most Medicare beneficiaries pay a monthly premium, along with deductibles and copayments when receiving care.

Medicare Part A covers inpatient and facility-based care, including:

• Inpatient hospital stays
• Skilled nursing facility care
• Hospice services
• Limited home health care

👉 Many individuals qualify for premium-free Part A based on work history.

Medicare Part B covers outpatient and preventive healthcare services, such as:

• Doctor visits and specialist care
• Outpatient procedures and treatments
• Medical equipment (wheelchairs, walkers, oxygen)
• Preventive services (annual wellness visits, screenings, vaccines)
• Some physician-administered medications

Medicare Part D helps cover the cost of prescription medications.

• Available as standalone plans or included in Medicare Advantage
• Covers both brand-name and generic drugs
• Plans vary by provider and location in Texas

Understanding your options is key to choosing the best Medicare coverage in Texas.

Original Medicare is the standard government-run program.

• Includes Part A (hospital) and Part B (medical)
• Allows you to visit any doctor or hospital that accepts Medicare
• Does not include prescription drug coverage (Part D must be added separately)

• No annual out-of-pocket maximum
• You may pay deductibles, coinsurance, and copays

Many Texans choose a Medigap (Medicare Supplement Insurance) plan to help cover:

• Copayments
• Coinsurance
• Deductibles

👉 Individuals with limited income may qualify for assistance through Medicaid or savings programs.

Original Medicare is the standard government-run program.

The federal government funds the cost of services covered in Medicare by Part:

• Part A is financed through payroll taxes that are deposited into the Hospital Insurance (HI) Trust Fund.
• Part B and Part D are financed mostly through income taxes that are overseen in a general fund of the Treasury, and partly through premiums paid by beneficiaries and state Medicaid agencies.

Medicare Advantage (MA) plans are an all-in-one alternative to Original Medicare offered by private insurance companies approved by Medicare.

• Part A (hospital coverage)
• Part B (medical coverage)
• Often include Part D (prescription drug coverage)

• Dental, vision, and hearing coverage
• Fitness programs
• Over-the-counter allowances
• Transportation benefits

• Annual out-of-pocket maximum for financial protection
• Lower upfront costs in many cases
• Coordinated care through provider networks

• Plans may have network restrictions (HMO or PPO)
• Coverage and costs vary by county in Texas

Medicare is funded through a combination of taxes and premiums:

• Part A is funded primarily through payroll taxes paid into the Hospital Insurance Trust Fund
• Part B and Part D are funded through general tax revenue and beneficiary premiums
• Medicare Advantage (Part C) is funded similarly using federal payments to private insurers

When comparing Medicare plans in Texas, consider:

• Your preferred doctors and hospitals
• Prescription drug needs
• Monthly premium vs. out-of-pocket costs
• Additional benefits (dental, vision, etc.)
• Travel coverage within or outside Texas

👉 Working with a licensed Medicare agent can help you compare plans available in your specific ZIP code.

Navigating Medicare can be confusing, but you don’t have to do it alone.

For official information, visit:
👉 https://www.medicare.gov

Or get personalized help comparing Medicare plans in Texas by speaking with a licensed professional