Medicare Part D Plans in Texas
Original Medicare was introduced in 1965 to help seniors pay healthcare costs after retirement. But the program never covered prescription medications until Congress passed the Medicare Modernization Act of 2003 (MMA). This legislation increased beneficiaries' Medicare plan options, introducing both Part C, better known as Medicare Advantage, and Part D, which provides prescription drug coverage. On this page, we explain Medicare Part D in Texas.
How Can You Get Medicare Part D in Texas?
You have two options to get Medicare Part D in Texas:
- A standalone Medicare Part D plan
- A Medicare Advantage Prescription Drug plan (MA-PD)
Original Medicare includes Part A, hospital insurance, and Part B, medical insurance. Medicare Advantage plans must offer the same benefits as Original Medicare does. However, most also offer additional coverage, such as prescription drugs, routine vision and dental care, and fitness programs.
You may add a standalone Part D plan to either Original Medicare or an Advantage plan that does not include prescription drug coverage. (Around 10 percent of MA plans do not cover prescriptions.)
If you prefer an all-in-one plan, you should consider a Medicare Advantage Prescription Drug plan. These combine your Original Medicare and Part D benefits into a single policy.
Please note that you cannot have both a standalone Part D plan and an MA-PD plan.
Who Is Eligible for Medicare Part D in Texas?
If you have Medicare Part A and/or Part B, you qualify for Part D as well. In addition, you must also meet the individual plan's requirements. This typically means living in the plan's service area.
U.S. citizens and permanent legal residents become eligible for Medicare once they turn 65. Enrollment is not automatic, however, unless you began receiving Social Security benefits at least 4 months before your 65th birthday. If not, you must apply for Medicare through the Social Security Administration.
You may also qualify for Medicare if you collect Social Security disability benefits for 24 months. In this case, you are automatically enrolled in both Parts A and B in your 25th month.
Nobody is ever automatically enrolled in Medicare Part D. Even you already collect Social Security, you must still choose to join a prescription drug plan.
When Can You Enroll in a Prescription Drug Plan in Texas?
Medicare Part D enrollment in Texas in limited to specific times.
- Initial Enrollment Period: Your IEP begins 3 months before the month you become eligible for Medicare and lasts for a full 7 months. For example, if your 65th birthday or 25th month of collecting disability benefits occurs in August, your IEP begins on May 1 and ends on November 30. Once you enroll in Part A and/or Part B, you may then sign up for Part D.
- General Enrollment Period: From January 1 through March 31, anyone who missed their Initial Enrollment Period AND does not qualify for a Special Enrollment Period (SEP) may sign up for Medicare Part A and/or Part B. You then have from April 1 through June 30 to join a prescription drug plan.
- Medicare Annual Enrollment Period: AEP is available to current Medicare beneficiaries from October 15 through December 7. During this time, you may make pretty much any change to your Medicare coverage that you want to, including joining a Part D or MA-PD plan.
- Medicare Advantage Open Enrollment Period: From January 1 through March 31, current Advantage enrollees may make the following changes to their coverage: Join a new Advantage plan or return to Original Medicare. If making that change leads to you losing your prescription drug coverage, you may also sign up for a standalone Part D plan.
- Special Enrollment Periods: If you experience certain life changes, such as moving to a new address or losing your current coverage, you may qualify for a Special Enrollment Period. Medicare.gov provides the full list of qualifying special circumstances here.
Comparing Medicare Part D Plans in Texas
Private insurance companies provide Medicare prescription drug plans, which means that coverage and costs can vary widely. To ensure you get the best plan for your particular needs and budget, you need to compare your Texas prescription drug plan options carefully.
Start by making a list of your prescription medications and then comparing it to the plan's drug formulary. If a plan does not include one or more of your medications, keep looking until you find one that does.
Next you should review the drug tiers, which lets you know approximately what your copay or coinsurance will be for a medication. Drugs on a lower tier cost less, with costs rising as the tiers do.
In addition to copays or coinsurance, your out-of-pocket costs for Medicare Part D may include an annual deductible and monthly premium. To understand the full cost of a plan, you need to look at all three of these metrics.
Extra Help is available to Medicare beneficiaries who have limited income and resources. You usually receive notification from either Medicare or Social Security if you qualify for Extra Help in Texas. If you believe you meet the requirements but did not receive this notification, contact your plan provider.
Please note that nobody from either Medicare or Social Security will ever call you. All communications are via United States mail unless you requested a phone call. If you receive a call from someone claiming to be from Medicare or Social Security, hang up the phone. Then, call the appropriate entity (1-800-MEDICARE or 1-800-772-1213) and follow their instructions.
Do You Have to Have Medicare Part D in Texas?
No, there is no law that requires you to have any part of Medicare, including prescription drug coverage. However, the Medicare program encourages enrollment by penalizing people who qualify for Medicare but do not enroll AND do not have creditable coverage elsewhere. To be considered creditable, your prescription drug plan must offer comparable benefits to what you'd get with Medicare Part D and at a similar price. If you go 63 days or more without Part D coverage, you face lifelong late penalties when you do finally join.