Medicare in Texas: 2025 Guide
Texas is home to approximately 4.5 million Medicare beneficiaries spread across 254 counties — the most counties of any state in the nation. Medicare Advantage penetration has reached roughly 50%, with the most competitive markets concentrated in the Houston, Dallas-Fort Worth, San Antonio, and Austin metropolitan areas. Texas's decision not to expand Medicaid under the ACA has created a notable coverage gap for lower-income residents who fall between Medicaid eligibility and Medicare enrollment age, affecting the dual-eligible landscape compared to expansion states.
- Medicare enrollees: ~4.5 million
- Medicare Advantage penetration: ~50%
- Average MA plans available: 40+ per county in Houston and Dallas-Fort Worth metro areas
- State SHIP program: Texas Department of Insurance SHIP
- SHIP phone: 1-800-252-9240
Medicare Advantage Plans in Texas
Texas hosts one of the most active Medicare Advantage markets in the country, particularly in its major metro areas. In Harris County (Houston) and Dallas County, beneficiaries can typically choose from 40 or more plans during Annual Open Enrollment, with many offering $0 monthly premiums. Major insurers active in Texas include UnitedHealthcare, Humana, Aetna, Cigna, Molina Healthcare, and Blue Cross Blue Shield of Texas. Competitive pressure in urban markets has driven many carriers to include extra benefits such as dental, vision, hearing, over-the-counter allowances, and fitness programs at no additional cost.
The picture changes dramatically outside metropolitan areas. Texas's vast geography means that rural counties — particularly in West Texas, the Panhandle, and the Rio Grande Valley — may have only a handful of plan options, and some counties may have no Medicare Advantage HMO plans at all. In these areas, Original Medicare paired with a Medigap supplement and a standalone Part D drug plan is often the more reliable choice, as it allows access to any Medicare-accepting provider without network restrictions.
For beneficiaries in border communities and rural areas, special-needs plans (SNPs) designed for dual-eligible individuals or those with chronic conditions may provide more comprehensive coordinated care than standard MA plans. Texas has a significant population of dual-eligible beneficiaries, and D-SNP plans from insurers like Molina and UnitedHealthcare are available in many Texas service areas to serve this population.
Medicare Savings Programs in Texas
Texas administers Medicare Savings Programs through Texas Health and Human Services (HHS). These federally established programs help low-income Medicare beneficiaries cover Part B premiums, deductibles, and cost-sharing. Texas follows the standard federal income thresholds: the Qualified Medicare Beneficiary (QMB) program covers those at or below 100% of the federal poverty level, the Specified Low-Income Medicare Beneficiary (SLMB) program covers those between 100% and 120% FPL, and the Qualifying Individual (QI) program helps those between 120% and 135% FPL with Part B premiums.
Unlike several other large states, Texas has not expanded its income limits above the federal minimums for these programs, and it has not expanded Medicaid under the ACA. This means that Texans with incomes above the MSP thresholds but below the ACA marketplace subsidy range may find themselves in a coverage gap prior to Medicare eligibility. Once enrolled in Medicare, QMB status provides a meaningful benefit: QMB beneficiaries cannot be billed for Medicare cost-sharing by any Medicare provider who accepts Medicare assignment.
To apply for Medicare Savings Programs in Texas, beneficiaries can contact Texas Health and Human Services at 2-1-1, visit a local HHS benefits office, or apply online at YourTexasBenefits.com. SHIP counselors can also assist with the application process and help determine which program you qualify for.
State Pharmaceutical Assistance Programs
Texas does not have a State Pharmaceutical Assistance Program (SPAP) for Medicare beneficiaries. There is no state-funded program that supplements Medicare Part D drug coverage or reduces prescription drug costs specifically for Medicare enrollees beyond what federal programs offer.
Texas Medicare beneficiaries with limited income and resources should apply for federal Extra Help (also called the Low Income Subsidy or LIS). Extra Help can reduce Part D plan premiums to $0 or near $0 and dramatically lower prescription copays — to no more than $4.50 for generics and $11.20 for brand-name drugs in 2025 for full subsidy recipients. To apply, contact the Social Security Administration at 1-800-772-1213 or apply online at SSA.gov. SHIP counselors at 1-800-252-9240 can also assist with Extra Help applications at no charge.
Finding Medicare Help in Texas
The Texas Department of Insurance operates the state's SHIP program, which provides free and unbiased Medicare counseling throughout Texas. Counselors can help beneficiaries compare Medicare Advantage and Medigap plans, understand enrollment periods, file Medicare appeals, and apply for cost-saving programs like Extra Help or Medicare Savings Programs. The statewide SHIP toll-free number is 1-800-252-9240.
In addition to SHIP, the Area Agencies on Aging (AAAs) across Texas provide local counseling and referral services. Texas also has a network of Benefits Counselors housed in local aging services organizations across all 254 counties. Texas's large geographic and demographic diversity means that local offices can often provide culturally and linguistically appropriate assistance — particularly important in communities where Spanish is the primary language.
Frequently Asked Questions: Medicare in Texas
Plan availability varies widely across Texas's 254 counties. In major metro areas like Houston (Harris County), Dallas, San Antonio, and Austin, beneficiaries can typically choose from 40 or more Medicare Advantage plans during Annual Open Enrollment, including many $0 premium options with extra benefits. In smaller cities and suburban counties, you may find 15–30 plans. In rural and West Texas counties, options can be limited to just a handful of plans — and some sparsely populated counties may have no HMO options at all, making Original Medicare with a Medigap supplement a better fit. Use Medicare.gov's Plan Finder or call 1-800-MEDICARE to see what's available at your address.
No — Texas does not have a State Pharmaceutical Assistance Program (SPAP) for Medicare beneficiaries. There is no state-funded drug assistance program that supplements Medicare Part D for Texans who are not on Medicaid. However, Texans with limited income and resources may qualify for federal Extra Help (the Low Income Subsidy), which is administered by the Social Security Administration and can significantly reduce Part D premiums and prescription drug copays. Contact the Texas SHIP at 1-800-252-9240 or Social Security at 1-800-772-1213 to learn if you qualify and to get application assistance.
Texas is one of the few remaining states that has not expanded Medicaid under the Affordable Care Act. For people approaching Medicare age (65), this means there is a large coverage gap for adults between 19 and 64 with low incomes who don't qualify for traditional Medicaid but also don't yet qualify for Medicare. Once a person becomes Medicare-eligible, the non-expansion primarily affects the number of dual-eligible individuals (those who qualify for both Medicare and Medicaid) — Texas has a lower dual-eligible rate than expansion states. For active Medicare beneficiaries, the key implication is that Medicare Savings Programs follow federal minimums only, and there is no expanded Medicaid to supplement Medicare cost-sharing for those above QMB income limits. The Texas SHIP at 1-800-252-9240 can help you understand all available assistance programs.
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