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Medicare in Texas 2025: What You Need to Know

Photo of Houston Texas for All About Medicare website, resource from Texas Medicare website.

Introduction

If you’re a Texan approaching 65 or already on Medicare, understanding your options for 2025 is key. Texas offers a wide range of Medicare Advantage, Supplement, and Prescription Drug Plans — but not all are created equal.

Key Changes for 2025

  • Updated premiums and deductibles for Medicare Part B and D.
  • New Advantage plan benefits for dental, hearing, and vision.
  • Expanded coverage in rural Texas counties.

Enrollment Tips

  • Compare plans early — the Annual Enrollment Period (AEP) runs from October 15 to December 7.
  • Review your medications and doctor network each year.
  • Use licensed Medicare agents in Texas for personalized quotes.
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The Size of Medicare (Nationally) in the U.S.

The Size of Medicare (Nationally) in the U.S.

For the whole US, Medicare enrolls 64 million people. Of those, 9.1 million are on Medicare due to a disability, 16% of the Medicare population. Another 500,000 are on Medicare due to End-Stage Renal Disease (ESRD). Medicare accounts for 4% of the US Gross Domestic Product (GDP), or around $780 billion dollars, making it the second most expensive Federal program. (Social Security, at about one trillion ($1,000,000,000,000) per year.

The average total cost per Medicare beneficiary is $12,187 per year. Of that, beneficiaries pay an average of $170.10 per month, or $2041,20, for Part B in 2022 and pay an additional average of ca. $6,000 out of pocket, for a total of around $8100. A very good private insurance plan, in contrast, would cost around $26,000 per year.

Medicare accounted for 20 percent of total national health spending, 30 percent of spending on retail sales of prescription drugs, 25 percent of spending on hospital care, and 23 percent of spending on physician services in 2017.

 

 

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Can You Be Turned Down for a Medicare Supplement Plan?

Can You Be Turned Down for a Medicare Supplement Plan?

The short answer is yes, except during your Medicare Supplement Open Enrollment period, which starts the first day you are enrolled in both Parts A and B of Original Medicare and ends six months later. Outside of this period, Medigap plans are allowed to use medical underwriting and deny you coverage or increase your premium if you have pre-existing health conditions.

Do I Have to Wait for Coverage?

Even if you enrolled during the open enrollment period, you can be denied coverage for pre-existing conditions for up to six months.

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Saving on Prescription Drugs While on Medicare

Saving on Prescription Drugs While on Medicare

If you are on Medicare, you probably spend an average of $581 per year, out-of-pocket on your prescription drugs, over and above your Part B premiums and any Medicare Advantage, Medigap, or prescription drug plan premiums that you pay. For some, it can be much more.

87% of adults aged 65-79 use prescription drugs, and the average number prescribed per person is 20.

How can you save? Medicare Advantage and Medicare Part D plans are required to provide a mail-order pharmacy option. When you use mail order, you are avoiding a retail pharmacy, prices are generally somewhat lower than in-person pharmacy service, but not always: it depends on the plan and the drug in question.

If you compare the full retail pharmacy price, using a discount card like GoodRx versus the mail-order cost, you may occasionally find that using the discount card is cheaper.

Another option has recently become available…

Billionaire Mark Cuban has started a mail-order pharmacy called CostPlusDrugs.com. Around 100 generic medications are available from this site, all at cost plus a 15% markup. You may find that the price from this site, assuming your drug is available, is far less than the mail-order price with your Medicare Advantage or prescription drug plan. New drugs will be added each month. At present, the plan is to offer only generics, but this may change. You can check if a generic is available for your prescription drug by asking your doctor’s office or googling “generic for name-of-prescription drug.” Currently, CostPlusDrugs.com does not accept insurance to keep administrative costs down. This may change in the future.

If you are considering ordering from other mail-order pharmacies, Blink Health has been rated best, it accepts most insurances and is available 24/7. Blink has most drugs available in addition to generics.

More than ever now, it pays to shop around for your prescriptions, as it true with so much else.

 

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Dental Coverage Under Medicare

Dental Coverage Under Medicare
Dental Coverage Under Medicare

Dental Coverage Under Medicare

Medicare covers almost no dental services. Not exams. Not cleaning. Not dentures. Not drilling. Not filling. Zip. Zero. Nada. The exceedingly rare situations in which Medicare covers dental services are those in which dental services are an integral part of care for a non-dental problem, such as a jaw injury or bone cancer.

That being said, the only way that you will obtain dental services under Medicare is to enroll in a Medicare Advance Plan that offers dental services as an extra benefit or enroll in a dental plan for seniors on Medicare. With Medicare Advantage Plans, precisely because they are an extra benefit, they tend to be limited, but some coverage is certainly better than none. Coverage in separate dental plans may be more generous.

Because both Medicare Advantage Plans and dental plans for seniors on Medicare are both private businesses not affiliated with the federal government, you must deal with a Medicare agent in order to get them. The Social Security office or Medicare can only refer you to an agent if you have questions about these plans.

When Can I Enroll?

For Medicare Advantage Plans that offer dental services as an extra benefit, your Original Enrollment period starts the third month before your 65th birthday and runs for seven months. There is also an open enrollment period from January 1 to March 31 of each year. You also have a special enrollment period if you lose coverage because your plan shut down, or stopped offering services in your area, you lost employer-provided insurance that you were using as evidence of creditable coverage, you were given wrong information about enrollment by a Federal employee, and a few other situations.

Open enrollment for stand-alone dental plans for seniors is usually year-round, but this may vary in some states and localities. Again, your Medicare insurance agent is your best source here; Medicare cannot help you.

How Much Does It Cost?

As with American health care in general, prices vary widely and wildly. Premiums for Medicare Advantage Plans with dental services range from $0 per month to around $100 per month; premiums for stand-alone dental plans range from $0 to $100 per month. That being said, why, you may ask, does not everyone pick the zero-premium plans? The answer is coverage. You get what you pay for, and higher-cost plans generally, but not always, offer lower deductibles and copayments and a wider range of services.

About half of adults on Medicare do not have dental coverage. It is not advisable to be one of them.

 

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Does Medicare Cover Ambulance Services?

Does Medicare Cover Ambulance Services?
Does Medicare Cover Ambulance Services?

Does Medicare Cover Ambulance Services?

The short answer is yes. If ground or air ambulance transport is medically necessary, Medicare will pay to transport you to the nearest facility that can provide the needed services. Services are provided under Part B. If you do not have Part B, Medicare will not pay.

The Part B deductible, which is $233 in 2022, applies. After that, you pay 20% of the Medicare-approved charges.

Most of the time when ambulance transport is necessary, it is obvious. In cases where it is not, your doctor can provide a certification that it is needed. For example, a dialysis patient may need ambulance transport to a dialysis center.

What If There’s a Question?

If the ambulance service doubts that you meet the definition of medical necessity, they are required to give you a notice that Medicare may not pay. This is called an Advanced Beneficiary Notice of Non-coverage. It is given if you requested an ambulance in a clearly non-emergency situation or the company believes Medicare will not pay. (The fact that you received such a notice, alone, does not mean that Medicare will not pay; this is determined later.)

Are There Special Situations?

Yes. If you live in the states of Delaware, the District of Columbia, Maryland, New Jersey, North Carolina, South Carolina, Virginia, or West Virginia, and you use non-emergency ambulance services more than three times in a ten-day period or once a week for three weeks or more, the company may request a pre-authorization before providing services. If the pre-authorization request is not approved, Medicare will not pay for the services.