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Medicare Part D in Texas


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What is Medicare Part D in Texas?

Medicare Part D in Texas is just one state’s part of a federal program that provides prescription drug coverage for Medicare beneficiaries. This coverage is popular among Texans with Medicare – almost 73% of those enrolled in Medicare have coverage under Medicare Part D in Texas.

Private insurance companies contract with Medicare to offer prescription drug coverage under Medicare Part D in Texas.

You typically have two options for getting prescription drug coverage through Medicare Part D in Texas. You can choose one or the other, but not both.

  • You can sign up for a Medicare Advantage Prescription Drug plan that combines medical and prescription drug benefits into a single plan if you have Medicare Part A and Part B.
  • You can enroll in a stand-alone Medicare Part D Prescription Drug Plan to work alongside your Medicare Part A and/or Part B coverage.

Medicare Advantage Prescription Drug plans and stand-alone Medicare Part D Prescription Drug Plans often have pharmacy networks that might that may help lower your prescription drug costs. Both types of plans:

  • Have formularies, or lists of medications covered by the plan, that typically include commonly prescribed brand-name medications and less expensive generic equivalent medications
  • Require copayments, coinsurance amounts, and (in some cases) an annual deductible that you pay for prescription medications covered by the plan
  • Might have networks of contracted pharmacies in Texas
  • Require you to live within the plan’s service area

However, Medicare Prescription Drug Plans in Texas are not all the same. Your costs (such as premiums, deductibles, and coinsurance) may be different among plans. Did you know that some Medicare Advantage Prescription Drug plans in Texas may have premiums as low as $0, and still include prescription drug coverage? Each plan establishes its deductible (if any), copayments, and/or coinsurance for medications covered by the plan.

Another way that plans may vary is that they don’t all cover the same list of prescription drugs. As mentioned above, each plan has its own formulary of covered medications. The formulary can change at any time, but the plan will notify you of changes if necessary.

So it’s wise to compare the plans available where you live and check to see if the medications you take are on the plan’s formulary. You can compare plans by entering your zip code in the box and clicking the button on this page.

When should I enroll in Medicare Part D in Texas?

Some people find that the best time to enroll in a Medicare Advantage Prescription Drug plan in Texas is when they’re first eligible for Medicare. This timeframe is called the Medicare Initial Enrollment Period. If you sign up when you’re first eligible, not only do you have the protection of prescription drug coverage – you avoid a potential late-enrollment penalty that may apply if you decide to get coverage under Medicare Part D in Texas later.

Other times you may be able to enroll in a Medicare Prescription Drug Plan in Texas, or change or drop plans, include:

  • The Annual Election Period (October 15 – December 7)
  • A Special Election Period for certain situations. For example, you might be able to sign up or change plans if you move outside your plan’s service area, move from home to a skilled nursing facility or vice versa, or lose your current coverage.

What else should I know about Medicare Part D in Texas?

You might have several plan options for Medicare Part D in Texas. According to the Centers for Medicare & Medicaid Services (CMS), in 2018:

  • There are 177 Medicare Advantage plans in Texas, providing 100% of Texans at least one Medicare Advantage plan option.
  • There are 24 stand-alone Medicare Part D Prescription Drug Plans in Texas
  • Out of the nearly 4 million people enrolled in Medicare in Texas, nearly 73% have prescription drug coverage under Part D.

If you have questions about Part D coverage or need help finding Medicare plan options in Texas, contact eHealth today for personalized assistance.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.

The Formulary, pharmacy network may change at any time. You will receive notice when necessary.”

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