Medicare in Austin is part of a federal health insurance program that offers healthcare benefits to those who are eligible, including individuals aged 65 and older or younger individuals with certain disabilities or health conditions.

The coverage includes hospitalization, medical visits, preventive care, and prescription drugs, but the details of coverage vary depending on the type of Medicare plan.

Enrollment in Medicare is available during specific periods, and individuals may be required to pay premiums, deductibles, and coinsurance, depending on their particular plan.

If you are registering for Medicare for the first time, check our navigation blog.

Medicare and Parts of Medicare

Medicare is made up of four parts: 

  • Medicare Part A (hospital insurance) covers inpatient hospital stays, skilled nursing facility care, hospice care, and limited home health services. There is no cost for most eligible individuals, but there is a deductible, and coverage limits reset after each benefit period.
  • Medicare Part B is medical insurance that covers doctor visits, outpatient care, preventive services, and medical equipment. It comes with a monthly premium, an annual deductible, and coinsurance costs.
  • Medicare Part C (Medicare Advantage), is an alternative to Original Medicare that provides all the coverage of Parts A and B, along with additional benefits such as dental, vision, and hearing coverage, wellness programs, and prescription drug coverage. Part C plans also have out-of-pocket limits.
  • Medicare Part D is a prescription drug plan offered by private insurance companies, which covers a wide range of prescription drugs. Costs can vary depending on the plan and insurance company, and there is a monthly premium, an annual deductible, and coinsurance or copayments for each medication.

Medicare Eligibility and
Enrollment in Austin

In Austin, Medicare eligibility is based on age, disability, or certain medical conditions.  This means that you need to be:

  • 65 or older
  • Younger than 65 but with a certain disability
  • Have ERSD or ALS
  • Be a U.S. resident or legal resident who has lived in States for five years minimum


You should sign up for Medicare for your Initial Enrollment Period (IEP), which is a 7-month period that begins 3 months before your 65th birthday and ends three months after.

However, you are automatically enrolled in Medicare (Part A and B) if you’re already receiving Social Security benefits when you turn 65 or under 65 and have a disability or certain medical conditions.

Health Insurance in Austin

Health insurance in the USA is a type of insurance coverage that pays for medical and surgical expenses incurred by the insured.

There are various health insurance plans available in Austin, Texas, such as HMOs, PPOs, and POS plans, each with its benefits and drawbacks. You can choose between major medical plans which follow Affordable Care Act (ACA) requirements, short-term plans, cancer insurance plans, catastrophic plans, and more.

Those plan options are sold by private insurance companies like Texas Medicare Advisors for all adult individuals or families who want health insurance coverage.

Health Insurance Plans and Benefits

Health insurance plans are contracts between an individual and an insurance company, where the individual pays a premium to receive coverage for medical expenses.

The benefits of health insurance plans can include coverage for doctor visits, hospitalization, prescription drugs, preventative care, and other medical services, which can help to reduce out-of-pocket costs and provide financial protection against unexpected medical expenses.

Different types of health insurance plans are available in Austin, including Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Point of Service (POS) plans, High Deductible Health Plans (HDHPs), Exclusive Provider Organizations (EPOs), and Catastrophic Health Plans with low premiums and high deductibles, usually for people under 30 or with hardship exemptions.

HMOs require a primary care physician and network providers, while PPOs allow for out-of-network specialists with higher out-of-pocket costs, POS plans to combine both, HDHPs have lower premiums and higher deductibles paired with HSAs, and EPOs are similar to PPOs but have no out-of-network coverage.

Cancer Insurance in Austin

Cancer insurance plans in Austin are specialized insurance policies that help cover the costs associated with cancer treatment.

These plans can help pay for expenses not covered by traditional health insurance, such as deductibles, copays, and out-of-pocket costs. T

hey may also provide benefits for travel and lodging expenses, experimental treatments, and more.

Frequently Asked Questions (FAQ)

1. What is Medicare and who is eligible for it?

Medicare is a federal health insurance program for people who are 65 years or older, younger people with disabilities, and people with End-Stage Renal Disease. Everyone that falls under this category is eligible for Medicare coverage.

2. What does Medicare cover in Austin?

Medicare covers a range of services including hospital care, medical services, prescription drugs, and preventive services such as flu shots and cancer screenings. Part A is known as hospital insurance and Part B is medical insurance.

Part C also goes by the Medicare Advantage plan and which is sold by private insurance companies and offers some coverage as Part A and be plus additional coverage like prescription drugs, dental, or vision. Part D is a standalone Medicare Plan that covers drug prescription.

3. Are there any out-of-pocket costs with Medicare in Austin?

Yes, Medicare in Austin has deductibles, coinsurance, and copayments that vary depending on the type of coverage. Some services may also not be covered by Medicare, such as dental care, vision care, and hearing aids.

Part A  hospital deductible is 1600$  and Part B’s annual deductible is 226$. Most people qualify for free premium Part A, but Part B  monthly premiums are obligatory for everyone and the average amount is 164.90$.

Five Common



and how you can avoid them

Five Common Medicare Mistakes Book Cover

For more information about asset based long term care, reach out to Texas Medicare Advisors today.

Living Benefits
of Life Insurance

Request an advisor contact you TODAY!!

Your one step away
from your FREE download.

Complete the form to instantly get access to our free book.