Turning 65 in Texas comes with a stack of mail — glossy brochures, plan pitches, and “act now” deadlines — that can make a fairly logical program feel bewildering. Underneath the marketing, Medicare is built from four parts, each covering something different and costing something different. Understanding that structure is the difference between choosing coverage that fits and being steered into a plan that doesn’t.
This guide lays out the four parts, what each covers, what they cost in 2026, and where Texans can get free, unbiased help comparing options — all from official federal and state sources.
The four parts, briefly
Medicare’s structure is explained on the federal site, Medicare.gov. Part A is hospital insurance — inpatient hospital stays, skilled nursing facility care, and some home health and hospice. Part B is medical insurance — doctor visits, outpatient care, lab tests, and preventive services. Part C, known as Medicare Advantage, is a private-plan alternative that bundles A and B (and usually drug coverage) together. Part D is prescription-drug coverage, sold through private plans.
Most Texans choose one of two paths: Original Medicare (Parts A and B, often with a separate Part D drug plan and sometimes a Medigap supplement), or a Medicare Advantage plan (Part C) that packages it all. Each path has tradeoffs in cost, provider choice, and paperwork.
What it costs in 2026
The federal government sets the standard Part A and Part B figures each year. For 2026, the Centers for Medicare & Medicaid Services announced a standard Part B monthly premium of $202.90, up $17.90 from 2025, with an annual Part B deductible of $283. The Part A inpatient hospital deductible is $1,736 per benefit period in 2026.
Most people pay no premium for Part A because they (or a spouse) paid Medicare taxes long enough while working. Higher-income beneficiaries pay more for Part B — an income-related surcharge that, in 2026, lifts the monthly Part B amount well above the standard figure, as CMS details. Part C and Part D premiums vary by plan and by where in Texas you live, so there is no single statewide number for those.
What Part A and Part B cover — and don’t
Part A covers inpatient care, but after the deductible there are daily coinsurance charges for long hospital or skilled-nursing stays, which CMS spells out in its cost overview. Part B generally pays 80% of the approved amount for covered services after the deductible, leaving you responsible for the other 20% with no annual out-of-pocket cap under Original Medicare alone. That uncapped 20% is the main reason many Texans add a Medigap policy or choose Medicare Advantage.
Notably, Original Medicare does not cover most routine dental, vision, or hearing care, nor long-term custodial care. Those gaps drive a lot of the plan-shopping decisions older Texans face.
Original Medicare vs. Medicare Advantage
The choice comes down to tradeoffs. Original Medicare lets you see almost any doctor or hospital nationwide that accepts Medicare — useful for Texans who travel or split time between cities — but it has that uncapped 20% unless you buy a supplement. Medicare Advantage plans often add dental, vision, and hearing benefits and include an annual out-of-pocket maximum, but they use provider networks and may require referrals or prior authorization. Network adequacy varies across rural and urban Texas, so confirm your doctors and hospitals are in-network before enrolling.
For Texans who choose Original Medicare and want protection from that uncapped 20%, the common solution is a Medigap (Medicare Supplement) policy — a standardized private plan that pays some or all of the coinsurance and deductibles Original Medicare leaves behind. Medigap policies are standardized into lettered plans, so a “Plan G” sold by one company covers the same things as a “Plan G” sold by another; the difference is price and service. One timing rule is critical: when you first enroll in Part B at 65, you get a one-time open-enrollment window during which insurers must sell you a Medigap policy regardless of health. Miss it, and in many cases they can charge more or decline you based on medical history. Medicare.gov’s Medigap guidance explains the protections and the deadline, which is why HICAP counselors urge Texans to make the Medigap decision at 65 rather than later.
Part D and the new drug-cost cap
Part D covers prescriptions, with premiums and covered-drug lists that differ by plan. A significant recent change benefits everyone with Part D: a federal cap now limits annual out-of-pocket spending on covered prescription drugs, a protection CMS describes in its cost materials. Because each plan covers different drugs at different prices, the right Part D choice depends on the specific medications you take — which is exactly what the plan-finder tool below helps you check.
Help paying the costs
Texans with limited income and resources may qualify for programs that cut Medicare costs sharply. Medicare Savings Programs can help pay premiums and other costs, and the Part D “Extra Help” (Low-Income Subsidy) reduces drug-plan expenses; both are described on Medicare.gov. Eligibility and applications for the Medicare Savings Programs in Texas run through the state, and the Social Security Administration handles Extra Help applications.
Free, unbiased help in Texas
You do not have to navigate this from a sales brochure. Texas runs the federally funded State Health Insurance Assistance Program under the name HICAP — the Health Information, Counseling and Advocacy Program — a partnership of the Texas Area Agencies on Aging, the Health and Human Services Commission, and the Texas Legal Services Center. HICAP offers free, unbiased Medicare counseling to beneficiaries and caregivers in all 254 counties. You can find local help through the SHIP/HICAP directory or your regional Area Agency on Aging. To compare specific plans against your own doctors and medications, use the official Medicare Plan Finder.
Timing deserves its own note, because Medicare’s deadlines are unforgiving. Most people get a seven-month Initial Enrollment Period around their 65th birthday. Miss it without other qualifying coverage, and you can face lifelong late-enrollment penalties added to your Part B and Part D premiums — a permanent surcharge, not a one-time fee. There is also an annual Open Enrollment window each fall, during which you can switch between Original Medicare and Medicare Advantage or change drug plans for the coming year. Medicare.gov details these enrollment periods, and getting them right is one of the most consequential things a Texan turning 65 can do, because the penalties for missing them follow you for life.
The three numbers to write down before you enroll
Three figures do most of the work in a 2026 Medicare decision: the $202.90 standard Part B premium, the $1,736 Part A hospital deductible per benefit period, and the uncapped 20% coinsurance that Original Medicare leaves on the table without a Medigap policy or an Advantage plan’s out-of-pocket maximum. Everything else — which path to choose, whether to add a Part D plan, whether Extra Help or a Medicare Savings Program applies to you — follows from those three numbers and your own doctors and prescriptions. Before signing anything a mailer or a call-center agent hands you, run those specifics through the official Plan Finder and call HICAP, whose Texas counselors sell nothing and are paid to work only for you. In a market built to sell a plan, that free second opinion is the most valuable thing available to a Texan turning 65.
This article was produced with AI assistance and reviewed by a human editor. Figures are linked to their primary sources; where a claim could not be verified from the public record, we say so.
