Texas Medigap — age-rated, no annual switch
Texas Medigap follows the federal standardized plan structure (Plan G, Plan N, etc.) but is age-rated: premiums rise as your parent ages. Unlike California or New York, Texas has no state-level annual switching window without medical underwriting. Once the federal Medigap Open Enrollment Period closes (6 months from Medicare Part B effective date), switching plans typically requires medical underwriting.1
Practical implications:
- Choose carefully during the 6-month initial enrollment period — that’s when your parent has full guarantee-issue rights regardless of health
- Plan G is the most popular full-benefit Medigap (Plan F is no longer available to those newly Medicare-eligible since 2020)
- Compare premiums by insurer and by issue-age vs. attained- age rating method
Medicare Advantage in Texas
Texas has one of the most competitive Medicare Advantage markets in the US. Approximately 261 MA plans are available across the state (varying by county), with major players including Humana, UnitedHealthcare, Aetna, Anthem, Wellcare, and Texas-specific plans like Baylor Scott & White Health Plan.
Texas MA penetration runs about 50% statewide — slightly below the national average, with substantial regional variation. Houston and Dallas-Fort Worth have higher penetration; rural West Texas is much lower.
The WISeR prior-authorization pilot
Beginning in 2026, CMS is piloting WISeR (Wasteful and Inappropriate Service Reduction) in six states including Texas. The pilot requires prior authorization for certain Original Medicare services that historically didn’t require it — certain skin substitutes, some spinal cord stimulation, certain wound-care services.2
For most routine care, WISeR has no impact. For specific procedures the pilot targets, your parent’s provider will need to obtain prior authorization through a CMS- contracted AI-augmented review platform. If your parent is scheduled for one of the targeted procedures, ask the provider whether prior auth has been initiated before the appointment.
Medicare Savings Programs (MSPs) in Texas
Texas MSPs are administered by HHSC? alongside Medicaid. Income thresholds for 2026:
- QMB (most generous): up to 100% FPL (~$1,255/month single)
- SLMB: 100–120% FPL
- QI: 120–135% FPL
Texas is one of the more restrictive states on MSP income tests — New York and many northeastern states have set thresholds well above the federal floor. Texas does not. Even so, eligible Texas retirees who don’t apply leave ~$2,200/year of Medicare premium relief on the table.
SHIP-Texas — free Medicare counseling
Texas’s SHIP? (State Health Insurance Assistance Program) operates through the Texas Department of Insurance. Free, unbiased counseling. Call 1-800-252-9240 or visit tdi.texas.gov.
What to do this month
- Pull last month’s Medicare Summary Notice. Check whether your parent could qualify for an MSP given current income.
- Call SHIP-Texas before AEP (Oct 15 – Dec 7) for free counseling.
- If your parent triggered IRMAA? from a one-time income event, file Form SSA-44 to appeal.
- If your parent has any of the WISeR-targeted procedures scheduled, confirm prior authorization is in motion.