How to Apply for Medicare in Texas
Over 4.4 million Texans currently enroll in Medicare, the federal health insurance program designed for people 65 or over. People younger than 65 with qualifying disabilities such as end-stage renal disease or amyotrophic lateral sclerosis may also qualify.

Original Medicare provides several choices for coverage options, from Parts A through D to Medicare Advantage plans administered by private insurers that combine coverages into packages administered by them. There are also optional plans available such as Medicare Advantage Prescription Drug plans and Medicare Supplements as supplementary options.


Over 4.4 million Texans currently benefit from Medicare, the federal health insurance program. Medicare covers medically necessary services for Americans 65 or older with qualifying disabilities such as end-stage renal disease or amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease). Residents in Texas may enroll in original Medicare Part A and B as well as Medicare Advantage plans or Supplement insurance options that offer additional benefits at different costs with associated deductibles and copayments; there are specific open enrollment periods each year during which individuals can sign up for coverage;

Individuals can enroll in Medicare Part A and Part B during their Initial Enrollment Period, typically starting the month they turn 65 (or sooner if receiving Social Security disability payments or Railroad Retirement Board disability payments for 24 months).

People typically can avoid late enrollment penalties by enrolling during their Initial Enrollment Period (IEP), though in certain situations people may qualify to enroll outside this window – for instance if someone did not sign up for Part B when first eligible due to having creditable group health plan coverage or TRICARE Prime they can sign up during a Special Enrollment Period.

Texas offers four Medicare Savings Programs that can assist those needing help paying their Medicare premiums, deductibles and copayments. Administered by the Texas Health and Human Services Commission, eligibility requirements differ among them but all have limits on the total accessible financial assets that individuals may own.

Anyone wishing to enroll in a Medicare Advantage plan during Texas’ open enrollment period of October 15 through December 7 can do so during this open enrollment period, from October 15 until December 7. Over 300 plans are available, typically offering lower monthly premiums than Original Medicare while providing extra benefits like vision care and dental coverage as well as prescription drug coverage. Although restrictions do apply when enrolling, such as living within its service area and meeting any minimum health requirements.

Open Enrollment

As soon as you become eligible for Medicare in Texas, there will be several coverage options to consider when selecting coverage. There is Original Medicare (the public option), Medicare Advantage plans with various cost sharing arrangements, Medicare Supplement plans or both. It is crucial that any plan selected be enrolled during its open enrollment period to avoid penalties or gaps in coverage.

If it’s your first time signing up for Medicare Part B, an Initial Enrollment Period (IEP) offers you the best opportunity. This window begins three months prior to your birthday month and continues through your birth month until three months post. If you miss this window and choose later enrollment instead of enrolling within this window, penalties will apply when enrolling later on.

Special Enrollment Periods (SEP) allow Medicare plan changes without incurring extra fees, should certain qualifying life events arise, such as moving states or getting married. You can take advantage of one if these circumstances apply; these windows of time provide an opportunity to switch plans without incurring penalties.

Discover more about Special Enrollment Plans (SEPs) by contacting the Medicare helpline or visiting their website, and there are also local advocacy organizations specializing in helping people make decisions regarding Medicare; these groups can also guide you through the registration process for Medicare.

Medicare assistance organizations also provide additional resources and financial support for your expenses. The Texas Health and Human Services Commission can be an excellent source for finding Medicare Savings programs which may provide financial help with Medicare deductibles, premiums and coinsurance costs.

As another option for those who missed their Initial Enrollment Period (IEP), Special Enrollment Periods (SEPs) provide individuals who did not enroll in Part B of Medicare during their Initial Enrollment Period due to misrepresentation or reliance on information from employers, GHPs, agents or brokers of health plans or anyone authorized to act on their behalf during that IEP window. It also applies when volunteers were performing service abroad with tax-exempt organizations that provided them health insurance while abroad.

Enrollment Options

Texas Medicare participants have several choices when enrolling, from Original Medicare (the public option) or private plans offering Parts A and B coverage bundled together through private insurers regulated by CMS; Medicare Advantage provides cost caps; enrollees should sign up during either their Initial Enrollment Period, General Enrollment Period or Special Enrollment Period to ensure coverage.

Individuals who missed their Initial Enrollment Period due to an emergency or disaster can use this Special Enrollment Period (SEP) as a second chance to enroll in Medicare Parts B and premium Part A without incurring penalties. Individuals must provide documentation or written attestation that circumstances beyond their control prevented them from enrolling when first eligible; it cannot be used to avoid paying late enrollment penalties due to ignorance, forgetfulness or nonpayment of premiums.

Not only can Medicare beneficiaries change or discontinue coverage during the Special Election Period (SEP), but other opportunities also exist to make necessary adjustments or drop coverage altogether. Open enrollment period takes place annually between October 15 and December 7; individuals can join or switch Medicare Advantage or Prescription Drug plans; they can also purchase Medigap policies approved by Medicare; they could even get Medigap coverage with private insurers approved by Medicare.

Individuals attempting to enroll in Medicare Advantage plans or Medigap policies outside their designated enrollment periods may be subject to medical underwriting, a process intended to determine whether an insurance company accepts their application and what amount will be charged for coverage.

Individuals ineligible for Medicare Advantage or supplement policies can apply for one of four Texas Medicare Savings Programs that help people pay their premiums and cost-sharing payments. Furthermore, Texas provides numerous resources that assist senior Texans and caregivers, including nonprofit organizations, Area Agencies on Aging (AAoA), and local public health agencies.

Plan Choices

Once eligible, Texans have a variety of Medicare options to select. Original Medicare provides hospital and medical coverage through Part A and B respectively; but as this doesn’t cover all costs, most opt for Medicare Advantage or Supplement plans instead.

Medicare Advantage plans from private companies provide an appealing alternative to Original Medicare with additional benefits such as dental, hearing and vision coverage. Medicare Advantage is ideal for people looking for one plan covering primary care provider visits, referrals to specialists as well as prescription drug coverage – these supplemental plans vary in cost and coverage depending on where you live.

Medicare Advantage plans provide Texas residents who want to remain close to home and remain within reach of their preferred doctors and facilities with access to local networks of providers that best suit them. It’s essential that they find one that complements both current healthcare providers and medical needs, so find one that matches up.

Texas Medicare Advantage Plans, also known as Medicare Part C, are the ideal choice for many residents who appreciate having easy access to a primary care physician and referrals or prior authorization for certain treatments. Many Medicare Advantage plans also come equipped with prescription drug plans which may save you money on medications.

Medicare Advantage plans differ from Medicare Supplement in that their prices and terms can differ considerably, making comparisons challenging. When shopping for an Advantage plan, keep your monthly premiums and total annual out-of-pocket costs in mind when making your selection; generally speaking, younger enrollees will typically pay less since their premium is determined based on age.

As with any major purchase, Medicare Advantage plans should be purchased during your six-month open enrollment window. Otherwise, medical underwriting could become necessary and you could end up answering health-related questions and potentially be denied coverage due to preexisting conditions or paying higher premiums than necessary.

Linda WilliamsLinda Williams
10:08 12 Jul 23
I had a 5 star experience and would recommend him. Always returning my calls promptly, very helpful and informative, listened to what my needs was regarding my Medicare. I truly felt comfortable with John's help to navigate through the maze of Medicare
Cindy KulakCindy Kulak
14:51 18 Jun 23
John is very knowledgable, honest and ethical in helping clients evaluate Medicare options and get enrolled. He made the process extremely easy for myself and my husband.
Leeann MoosLeeann Moos
17:26 06 Apr 23
When I became eligible for Medicare, my phone was constantly under attack from Medicare options sales folk. Since I needed help understanding my options and life is too short to do business with annoying people a little research was in order. Thats how I found John. His other customers seem very pleased with his service and I decided to give him a try. I was NOT disappointed! He did an excellent job for me, is extremely personable and I could not be happier. Thank you John
Rose WrightRose Wright
16:07 05 Apr 23
I am so thankful for the help that Mr. John was able to assist me with medicare information. After being bombarded with letters and phone calls you just need someone who can walk you through the confusion. And after getting all the info and the best plan and benefits for what i needed. I am glad that He was there for me.Thank you so very much,Rose Wright
Steve HenselSteve Hensel
21:08 04 Apr 23
Claeys Group is great to work with. John is truly professional, knowledgeable and makes the entire process flow so much more smoothly than I expected. I would highly recommend him.
Deborah RounsavallDeborah Rounsavall
14:25 07 Mar 23
I changed from my person finance planning group to John for help. Others led me astray. John is very responsive and follows up promptly. Even helped me on the weekend at the end of year to get all my documents in on time so I didn't lose insurance coverage. Explains all the options in a manner that us rookies can understand it. I highly recommend John.
Setella ParksSetella Parks
13:12 07 Mar 23
John's knowledge is invaluable when it comes to navigating the murky water of Medicare plans. He answered all our questions in a manner we could understand and helped us compare benefits between plans, services, and providers readily available in our area. I am so happy we called on him to assist us! He handled EVERYTHING professionally and patiently and has followed up to make sure we are good. Highly recommend his 5 star service!
Sherry JonesSherry Jones
21:01 23 Feb 23
John was recommended by my sister-in-law, who spoke very highly of him. He wrote out the differences between policies and explained it step by step to me so I could understand which policy would be best for my needs. He was professional but also down to earth so I could be at ease. He did this at my bed side which was such a blessing for me. I highly recommend John for your Insurance needs.
19:40 20 Feb 23
We were recommended by friends to call John Claeys for our insurance. He came twice to gather information on what we were looking for and returned with information and details. We are delighted to have John Claeys as our agent and would recommend to our friends and anyone else to call John Claeys today.Tom and Debbie
Joyce SandvikJoyce Sandvik
20:32 30 Aug 22
John Claeys came to our house to talk about all aspects of Medicare. He wrote out some information on a notepad as he talked and answered our questions. He gave us the handwritten notes along with printouts of more information specific to my needs. My husband and I took o a few days to discuss the options. John took a list of my medications and researched all the available prescription insurance policies for me. He narrowed it down to the best policy (best prescription prices) for me. It was so easy and I felt confident I was getting exactly what I need when I turn 65. Every September, he will research prescription policies from my updated list of medications to find the best policy for my needs. Thanks to John Claeys for making this transition extremely easy and effortless.
Marilyn ScottMarilyn Scott
09:35 23 Jul 22
John enrolled my husband into Medicare 4 years ago. I knew then I wanted him to help me with my Medicare when it was my time to enroll. John helped me recently. He is very knowledgeable, humble and so patient. He made sure I had the best plan for me. He genuinely cares about his clients. He is the best insurance consultant! I highly recommend John for your Medicare needs!!
James MartinJames Martin
20:31 20 Jun 22
John did a great job of providing many options for my insurance. He is very thorough.
Judy MarkmanJudy Markman
17:02 20 Jun 22
John goes above and beyond to find the best insurance to fit your needs at an affordable price. I definitely recommend!
Dave LemingDave Leming
16:56 20 Jun 22
John was referred to my wife and I as we began to transition to use Medicare as our insurance options. He was very knowlegeable about all things related to government programs and supplemental options as well. I would strongly recommend his services to anyone requiring such support.
Ed HareEd Hare
14:16 08 Jun 22
John was recommended to us by a friend as we were turning 65 and having to make decisions on our medicare and advantage plan choices.John was thorough, informed, patient and engaged in helping us wade through all the minutia we were receiving to package the best set of programs for our future healthcare needs.We are happy and confident as healthcare needs arise having John at our side.Debi and Ed Hare
Julie SimpsonJulie Simpson
02:36 14 May 22
We selected an awesome advisor in John Claeys! John was dedicated to our needs in counseling our new Insurance choices with Medicare. He is sincere in getting his customers into the program that is best for their situation. John was sincere in explaining the process and we are happy to refer him to others! Steve and Julie Simpson
Sherry HilliardSherry Hilliard
16:55 18 Feb 22
John was extremely helpful when I had to select my Medicare supplemental policy. He is very knowledgeable in the various insurance products. I would recommend John to anyone needing insurance, and in fact, I have recommended him to several of my friends.
Margie SmithMargie Smith
01:08 16 Feb 22
Highly recommend Claeys Group Ins Service, John has assisted with my Medicare supplement and RX choices for past couple years. He is very knowledgeable of the various companies and policies available. Saved money and introduced me with a 5star company.
16:56 10 Feb 22
John came to my house and explained the process of signing up to Medicare in an understandable way. He gave me the steps to take and assisted in the planning. With his help, I got it done. Before he came, it all seemed overwhelming. He's so genuinely nice, and I felt like I had known him for a long time. I highly recommend him, and in fact, already have recommended him to friends and family.
Rebecca NelsonRebecca Nelson
21:00 04 Feb 22
John Claeys is a great individual to work with you on insurance needs. He searched out the best policy and an affordable one that I could handle. He researches every year to be sure I’m getting the most for my money! Highly recommend this group.
Dorys GardensDorys Gardens
12:20 23 Jan 22
John was so pleasant to work with. He explained everything clearly and did not pressure me to make a decision one way or the other. He shopped for the best customized drug plan which will be saving me money in the long run. I highly recommend letting him guide you through the medicare process.