Medicare Advantage vs. Original Medicare in Texas: How to Choose

Once you have Parts A and B, you face Medicare's biggest decision: stay with Original Medicare and add to it, or join a Medicare Advantage plan. In a state as big as Texas, where one person lives ten minutes from a major medical center and another lives two hours from the nearest specialist, the right answer depends a lot on where you live. Here's a clear side-by-side.

The two paths

	Original Medicare (+ Medigap + Part D)	Medicare Advantage (Part C)
Doctors and hospitals	Any provider in the U.S. that accepts Medicare	Generally in-network providers in the plan's service area for non-emergency care
Referrals	Usually not required	May be required to see a specialist
Monthly cost	Part B premium + Medigap premium + Part D premium	Part B premium + plan premium (some plans are $0)
Cost when you get care	20% Part B coinsurance after the deductible, much of which Medigap can cover	Copays and coinsurance that vary by plan
Yearly out-of-pocket cap	None without supplemental coverage	Yes, every plan has one
Drug coverage	Separate Part D plan	Included in most plans
Dental, vision, hearing	Not generally covered	Some plans include some of these
Prior authorization	Usually not required	May be required for certain services

New to Medigap? Our guide to Medigap in Texas explains the timing rules that matter most.

Questions Texans should ask first

How far is your care? Most Texas counties are rural. If your nearest hospital is small and you travel to Dallas, Houston, San Antonio, or Lubbock for specialty care, check whether those facilities are in a plan's network. With Original Medicare, any provider that accepts Medicare will do.

Do you split time between places? If you spend part of the year with family in another state, or winter in the Valley and summer elsewhere, a network tied to one service area may not fit. Original Medicare works with Medicare-accepting providers nationwide.

Are you near the border? Original Medicare generally doesn't cover care in Mexico, and most Medicare Advantage plans don't either, though some offer emergency or urgent care abroad as an extra. Ask before you count on it.

Are you a military retiree? TRICARE For Life works alongside Original Medicare and requires both Part A and Part B. See our guide to Medicare and TRICARE For Life in Texas.

Who often leans toward Original Medicare

• Frequent travelers and people who split time between states
• People who want to see any specialist without referrals
• People who prefer predictable costs and can handle higher monthly premiums
• People with ongoing health conditions who expect to use a lot of care

Who often leans toward Medicare Advantage

• People who want lower or $0 plan premiums
• People who want drug coverage in the same plan
• People whose doctors and hospitals are in the plan's network
• People who value extras that some plans include, like dental, vision, or hearing
• People comfortable with referrals and prior approval

Hurricane season and networks

If you live along the Gulf Coast, it helps to know what happens in a disaster. When an emergency or disaster is declared and access to care is disrupted, Medicare Advantage plans must let you see providers at out-of-network Medicare-certified facilities, without a referral, and apply in-network rates. Keep your cards and a medication list in your go-kit, and check your plan's website for any temporary rule changes.

The Medigap timing trap

Your best chance to buy Medigap is your six-month Medigap open enrollment period, which starts when you're 65 or older and enrolled in Part B. The Texas Department of Insurance says companies must sell you any Medigap plan they offer in Texas during that window, regardless of health history. There's also a trial right: if you join a Medicare Advantage plan when you're first eligible at 65 and switch back to Original Medicare within the first year, you can generally buy a Medigap policy.

When you can make the switch

• Oct. 15 to Dec. 7: Change your coverage for the following year.
• Jan. 1 to March 31: If you're in Medicare Advantage, switch plans or return to Original Medicare, once.
• Special Enrollment Periods: Moving, losing other coverage, and certain other life events can open a window. See our 2027 open enrollment guide.

Free, unbiased help

You can compare plans in your county on the Medicare.gov Plan Finder, see plan counts on our Medicare by county page, or call the Texas Health Information, Counseling and Advocacy Program (HICAP) at 1-800-252-9240 for free counseling. Spanish speakers can call 1-800-MEDICARE and ask for an interpreter.