The 2026 Texas + Florida Medicare Guide

1. The four parts of Medicare

Medicare is a federal health-insurance program for people 65 and over and certain younger people with disabilities. It is divided into four parts that fit together:

• Part A — hospital insurance. Inpatient stays, skilled nursing, hospice. Most people pay no premium because they paid into Medicare via payroll taxes for at least 10 years.
• Part B — medical insurance. Doctor visits, outpatient care, preventive screenings, durable medical equipment. There is a monthly premium ($202.90 standard for 2026, higher for high earners).
• Part C — Medicare Advantage. Private-carrier plans that replace Parts A + B and usually bundle Part D and extras. You still pay the Part B premium.
• Part D — prescription drug coverage. Stand-alone drug plans, or included inside a Medicare Advantage plan. The 2026 out-of-pocket cap is $2,100 per year.

2. Two paths after Original Medicare

Original Medicare (Parts A + B) covers about 80% of approved costs and has no annual out-of-pocket maximum. A serious hospital stay can leave you owing tens of thousands. The two ways to cap that exposure:

Path A — Medicare Advantage. A private plan replaces your Parts A + B, bundles drug coverage and often dental, vision, hearing, and a gym benefit, and caps your annual out-of-pocket. Lower up-front premiums, network restrictions, copays at point of service.

Path B — Supplement (Medigap) + standalone Part D. You keep Original Medicare, add a Medigap policy that fills the 20% gap, and add a Part D plan for drugs. Higher monthly premium, no networks, very predictable cost sharing. Often the better path for retirees who travel or have a specialist they will not lose.

Neither path is universally better. We map your doctors, drugs, and budget against both before recommending.

3. Medicare Advantage explained

Medicare Advantage (MA) plans are sold by private carriers — UnitedHealthcare, Humana, Aetna, Anthem, Cigna, Devoted, Wellcare, and others — under contract with CMS. They must cover everything Original Medicare covers, and most also cover Part D drugs and add extras.

The trade-off is the network. HMO plans require you stay in-network for non-emergency care and get referrals for specialists. PPO plans give you out-of-network access at higher cost. SNPs (Special Needs Plans) restrict enrollment to specific eligibility groups — chronic conditions, dual Medicare-Medicaid, institutional care — and tailor benefits and provider lists to that group.

The 2026 maximum out-of-pocket cap for an MA plan is $9,250 in-network. Many plans set a lower limit. Look at the MOOP, not just the premium.

4. Medicare Supplement explained

Medigap plans pay the 20% (and other gaps) that Original Medicare does not cover. Plans are standardized — a Plan G policy from Carrier X covers the same benefits as a Plan G from Carrier Y. What differs is the monthly premium and the carrier's reputation for rate stability.

The most popular 2026 picks: Plan G (covers everything except the Part B deductible), Plan N (lower premium, small copays at the doctor and ER), and Plan G High-Deductible (much lower premium, you cover the first ~$2,800 of gaps each year).

Underwriting catches almost everyone outside their Medigap Open Enrollment Period (the six months starting the month you are 65 and enrolled in Part B). Plan around that window or you may not qualify for the carrier you want.

5. Part D drug coverage

Part D is either bundled into your MA plan or purchased as a stand-alone PDP to pair with a Medigap policy. Every plan has a formulary — the list of drugs it covers — and a tiered cost structure (tier 1 generics cheap, tier 5 specialty most expensive).

The 2026 cap: $2,100 maximum out-of-pocket on covered drugs. Once you hit it, the plan covers 100%. You can also opt into the Medicare Prescription Payment Plan to spread that $2,100 across 12 monthly bills instead of paying when you fill.

The non-obvious trap: formularies change in January. A tier 1 drug can move to tier 3, or a brand can drop entirely. That is why we built Plan-Drift Guardian — we monitor CMS formulary updates every quarter and text our clients within seven days of any change that affects them.

6. When to enroll — the four windows

• Initial Enrollment Period (IEP) — the 7-month window around your 65th birthday. Three months before, your birth month, and three months after. Sign up for Part A and B here; pick MA or Medigap + Part D at the same time.
• Annual Enrollment Period (AEP) — Oct 15 to Dec 7 every year. Switch MA plans, change PDPs, drop MA back to Original Medicare. New coverage starts Jan 1.
• Medicare Advantage Open Enrollment (MA-OEP) — Jan 1 to Mar 31. One switch only, if you are currently in an MA plan: change MA plans or drop back to Original Medicare + standalone PDP. You cannot move from Original to MA here.
• Special Enrollment Periods (SEP) — triggered by life events: moving out of your plan's service area, losing employer coverage, qualifying for Extra Help, the 5-star SEP, and others. Often the only mid-year path to switch.

7. Texas and Florida — what's different

Texas: Texas Medigap is community-rated for some carriers (premiums tied to your enrollment age, not your current age) — a powerful long-term strategy when you compare the same plan across carriers. Texas also has the largest TX Department of Insurance complaint database in the country; we cross-check carrier complaint ratios before recommending.

Florida: Florida has a higher Medicare-eligible population concentration than any other state, so MA plan competition is fierce — extras like OTC allowances, transportation, and meals after hospital discharge are routinely $1,500–$3,000/year of value. The flip side: a few major insurers have been exiting specific counties (see our 2026 carrier exits page for the current list). If you are in an affected county we will get ahead of it.

8. Star ratings and what they mean

CMS rates every Medicare Advantage and Part D plan from 1 to 5 stars based on quality measures — preventive screenings completed, member complaints, customer service responsiveness, drug pricing accuracy, and dozens more. The rating is published every October and is binding for the next plan year.

Two practical implications:

• A 5-star plan triggers a Special Enrollment Period — you can switch into it at any time of year, once per year, until November 30.
• Plans below 3 stars for three consecutive years get a "low-performing" warning from CMS and are often de-enrolled by CMS. Avoid them.

A 4-star plan in your county is usually safer than a 4.5-star plan two counties over, because doctor networks are local.

9. Five mistakes to avoid

1. Picking the lowest premium. A $0-premium MA plan can have a $9,250 MOOP and high specialist copays. Total cost of care matters more than the sticker price.
2. Skipping the formulary check. If your specialty drug is not on the formulary, you pay 100% out-of-pocket. Always run your drug list before enrolling.
3. Missing your Medigap Open Enrollment. You have one shot at guaranteed-issue Medigap when you turn 65 and enroll in Part B. Miss it and underwriting can decline you.
4. Trusting a TV commercial with a celebrity. Many of those plans are not available in Texas or Florida; the ads are nationally produced. Always verify with an independent broker who shows you the actual plans for your county.
5. Not having an agent. Direct-from-carrier means no advocacy when claims or billing go wrong. An independent agent costs you nothing — the carriers pay us — and stays with you year-round.

10. Your next step

If you have specific questions, call us — Matt at (713) 997-5768 (Texas) or (305) 306-3301 (Florida). We answer the phone during business hours and reply to email within one business day.

If you want to see what plans are available in your ZIP without talking to anyone yet, run our 6-step quote wizard: