Texas is the second-largest Medicare Advantage market in the country by enrollee count, behind only California. About 2.3 million Texans had a Medicare Advantage plan in 2026, roughly 51% of the state's Medicare-eligible population. The market is dominated by Humana and UnitedHealthcare, with Aetna (CVS Health), Wellcare (Centene), Cigna, and Blue Cross Blue Shield of Texas as the next tier. The statewide average premium of $13/month is right around the national MA average of $14.
What makes Texas different: the urban-rural split is wider than almost any other large state. Plans concentrate in the Houston, Dallas-Fort Worth, San Antonio, and Austin metros, where shoppers may have 50+ plans to compare. Counties in West Texas, the Panhandle, and the Big Bend region can have 15 to 25 plans and noticeably higher premiums. Texas also did not expand Medicaid, which keeps the dual-eligible (D-SNP) population smaller relative to total Medicare enrollment than in expansion states, though D-SNPs are still a major product line for carriers like Humana, Wellcare, and Molina.
This guide covers the 2026 Texas Medicare Advantage market: how many plans, which carriers, what to look for when shopping, and the key enrollment dates. Annual Election Period runs October 15 - December 7, 2026, with coverage starting January 1, 2027.
2026 Medicare Advantage Market Overview in Texas
In 2026, Texas has 156 Medicare Advantage plans available, with 2,300,000 beneficiaries enrolled (51% MA penetration). The average monthly premium is $13 and the statewide average Star Rating is 3.8.
Top Medicare Advantage carriers in Texas (2026)| Carrier | Plans | Avg Star Rating | Avg Premium |
|---|
| Humana | 32 | 4.0 | $10/mo |
| UnitedHealthcare | 28 | 3.5 | $8/mo |
| Aetna | 22 | 3.5 | $12/mo |
| Wellcare (Centene) | 19 | 3.5 | $0/mo |
| Cigna | 14 | 4.0 | $15/mo |
| Blue Cross Blue Shield of Texas | 13 | 3.5 | $18/mo |
| WellMed (UnitedHealthcare) | 10 | 4.0 | $0/mo |
| Molina Healthcare | 8 | 3.5 | $0/mo |
Source: CMS Medicare Plan Finder Q4 2025, KFF Medicare Advantage 2026 Spotlight
Plan Types in Texas: HMO vs PPO vs SNP
Medicare Advantage plan-type breakdown in Texas| Plan Type | Plans Available | Avg Premium | Best For |
|---|
| HMO | 84 | $9/mo | Lower premiums, willing to use network providers |
| PPO | 46 | $24/mo | Flexibility to see out-of-network providers |
| Special Needs Plan (SNP) | 24 | $0/mo | Dual-eligible (Medicaid + Medicare), chronic conditions, institutional |
| PFFS / MSA | 2 | varies | Rare in TX; mostly legacy private fee-for-service plans |
HMO plans dominate Texas, accounting for roughly 54% of all MA plans. PPO grew faster in 2025-2026 as carriers expanded broader-network options outside the major metros.
Source: CMS Medicare Plan Finder Q4 2025
County-Level Variance in Texas
Texas has 254 counties and plan availability varies sharply between them. Urban counties around Houston, Dallas-Fort Worth, San Antonio, and Austin typically offer 50 to 70 plans. Rural counties in West Texas, the Panhandle, and Big Bend often have only 15 to 25 plans and noticeably higher premiums.
Plan count and average premium by county in Texas| County | Plans Available | Avg Premium |
|---|
| Harris County (Houston) | 68 | $9/mo |
| Dallas County | 62 | $10/mo |
| Bexar County (San Antonio) | 55 | $8/mo |
| Hidalgo County (Rio Grande Valley) | 42 | $5/mo |
| Lubbock County | 28 | $17/mo |
| Brewster County (Big Bend) | 18 | $26/mo |
Plan counts and premiums are from CMS Medicare Plan Finder Q4 2025. Run a personalized search at medicare.gov to see exact plans for your ZIP code.
Source: CMS Medicare Plan Finder Q4 2025
What to Look For in a Medicare Advantage Plan in Texas
Picking a Medicare Advantage plan in Texas is not just about premium. Here's what matters for shopping in 2026:
- Provider network. Confirm your primary care physician, specialists, and preferred hospital are all in-network before enrolling. Texas networks vary by county, and major systems like Houston Methodist, UT Southwestern, Baylor Scott & White, and Methodist San Antonio are not in every carrier.
- Prescription drug coverage (formulary). Most Texas MA plans include Part D. Check that your specific medications are on the plan's formulary at the tier you can afford. The 2026 Part D out-of-pocket cap is $2,100 across all plans, set by the Inflation Reduction Act.
- Star Ratings. CMS rates plans 1 to 5 stars annually on quality of care, member experience, and customer service. 4-star and 5-star plans get bonus payments from CMS that fund richer benefits. The Texas statewide weighted average is about 3.8 for 2026; Humana and Cigna plans tend to score highest among the major carriers.
- Extras (dental, vision, hearing, fitness, transportation). MA plans differ widely on supplemental benefits. Wellcare, Humana, and Molina D-SNPs in Texas often include OTC and grocery allowances; UnitedHealthcare AARP plans include Renew Active fitness; some plans cover Uber/Lyft rides to medical appointments, valuable in the Rio Grande Valley and rural areas with limited transit.
- Maximum out-of-pocket (MOOP). MA plans cap your annual in-network out-of-pocket spending. The 2026 federal MOOP ceiling for in-network MA is $9,250 (down $100 from $9,350 in 2025); many Texas plans set it lower (typically $4,500 to $7,500). Original Medicare has no MOOP unless you add a Medigap policy.
- Prior authorization burden. MA plans can require prior authorization for surgeries, advanced imaging, skilled nursing, and specialist referrals. If you have a chronic condition or expect significant care, ask how often the plan requires PA and check denial rates published by CMS. Several large Texas carriers have committed to reducing PA volume starting in 2026.
Key Medicare Dates in Texas
Medicare and Medicare Advantage have several enrollment windows. Miss them and you may face delays or late penalties.
- Annual Election Period (AEP): October 15 - December 7, 2026 — Switch between Original Medicare and MA, change MA plans, or change Part D plans. Coverage starts January 1, 2027.
- Medicare Advantage Open Enrollment Period (MA OEP): January 1 - March 31, 2026 — If you're already in an MA plan, you can switch to a different MA plan or return to Original Medicare. One switch only.
- Initial Enrollment Period (IEP): 7-month window around your 65th birthday — Starts 3 months before your 65th birthday month, includes the birth month, and runs 3 months after. Enroll in Medicare Parts A and B, then choose MA or Original + Part D.
- Special Enrollment Periods (SEPs): Varies by qualifying event — Triggered by moving out of your plan's service area, losing employer coverage, qualifying for Medicaid (dual eligible), or other life events. Typically a 2-3 month window.
Notable Extras in Texas Plans
Texas Medicare Advantage plans have a few state-specific quirks worth knowing about:
- Texas did not expand Medicaid: Texas is one of 10 states that has not expanded Medicaid under the ACA. That means the dual-eligible population is smaller as a share of total Medicare enrollment than in expansion states, but D-SNPs are still a major product line. To qualify for a D-SNP in Texas you generally need to be eligible for both Medicare and traditional Medicaid (low-income aged, blind, or disabled).
- WellMed clinics in San Antonio and South Texas: WellMed is a UnitedHealthcare-owned medical group with deep roots in South and Central Texas. Many MA HMO plans in Bexar, Hidalgo, and Cameron counties are built around the WellMed clinic network. If you live in those areas, check whether WellMed is your assigned medical group before enrolling.
- Rural Texas plan deserts are real: Counties in the Panhandle, West Texas, and Big Bend region routinely have fewer than 25 MA plans. Blue Cross Blue Shield of Texas has the broadest rural footprint; Humana and UnitedHealthcare cover most metros and many regional hubs. If you live in a sparsely populated county, expect higher average premiums and fewer $0 plan options than in Houston or Dallas.
- Border-region bilingual plans: Plans in the Rio Grande Valley, El Paso, and Laredo markets often offer fully bilingual member services, Spanish-language formulary documents, and provider directories weighted toward Spanish-speaking physicians. Wellcare, Humana, and WellMed compete aggressively for Spanish-speaking dual-eligible enrollees in these markets.
Medicare Advantage vs Original Medicare in Texas
Original Medicare (Parts A and B) plus a Medigap supplement and a standalone Part D drug plan gives you nationwide provider freedom and no prior authorization for most services, but your monthly premium for Medigap + Part D in Texas typically runs $180 to $350/month, on top of the 2026 Part B premium of $202.90. Medicare Advantage plans bundle hospital, medical, and usually drug coverage into one plan with average premiums of $13/month statewide, but the trade-off is a defined network and prior authorization for many services.
If you split time between Texas and another state (snowbirds in the Hill Country or Gulf Coast, Texans with second homes in Colorado or New Mexico), Original Medicare + Medigap is usually the better fit because Medigap travels with you nationwide. If you spend all your time in one Texas metro and want lower premiums plus extras like dental, vision, and transportation, Medicare Advantage usually wins on total cost.
One Texas-specific consideration: Medigap underwriting rules are less consumer-friendly than in states like California or New York. Texas does not have a birthday rule or open enrollment beyond the federal 6-month guaranteed-issue window when you first turn 65 or first sign up for Part B. If you switch from Medicare Advantage back to Original Medicare years later, Medigap carriers in Texas can deny coverage or charge much higher premiums based on health. Build that into your enrollment decision.
How Star Ratings work and why they matter in Texas
CMS publishes Medicare Advantage Star Ratings every October, rating plans 1 to 5 stars based on roughly 40 quality measures: how well plans manage chronic conditions, customer service ratings, member complaints, and Part D drug safety. Plans rated 4 stars or higher receive quality bonus payments from CMS, which often translate to richer benefits the next plan year.
Texas runs close to the national average. The statewide weighted-average Star Rating for 2026 is about 3.8, compared to a national average of roughly 3.8 as well. Humana, Cigna, and several WellMed-linked UnitedHealthcare plans are the consistently higher-rated options in major Texas metros. If a Texas plan holds a 5-star rating, that triggers a Special Enrollment Period,ecial Enrollment Period letting you switch into it any time of year, not just during AEP.
Medicaid, D-SNPs, and dual eligibility in Texas
Texas did not expand Medicaid under the ACA, so eligibility for full Medicaid in Texas is much narrower than in expansion states. Aged, blind, and disabled Texans with low income can still qualify for traditional Medicaid (often called Medicaid for the Elderly or People with Disabilities, or MEPD), and that group is the core dual-eligible population. Check whether you qualify for Extra Help with drug costs. Texas has about 24 Dual Special Needs Plans (D-SNPs) in 2026 across Wellcare, Humana, Molina, UnitedHealthcare, and others.
Dual eligibility unlocks a special enrollment right: dual-eligible beneficiaries — those who qualify for both Medicare and Texas Medicaid — can change MA plans (or move between MA and Original Medicare) once per quarter in Q1, Q2, and Q3, plus another time during AEP. D-SNP plans in Texas typically have $0 monthly premium, $0 primary care copays, and additional benefits like grocery and OTC allowances. If you think you might qualify, the Texas Health and Human Services Commission handles Medicaid eligibility determinations.
Frequently Asked Questions
How many Medicare Advantage plans are available in Texas in 2026?
Texas has 156 Medicare Advantage plans available statewide in 2026. The exact number available to you depends on your county and ZIP code. Urban counties like Harris (Houston) offer 60+ plans; rural counties in the Panhandle or Big Bend may have only 15 to 25 plans. Run a ZIP-code search at medicare.gov to see your exact options.
What is the average Medicare Advantage premium in Texas for 2026?
The statewide weighted-average Medicare Advantage premium in Texas is about $13 per month in 2026, right around the national MA average of $14. Many Texas HMO plans charge $0 monthly premium, especially in competitive markets like Houston, Dallas-Fort Worth, San Antonio, and the Rio Grande Valley. Premiums tend to be higher ($25 to $50/mo) for PPO plans with broader networks, and noticeably higher in rural West Texas counties.
When can I sign up for Medicare Advantage in Texas?
The main enrollment window is the Annual Election Period (AEP) from October 15 to December 7, 2026, for coverage starting January 1, 2027. You can also enroll during your 7-month Initial Enrollment Period around your 65th birthday, or during a Special Enrollment Period triggered by events like moving, losing employer coverage, or qualifying for Medicaid. Existing MA enrollees can switch plans during the MA Open Enrollment Period (January 1 - March 31, 2026).
Who has the best Medicare Advantage plans in Texas?
Humana leads Texas in total MA enrollment and has strong Star Ratings (averaging around 4.0 stars). UnitedHealthcare offers the broadest network statewide and many $0 premium options under the AARP brand. Cigna, headquartered in Texas, tends to score well on Star Ratings in DFW and Houston. Wellcare and Molina compete hardest in the D-SNP segment. The best plan for you depends on your doctors, your medications, and whether you value low premium or wide network.
Can I switch from Medicare Advantage back to Original Medicare in Texas?
Yes. You can switch back during the Annual Election Period (October 15 - December 7) or the Medicare Advantage Open Enrollment Period (January 1 - March 31). However, returning to Original Medicare does not automatically guarantee you can buy a Medigap policy in Texas: Texas Medigap insurers are generally not required to sell you a plan outside your initial 6-month Medigap open enrollment window, except under specific guaranteed issue rights. Texas does not have a Medigap birthday rule or annual open enrollment. Plan ahead.
What is the difference between an HMO and a PPO in Texas Medicare Advantage?
HMOs (84 of Texas's 156 plans) require you to use in-network providers and usually need a referral to see a specialist. They offer lower premiums (average $9/mo) and Humana, WellMed, and Wellcare are big HMO operators in Texas. PPOs (46 plans) let you see out-of-network providers at a higher cost share and don't require referrals, but charge higher premiums (average $24/mo). Choose HMO for lower cost in network; choose PPO for flexibility, especially in rural areas with fewer network providers.
Does Medicare Advantage cover prescription drugs in Texas?
Most Texas Medicare Advantage plans (roughly 89%) include Part D prescription drug coverage built in. These are called MA-PD plans. The 2026 Part D annual out-of-pocket maximum is $2,100 across all plans, set by the Inflation Reduction Act. Insulin is capped at $35/month, and certain vaccines like shingles are free. Always check the plan's formulary to confirm your specific medications are covered, and at what tier.
Are dental, vision, and hearing covered by Medicare Advantage in Texas?
Most Texas Medicare Advantage plans include some level of dental, vision, and hearing benefits, which Original Medicare does not cover. Coverage varies widely: some plans cover only cleanings and exams, while others cover crowns, hearing aids, and prescription eyewear. Humana, Cigna, and WellMed-linked UnitedHealthcare plans tend to have the most generous packages in Texas. Always check the Evidence of Coverage for annual limits and what's actually covered.
