Medicare & Medicaid in Texas (TX)
2026 healthcare costs, coverage, and spending data for Texas.
$13,718
Spending/Capita
7,030,295
Medicare Enrollees
9,457,062
Medicaid Enrollees
11.4%
Uninsured Rate
Medicare Premiums in Texas
Part B Premium
$286/mo
Part D Premium (Avg)
$77/mo
Medigap Premium (Avg)
$193/mo
Medicaid Expansion: No - Texas has not expanded Medicaid
Procedure Costs in Texas
Hospital
| Procedure | Avg Cost | Medicare Pays | You Pay |
|---|---|---|---|
| Liver Transplant | $182,473 | $145,979 | $36,495 |
| Kidney Transplant | $148,676 | $118,941 | $29,735 |
| Heart Valve Replacement | $86,926 | $69,541 | $17,385 |
| Coronary Artery Bypass Graft (CABG) | $67,370 | $53,896 | $13,474 |
| Spinal Fusion | $47,062 | $37,649 | $9,412 |
| Defibrillator Implantation (ICD) | $40,274 | $32,219 | $8,055 |
| Sepsis Treatment | $29,995 | $23,996 | $5,999 |
| Hip Fracture Repair | $29,373 | $23,499 | $5,875 |
| Total Knee Replacement | $28,413 | $22,731 | $5,683 |
| Total Hip Replacement | $26,446 | $21,157 | $5,289 |
| Carotid Endarterectomy | $25,915 | $20,732 | $5,183 |
| Colectomy | $24,770 | $19,816 | $4,954 |
| Lumbar Disc Surgery | $24,690 | $19,752 | $4,938 |
| Pacemaker Implantation | $24,116 | $19,293 | $4,823 |
| Stroke Treatment (Acute) | $23,372 | $18,698 | $4,674 |
Outpatient
| Procedure | Avg Cost | Medicare Pays | You Pay |
|---|---|---|---|
| Lithotripsy (Kidney Stones) | $8,007 | $6,406 | $1,601 |
| Endoscopic Sinus Surgery | $7,400 | $5,920 | $1,480 |
| TURP (Prostate) | $7,129 | $5,703 | $1,426 |
| Arthroscopic Knee Surgery | $6,713 | $5,370 | $1,343 |
| Bunionectomy | $6,575 | $5,260 | $1,315 |
| Dialysis Access Surgery | $6,407 | $5,126 | $1,281 |
| Hemorrhoid Surgery | $6,245 | $4,996 | $1,249 |
| Tonsillectomy | $5,425 | $4,340 | $1,085 |
| Septoplasty | $5,115 | $4,092 | $1,023 |
| Carpal Tunnel Release | $4,936 | $3,949 | $987 |
| Adenoidectomy | $4,902 | $3,922 | $980 |
| Pilonidal Cyst Surgery | $4,316 | $3,453 | $863 |
| Cataract Surgery (Outpatient) | $3,509 | $2,807 | $702 |
| Nasal Polyp Removal | $3,436 | $2,749 | $687 |
| Ganglion Cyst Removal | $3,215 | $2,572 | $643 |
Imaging
| Procedure | Avg Cost | Medicare Pays | You Pay |
|---|---|---|---|
| PET Scan | $2,664 | $2,131 | $533 |
| Nuclear Stress Test | $2,498 | $1,998 | $500 |
| MRI Brain | $1,765 | $1,412 | $353 |
| MRI Spine (Cervical) | $1,621 | $1,297 | $324 |
| MRI Shoulder | $1,497 | $1,198 | $299 |
| CT Angiography | $1,479 | $1,183 | $296 |
| MRI Spine (Lumbar) | $1,370 | $1,096 | $274 |
| Bone Scan | $1,192 | $954 | $239 |
| MRI Knee | $1,063 | $851 | $213 |
| CT Scan Abdomen/Pelvis | $1,007 | $806 | $201 |
| MRI Hip | $1,007 | $805 | $201 |
| CT Scan Chest | $1,005 | $804 | $201 |
| CT Colonography (Virtual) | $962 | $770 | $192 |
| CT Scan Head | $746 | $597 | $149 |
| Fluoroscopy | $589 | $471 | $118 |
Physician/Office
| Procedure | Avg Cost | Medicare Pays | You Pay |
|---|---|---|---|
| Sleep Study Consultation | $317 | $254 | $63 |
| Allergy Testing | $279 | $223 | $56 |
| Psychiatry Visit | $247 | $198 | $49 |
| Bone Density Test (DEXA Scan) | $237 | $190 | $47 |
| Shingles Vaccination | $231 | $231 | $0 |
| Wound Care Visit | $229 | $183 | $46 |
| Mammogram (Screening) | $202 | $202 | $0 |
| Annual Wellness Visit | $192 | $192 | $0 |
| Office Visit (New Patient) | $183 | $146 | $37 |
| EKG (Electrocardiogram) | $175 | $140 | $35 |
| Vision Exam (Diabetic) | $172 | $137 | $34 |
| Physical Therapy Session | $154 | $123 | $31 |
| Mental Health Counseling | $152 | $121 | $30 |
| Occupational Therapy Session | $151 | $121 | $30 |
| Speech Therapy Session | $148 | $118 | $30 |
Laboratory
| Procedure | Avg Cost | Medicare Pays | You Pay |
|---|---|---|---|
| Thyroid Panel (TSH) | $49 | $39 | $10 |
| BNP (Heart Failure Marker) | $44 | $35 | $9 |
| Blood Culture | $41 | $33 | $8 |
| Blood Type and Crossmatch | $40 | $32 | $8 |
| Vitamin D Level | $39 | $31 | $8 |
| PSA (Prostate-Specific Antigen) | $39 | $31 | $8 |
| Troponin Level | $35 | $28 | $7 |
| Glucose Tolerance Test | $35 | $28 | $7 |
| Urine Drug Screen | $34 | $27 | $7 |
| Hemoglobin A1C | $33 | $27 | $7 |
| Lipid Panel | $33 | $26 | $7 |
| Comprehensive Metabolic Panel | $32 | $26 | $6 |
| Liver Function Panel | $31 | $25 | $6 |
| Kidney Function Panel (BUN/Creatinine) | $30 | $24 | $6 |
| Complete Blood Count (CBC) | $30 | $24 | $6 |
Compare Texas With Other States
Frequently Asked Questions
How much does Medicare spend per person in Texas?
In 2026, the average Medicare spending per beneficiary in Texas is $13,718.
How many people are enrolled in Medicare in Texas?
Texas has approximately 7,030,295 Medicare beneficiaries.
Did Texas expand Medicaid?
No, Texas has not expanded Medicaid under the Affordable Care Act.
What is the uninsured rate in Texas?
The uninsured rate in Texas is 11.4%.
What is the average Medigap premium in Texas?
The average Medigap (Medicare Supplement) premium in Texas is $193 per month.