Research
Medicare Advantage share by Texas county
In October 2026, 54.8% of Texans eligible for Medicare were enrolled in a Medicare Advantage plan, up from 43.3% in October 2020, according to CMS data. In the past year the share rose less than 0.2 percentage points, the smallest yearly rise since 2020.
By Quote My Policy · Published November 12, 2026 · Data: Centers for Medicare & Medicaid Services; U.S. Census Bureau (OMB area definitions)
Key numbers
54.8%
of Texans eligible for Medicare were in a Medicare Advantage plan in October 2026 (2,777,138 of 5,063,557)
CMS, MA State/County Penetration, October 2026
11.5
percentage-point rise since October 2020 (43.3%), but less than 0.2 in the past year
CMS, MA State/County Penetration, October 2020 to 2026
48.3%
in Texas’s 168 non-metro counties, against 55.9% in its 86 metro counties
CMS, MA State/County Penetration, October 2026; OMB July 2023 area definitions
84.5%
in Starr County, the highest share; Ochiltree County had the lowest, 22.1% (counties with at least 1,000 eligibles)
CMS, MA State/County Penetration, October 2026
The rise has slowed sharply
Every person with Medicare gets their benefits either through Original Medicare, run by the federal government, or through a Medicare Advantage plan, a private plan approved by Medicare. In October 2020, 1,851,692 of Texas’s 4,275,934 Medicare eligibles were in a Medicare Advantage plan (43.3%). By October 2026 it was 2,777,138 of 5,063,557 (54.8%): Medicare Advantage enrollment grew 50% while the count of Medicare eligibles grew 18%.
The yearly rise has shrunk: 3.8 points from 2020 to 2021, 2.6 points from 2021 to 2022, 2.9 points from 2022 to 2023, 1.4 points from 2023 to 2024, 0.7 points from 2024 to 2025 and 0.1 points from 2025 to 2026. Between October 2025 and October 2026, the share fell in 63 of the 204 counties with at least 1,000 eligibles.
Metro and non-metro counties
Metro counties have a higher share every year, but the gap has narrowed. In October 2020 the share was 44.9% in metro counties and 34.4% in non-metro counties, a gap of 10.5 points. By October 2026 it was 55.9% and 48.3%, a gap of 7.6 points: non-metro counties rose 13.9 points and metro counties 11.0. Metro counties hold 86% of the state’s Medicare eligibles.
- Metro counties (86)
- Non-metro counties (168)
Metro: counties in a Metropolitan Statistical Area (OMB, July 2023). Source: CMS, MA State/County Penetration, October of each year.
| October | Texas | Metro | Non-metro | Eligibles | Enrolled |
|---|---|---|---|---|---|
| 2020 | 43.3% | 44.9% | 34.4% | 4,275,934 | 1,851,692 |
| 2021 | 47.1% | 48.6% | 39.0% | 4,387,809 | 2,068,761 |
| 2022 | 49.7% | 51.0% | 42.2% | 4,509,258 | 2,242,337 |
| 2023 | 52.6% | 53.8% | 45.3% | 4,641,577 | 2,441,599 |
| 2024 | 54.0% | 55.1% | 47.1% | 4,771,533 | 2,575,805 |
| 2025 | 54.7% | 55.8% | 48.0% | 4,908,299 | 2,683,306 |
| 2026 | 54.8% | 55.9% | 48.3% | 5,063,557 | 2,777,138 |
County by county
Among the 204 Texas counties with at least 1,000 Medicare eligibles, the share in October 2026 ranged from 22.1% in Ochiltree County to 84.5% in Starr County. In 94 of them, most eligibles were in a Medicare Advantage plan. Every one of the 202 counties that also had at least 1,000 eligibles in 2020 had a higher share in 2026 than in 2020.
| County | Area | Eligibles, 2026 | Share, 2020 | Share, 2026 | Change (points) |
|---|---|---|---|---|---|
| Starr | Non-metro | 10,665 | 54.8% | 84.5% | 29.7 |
| Willacy | Non-metro | 3,774 | 56.1% | 79.9% | 23.8 |
| Hidalgo | Metro | 126,980 | 61.1% | 78.0% | 16.9 |
| Maverick | Metro | 11,720 | 47.1% | 77.2% | 30.1 |
| Zavala | Non-metro | 2,130 | 53.5% | 75.6% | 22.1 |
| Cameron | Metro | 74,082 | 55.9% | 75.1% | 19.2 |
| El Paso | Metro | 155,815 | 64.9% | 74.9% | 10.0 |
| Zapata | Non-metro | 2,188 | 36.3% | 74.9% | 38.6 |
| Brooks | Non-metro | 1,570 | 45.4% | 71.2% | 25.8 |
| Jim Wells | Non-metro | 8,790 | 53.8% | 71.1% | 17.3 |
| County | Area | Eligibles, 2026 | Share, 2020 | Share, 2026 | Change (points) |
|---|---|---|---|---|---|
| Ochiltree | Non-metro | 1,457 | 17.1% | 22.1% | 5.0 |
| Parmer | Non-metro | 1,553 | 18.5% | 25.0% | 6.5 |
| Wheeler | Non-metro | 1,157 | 20.8% | 26.4% | 5.6 |
| Kimble | Non-metro | 1,476 | 22.8% | 26.7% | 3.9 |
| Young | Non-metro | 4,669 | 19.1% | 27.0% | 7.9 |
| Archer | Metro | 2,291 | 22.1% | 27.6% | 5.5 |
| Gillespie | Non-metro | 9,998 | 22.3% | 29.9% | 7.6 |
| Runnels | Non-metro | 2,631 | 19.6% | 30.9% | 11.3 |
| Coleman | Non-metro | 2,684 | 22.8% | 31.0% | 8.2 |
| Clay | Metro | 2,895 | 25.0% | 31.1% | 6.1 |
| County | Area | Eligibles, 2026 | Share, 2020 | Share, 2026 | Change (points) |
|---|---|---|---|---|---|
| Harris | Metro | 668,487 | 51.5% | 61.4% | 9.9 |
| Dallas | Metro | 366,287 | 43.6% | 54.9% | 11.3 |
| Bexar | Metro | 345,520 | 49.8% | 59.0% | 9.2 |
| Tarrant | Metro | 331,485 | 48.5% | 55.5% | 7.0 |
| Collin | Metro | 165,730 | 34.7% | 42.7% | 8.0 |
| Travis | Metro | 165,210 | 35.4% | 46.9% | 11.5 |
| El Paso | Metro | 155,815 | 64.9% | 74.9% | 10.0 |
| Fort Bend | Metro | 138,749 | 45.1% | 55.6% | 10.5 |
| Denton | Metro | 138,422 | 36.9% | 45.0% | 8.1 |
| Hidalgo | Metro | 126,980 | 61.1% | 78.0% | 16.9 |
Source: CMS, MA State/County Penetration, October 2020 and October 2026. Every county’s figures for each October from 2020 to 2026 are in the CSV download.
What this means for Texans with Medicare
- What your neighbors chose is not a guide for you. Both ways of getting Medicare are common in Texas, and the right one depends on your doctors, your health, how you travel and what you can afford in a bad year. Our guide to Original Medicare and Medicare Advantage sets out the tradeoffs.
- Plans are offered county by county. A Medicare Advantage plan serves a set area, and plans change every year. Read how Medicare Advantage works before you compare.
- Changing your mind later can be harder than it looks. You can leave a Medicare Advantage plan during Open Enrollment (October 15 to December 7) or from January 1 to March 31, but buying a Medigap policy afterward may mean answering health questions. See leaving Medicare Advantage.
Method
CMS publishes a Medicare Advantage “penetration” file each month with two counts for every county: Medicare eligibles and Medicare Advantage enrollees. We downloaded the October file for each year from 2020 to 2026 (October 2026 is the latest CMS has published) on November 12, 2026, 1:12 p.m. Pacific time. A county’s share is its enrollees divided by its eligibles, which is CMS’s own penetration rate. Texas, metro and non-metro shares add up enrollees and eligibles across counties. Changes are in percentage points, taken from the rounded shares shown.
CMS counts people in Medicare Advantage plans and in cost plans, PACE and Medicare demonstration plans as enrollees. Metro counties are those in a Metropolitan Statistical Area in OMB Bulletin 23-01 (July 2023); every other county is non-metro, the definition the USDA’s Economic Research Service most often uses for rural areas. County rankings use the 204 counties with at least 1,000 eligibles in October 2026, so a handful of people does not swing a small county to the top or bottom.
Limits
- The share says how many people are enrolled, not whether a plan suits them or how well plans perform.
- CMS hides enrollment of 10 or fewer. In October 2026 that applied to 2 small counties, which count as zero in the totals.
- CMS assigns people to the county on their Social Security address, which can lag a move.
- Shares move a little from month to month. Our Texas county guides show CMS’s September 2026 figures, so a county can differ slightly from this October data.
Sources
- Centers for Medicare & Medicaid Services, MA State/County Penetration, October files for 2020 to 2026. Accessed November 12, 2026, 1:12 p.m. Pacific time.
- U.S. Census Bureau, Delineation files, List 1, July 2023 (OMB Bulletin 23-01).
- USDA Economic Research Service, Rural classifications.
- Medicare.gov, Joining a health or drug plan (enrollment periods).
Cite this study
Quote My Policy, “Medicare Advantage share by Texas county,” November 12, 2026, https://www.quotemypolicy.com/research/texas-medicare-advantage-share. Data: Centers for Medicare & Medicaid Services, MA State/County Penetration files.
Download the data (CSV) for all 254 counties. You may reuse it with credit to Quote My Policy and a link to this page (CC BY 4.0).
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Want help with your own Medicare choices?
In Texas, the Health Information, Counseling and Advocacy Program (HICAP) gives one-on-one Medicare counseling and does not sell plans: call 1-800-252-9240. You can also compare the plans offered in your county on Medicare.gov or call 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048, 24 hours a day, 7 days a week.
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