Medicare Savings Programs in Texas

Texas Medicare Savings Programs help Medicare beneficiaries with low financial resources pay for Medicare-related expenses.

As we age, we tend to need more medical services. Healthcare expenses can become overwhelming, especially for individuals with lower financial resources. If you have low income and resources and need help paying for Medicare expenses, you may be eligible for one of the Texas Medicare Savings Programs (MSPs). 

Key Takeaways:

• Texas Medicare Savings Programs help Texas residents with low incomes and resources pay for Medicare expenses.

• There are four types of Medicare Savings Programs in Texas, and each has different benefits and eligibility requirements.

• You can apply for Medicare Savings Programs through the Texas Health and Human Services Commission.

• Our licensed Medicare Advisors can help you determine if you’re eligible and apply for a Medicare Savings Program and explore other cost-saving options.

What are Medicare Savings Programs?

Medicare Savings Programs are Medicaid-run programs that help low-income Texas residents pay for some of the costs of Medicare. There are four types of Medicare Savings Programs:

• The Qualified Medicare Beneficiary (QMB) Program

• The Specified Low-Income Medicare Beneficiary (SLMB) Program

• The Qualifying Individual (QI) Program

• The Qualified Disabled and Working Individual (QDWI) Program

Each of these four programs covers some or all of the following out-of-pocket Medicare costs:

• Medicare Part A Premium

• Medicare Part B premium

• Medicare deductibles

• Medicare coinsurance

The Texas Health and Human Services Commission is responsible for managing Medicaid and the Medicare Savings Programs and determining eligibility.

Texas Medicare Savings Program Benefits and Eligibility

Benefits and income and resource requirements are different for each of the four Medicare Savings Programs in Texas. 

The income and resource requirements below are for 2023. Income requirements are updated each year, based on 100% of the federal poverty level. Resource requirements change each year, based on the consumer price index.

What Counts as income in Texas?

• Social Security benefits

• Railroad retirement benefits

• State or local retirement benefits

• Interest or dividends

• Gifts or contributions

• Civil service annuities

• Veterans benefits

• Private pension benefits

• Royalty and rental payments

• Earnings or wages

• Value of food, clothing or shelter paid by someone else

What counts as resources in Texas?

• Bank accounts and certificates of deposit (CDs)

• Real property

• Life insurance policies

• Burial funds

• Individual retirement accounts (IRAs)

• Stocks and bonds

• Oil, gas or mineral rights

• Jewelry and antiques

• Cars and other vehicles

• Boats and recreational vehicles

What can be excluded from resource counts?

• A Texas homestead: where an individual lives and considers their principal residence

• Life insurance with a face value of $1,500 or less

• $1,500 identified as burial funds

• A car

• A burial space

The Qualified Medicare Beneficiary (QMB) Program

If you’re eligible for the QMB Program in Texas, Medicaid will pay for your Medicare premiums, deductibles, and coinsurance. 

Texas QMB Eligibility

You’re eligible for the QMB Program in Texas if you meet the following criteria:

• You’re entitled to Medicare Part A benefits

• You’re a Texas resident

• You meet the resource and income requirements specified in the table below

Can you receive Medicaid and QMB benefits?

An individual can receive both Medicaid and QMB benefits if they meet any of the following criteria:

• 65 or older and living in a state hospital

• Any age, living in a state supported living center

• Any age, living in an intermediate care facility due to an intellectual disability

The Specified Low-Income Medicare Beneficiaries (SLMB) Program

The SLMB Program is intended to extend the QMB Program. If you’re eligible for the SLMB Program in Texas, Medicaid will pay for your Part B premium.

Texas SLMB Eligibility

You’re eligible for the SLMB Program in Texas if you meet the following criteria:

• You’re entitled to Medicare Part A benefits

• You’re a Texas resident

• You meet the resource and income requirements specified in the table below

The Qualified Individual (QI) Program

The Qualifying Individual Medicare Savings Program is another extension of the QMB Program. Unlike with both the QMB and SLMB Program, someone receiving QI benefits cannot also receive benefits from another Medicaid-funded program. 

If you’re eligible for and receive QI benefits, Medicaid will pay for your Part B premium. 

Texas QI Eligibility

You’re eligible for the QI Program in Texas if you meet the following criteria:

• You’re entitled to Medicare Part A benefits

• You’re a Texas resident

• You meet the resource and income requirements specified in the table below

Qualified Disabled and Working Individuals (QDWI) Program

The QDWI Medicare Savings Program is intended for individuals with disabilities who lose their Social Security disability benefits and premium-free Medicare Part A because they returned to work. 

If you’re eligible for the QDWI Program, Texas Medicaid will pay for your Part A premium.

Texas QDWI Eligibility

You’re eligible for the QI Program in Texas if you meet the following criteria:

• You’re under 65 years old

• You’re entitled to Medicare Part A benefits

• You aren’t receiving benefits from any other Medicaid-funded programs

• You meet the resource and income requirements specified in the table below

How to apply for a Texas Medicare Savings Program?

You can apply for Medicare Savings Programs:

1. Online

2. Over the phone

3. In person at a local office. 

If you’re having trouble with the process or were denied benefits when you believe you’re entitled to them, we can help. Give us a call at (855) 900-2427 to get help with Medicare Savings Programs and any other Medicare-related questions.

Other ways to reduce your Medicare costs

Healthcare expenses add up. Many Americans need financial assistance, smart advice, and caring support to reduce their costs, so they can receive the healthcare they need. For more detailed information on Medicare in Texas, read out Texas Medicare guide.

Extra Help

If you’re eligible for a Medicare Savings Program, you should also apply for Extra Help (the Part D Low-Income Subsidy). Extra Help provides financial assistance for costs associated with Medicare prescription drug plans. 

Switch to comparable prescriptions

Many people know that switching to a generic version of your prescription can save you money. In some cases, even switching the form of your prescription (e.g., from a soft gel to a tablet) can result in cost savings!

Price check your pharmacy

Pharmacies charge different prices for the same medications. Check the pricing for your prescriptions at local pharmacies as well as mail order pharmacies. We’ll help you compare prices and find your plan’s preferred pharmacies with cost savings if you reach out!

Re-evaluate your Medicare coverage each year

Every year, during the Medicare Open Enrollment Period, Medicare beneficiaries have an opportunity to review and change their coverage. Because Medicare plans change (and your healthcare needs can too!), it’s important to make sure there’s not better coverage available.

Our Texas Medicare Advisors are here to help you get the best value from Medicare. We’ll help you understand your options, enroll in coverage that best matches your health and financial needs, and save on costs wherever possible. 

Schedule a free consultation or call us at (855) 900-2427 to get your questions answered and feel confident in your Medicare decisions.