Texas Medicare Savings Programs: Eligibility and Benefits

Medicare Savings Programs can help Texans with limited income and resources pay certain Medicare expenses. Depending on the program, assistance may cover the Medicare Part B premium, certain Medicare-covered deductibles and coinsurance, or the Part A premium for qualifying workers with disabilities.

Texas Health and Human Services determines eligibility.

The four Medicare Savings Programs

The main programs are Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), Qualifying Individual (QI), and Qualified Disabled and Working Individual (QDWI).

They do not all provide the same benefits. Your eligibility depends on countable income, resources, Medicare status and other program-specific conditions. See Medicare Savings Programs at Medicare.gov and Texas Health and Human Services.

QMB: the broadest Medicare cost-sharing assistance

QMB can help eligible beneficiaries pay Medicare Part A and Part B premiums, plus Medicare-covered deductibles, coinsurance and copayments. An important federal protection generally prohibits Medicare providers from billing QMB beneficiaries for Medicare-covered cost sharing.

That protection can apply even when a provider does not participate in Medicaid. It does not mean every service that Medicare excludes is free.

If you have QMB and receive a bill for Medicare-covered cost sharing, tell the provider you have QMB and request a billing review before paying. Keep the bill and contact Medicare or the appropriate assistance program if the issue is not resolved.

SLMB: help with the Part B premium

The Specified Low-Income Medicare Beneficiary program helps qualifying people pay the Medicare Part B premium. It does not provide the same broad protection against Medicare-covered deductibles and coinsurance as QMB.

For someone on a fixed income, eliminating the monthly Part B premium can nevertheless provide substantial relief. SLMB beneficiaries also generally qualify automatically for Extra Help with prescription drug costs.

QI: another level of Part B premium assistance

The Qualifying Individual program helps eligible people pay the Part B premium. QI has its own eligibility requirements, and beneficiaries generally must apply for assistance each year. Individuals who qualify for certain other Medicaid benefits may not qualify for QI.

Do not assume that a prior approval guarantees continuing eligibility without following renewal instructions. QI also generally provides automatic eligibility for Extra Help.

QDWI: assistance for certain working people with disabilities

The Qualified Disabled and Working Individual program is intended for certain people with disabilities who returned to work and lost premium-free Medicare Part A. It can help pay the Part A premium.

The income, resource and other eligibility rules differ from QMB, SLMB and QI. It is not a general substitute for the other Medicare Savings Programs.

Texas income and resource limits

The state evaluates countable income and resources, not necessarily every dollar received or owned. Certain income disregards and resource exclusions may apply, including treatment of a primary home and personal property under relevant rules.

Limits can change, so check the current Texas HHSC budget reference chart instead of relying on an older threshold in an article.

If you are close to a published limit, apply and request an official determination rather than assuming you are ineligible.

How Medicare Savings Programs connect to Extra Help

People who qualify for QMB, SLMB or QI generally also qualify for Extra Help with Medicare Part D prescription costs. Extra Help can reduce certain drug premiums, deductibles and copayments, but it does not guarantee that every medication appears on every plan's formulary.

Review Extra Help with prescription costs and Part D coverage to understand the separate benefits.

How to apply in Texas

Apply through Your Texas Benefits or contact Texas Health and Human Services.

Be prepared to provide Medicare coverage information, Texas residency, household details, income statements and financial-resource information. The state may ask for additional documents.

Respond by the deadline on any request for information and keep a copy of the eligibility decision. If denied, review the reason and appeal instructions.

A Medicare Savings Program is not always the same as full Medicaid. Some beneficiaries qualify only for premium assistance; others qualify for broader benefits. Read Medicare and Medicaid in Texas for the distinction.

Example: Someone who needs help with Part B

Consider a retiree receiving Social Security who finds that the monthly Part B premium is reducing money available for housing and prescriptions. If their countable income and resources fall within the applicable SLMB or QI limits, Texas may pay the Part B premium.

For the underlying Part A and Part B expenses these programs may help with, review How Much Does Original Medicare Cost in Texas?.

If they qualify for QMB, additional Medicare-covered cost-sharing protections may apply. The exact outcome requires an eligibility determination by Texas HHSC.

Frequently asked questions