Medicare and Medicaid in Texas: Eligibility & How to Enroll

While Medicare and Medicaid are separate programs, you may be eligible for both. This could help you save on premiums, out-of-pocket costs, and/or long-term care.

What is Medicare, and Who is Eligible?

Medicare is a United States federal health insurance program. It is designed to provide and reduce the cost of healthcare services for eligible beneficiaries in Texas and across the United States.

Original Medicare and Private Medicare Plan Options

Texans have both public (Original Medicare) and private Medicare plan options. Original Medicare includes Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). Original Medicare does not cover 100% of costs, and most people have a private health plan such as Medicare Part C, Medicare Part D, or Medicare Supplement.

Medicare Part C (Medicare Advantage), Medicare Part D (Prescription Drug Coverage), and Medicare Supplement (Medigap) are your private health plan options. These are approved by the Centers for Medicare and Medicaid Services (CMS).

Learn more about your public and private Medicare plan options in “Medicare in Texas.”

Medicare Eligibility in Texas

If you’re a Texan and meet the following criteria, you are eligible for Medicare in Texas.

  • You’re aged 65 or older.
  • You’re younger than 65 with eligible disabilities by the Social Security Administration.
  • You have End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS).

 

If you meet the above criteria, then you can apply for Medicare in Texas. Now, you’ll want to learn more about your public and private Medicare plan options—and choose a plan that meets your health and budget needs.

Not sure where to begin? Have a local Medicare agent guide you through your Medicare options. A local Connie Health agent can help you find the optimal plan. Schedule a time to speak with an agent or call (623) 223-8884 (TTY 711).

What is Texas Medicaid?

Medicaid is a nationwide program funded by the federal government and administered and managed by states within federal guidelines. Medicaid improves the health of Texans who might otherwise go without health care. This includes those with low income or disabilities.

Although the program helps a wide range of Texans, we’re focusing on Medicaid’s help to Texans aged 65 and over, especially those with long-term care needs.

In Texas, Medicaid is administered by the Texas Health and Human Services Commission (HHSC). Most Medicaid plans in Texas are provided by Managed Care Organizations (MCO). Texas-managed Medicaid for those 65 and older and the disabled are often referred to as STAR+PLUS. When you have a STAR+PLUS plan, you receive Medicaid health care services such as doctor visits, and long-term services and support for:

  • Basic, daily activities in your home.
  • Help to make modifications to your home so you can safely move around,
  • Short-term care to provide a break for caregivers,
  • Personal assistance.

 

With STAR+PLUS, you get to choose your health plan, and many come with “value-added” or extra services such as dental, vision, hearing, and prescription bonuses. You can use the STAR+PLUS Comparison Charts to find the STAR+PLUS health plans offered in your county or service area.

Or you can reach out to a local Medicare agent who can support you through your Medicare and Medicaid journey. Schedule a time that works for you, or call (623) 223-8884 to speak to a local licensed agent in your community.

Who is Eligible for Medicaid in Texas?

To be eligible for Medicaid in Texas, you must:

  • Be a resident of the state of Texas,
  • Be a U.S. national, citizen, permanent resident, or legal alien,
  • Need health care/insurance assistance,
  • Be low or very-low-income according to Texas,
  • Be 65 years of age or older or have a disability.

 

If you’re eligible for both Medicare and Medicaid, you’re likely to be what’s called “Dual-Eligible.” 

Medicaid eligibility is tied to income and financial resource levels. Unlike Medicare, with Medicaid, you must recertify with Texas each year to ensure you continue to qualify.

What’s Considered Income and Assets?

What Defines Income?

To be eligible for Medicaid, you must meet income requirements. Texas will count some of your income, but not all of it. Your income includes regular benefit payments from Social Security retirement or disability payment, veterans benefits, you or your spouse’s pension, salaries or wages, and interest from CDs (Certificates of Deposit), bank accounts, or dividends from investments. 

Things that are not counted as income include nutritional assistance from programs such as food stamps, housing assistance provided by the federal government, home energy assistance, and potentially some of your earnings from earned work that you perform. 

What Assets Count When Applying for Medicaid? 

When applying for Medicaid, financial assets counted for include cash, stocks, bonds, investments, savings and checking accounts, and real estate that is not your primary residence. 

Many assets are considered exempt and not countable for your eligibility. These items include your personal belongings, household furnishings, one car, irrevocable burial trusts, and your primary place of residence.

Medicaid Programs in Texas

Medicare Part A & B Assistance

If you receive or are eligible for Medicare, but you’re unable to pay for your premiums, co-pays, or deductibles, you should read more about Medicare Savings Programs in Texas. Four Medicare Savings Programs could help you pay for Medicare Part A and/or Part B deductibles, coinsurance, and copayments.

Long-Term Care Assistance

There are three buckets of Medicaid long-term care programs that you or your loved one may be eligible for:

  1. Institutional / Nursing Home Medicaid
  2. Medicaid Waivers / Home and Community-Based Services
  3. Regular Medicaid / Aged Blind and Disabled

 

Each program bucket has slightly different eligibility requirements and benefits. Continue reading and review “[Tables] 2021 Texas Medicaid Long-Term Care Eligibility for Aged 65 and over” for income and financial asset eligibility, plus the coverage the program provides.

In Texas, some programs are entitlements, while others have limited enrollment. For example, nursing home care and regular Medicaid are entitlement programs available to you if you’re eligible.

However, Medicaid Waivers and Home Community-Based Services are available to a limited number of participants. These programs are not guaranteed. Read more about the three buckets below and long-term care programs in Texas.

  1. Institutional / Nursing Home Medicaid is an entitlement and is provided only in nursing homes.
  2. Medicaid Waivers / Home and Community-Based Services: Limited number of participants. Provided at home, adult day care, adult foster care home, or assisted living.
  3. Regular Medicaid / Aged Blind and Disabled is an entitlement and is provided at home or adult daycare.

 

Not sure which Medicaid program you should be applying for? Schedule a time to speak with a local Medicare agent or call (623) 223-8884

Long-Term Care Program Options in Texas

Day Activity and Health Services (DAHS) is an adult day care program that facilitates care up to 10 hours per day, Monday through Friday—during regular business hours. This helps you or your loved one receive care outside of a nursing home. Services may address physical, mental, medical, and social needs.

The STAR+PLUS Waiver is a limited enrollment, managed care program that covers assisted living, adult foster care, and in-home support to help you stay in your home and avoid going to a nursing home. Sometimes Medicaid will pay for home care locations if it can be obtained at a lower cost than a nursing home. This is achieved through a Medicaid Waiver, also referred to as Home and Community Based Services (HCBS) Waivers or Waiver Funded Services.

The Community First Choice (CFC) Program provides help with daily living activities and health-related tasks. One of the main goals is to create continuity of services and support while helping you or a loved one learn to care for themself. It supports the caregiver with training on how to select, manage, and dismiss healthcare attendants.

Primary Home Care in Texas (PHC) is another program that provides personal care in the home. This program is also a non-skilled, nontechnical service provided to those eligible—and are functionally limited in their ability to perform daily activities. PHC provider agencies also provide Family Care services. This program, like Community First Choice, allows you to choose your caregivers. You may be able to select family members as your hired caregiver.

Community Attendant Services (CAS) provides non-medical personal care assistance, homemaker services, and transportation assistance to/from medical appointments. This non-technical, medically related personal care service is eligible to adults whose health problems cause them to be limited in performing daily living activities according to their doctor’s statement of medical need.

Are you single, married with both spouses applying for Medicaid, or married with one spouse applying? Review the chart(s) that apply to you to learn about the maximum income and financial assets and the level of care for each of the three categories of Medicaid services in Texas.

[Tables] 2021 Texas Medicaid Long-Term Care Eligibility for Aged 65 and over

Type of Texas Medicaid Single
Maximum Income Maximum Financial Assets Level of Care Required
Institutional / Nursing Home Medicaid $2,382 per month $2,000 Nursing Home
Medicaid Waivers / Home and Community-Based Services $2,382 per month $2,000 Nursing Home
Regular Medicaid / Aged Blind and Disabled $794 per month $2,000 None
Type of Texas Medicaid Married, Both Spouses Applying
Maximum Income Maximum Financial Assets Level of Care Required
Institutional / Nursing Home Medicaid $4,764 per month $3,000 Nursing Home
Medicaid Waivers / Home and Community-Based Services $4,764 per month $3,000 Nursing Home
Regular Medicaid / Aged Blind and Disabled $1,191 per month $3,000 None
Type of Texas Medicaid Married, One Spouse Applying
Maximum Income Maximum Financial Assets Level of Care Required
Institutional / Nursing Home Medicaid $2,382 per month for the applicant $2,000 for applicant & $130,380 for non-applicant Nursing Home
Medicaid Waivers / Home and Community-Based Services $2,382 per month for the applicant $2,000 for applicant & $130,380 for non-applicant Nursing Home
Regular Medicaid / Aged Blind and Disabled $1,191 per month $3,000 None

How Do I Apply For Medicaid in Texas?

Medicaid benefits could help you pay for your Part A and/or B premiums, copays, and deductibles. It could also help you or a loved one afford additional care, like long-term care. Gather benefit information, and ensure that you meet all of the eligibility requirements for the program you’re interested in applying for.

If your income or assets are over the limits or you’re unsure if you meet the eligibility criteria, a local Medicare agent can help. A local agent can guide you through your Medicaid eligibility and application options. They’ll help you understand your options and the optimal dual-eligible plan for your health and budget—if you’re eligible.

Want to apply for Medicaid on your own?

  • Complete an “Application for Benefits: Texas Health and Human Services Commission.” This is a link to the PDF version that you can complete and then physically mail or fax.
  • Apply for benefits online through “Your Texas Benefits.”

 

Receive help applying for Medicare and/or Medicaid. Be confident that you’re on the optimal plan for your health needs and budget. Schedule a time to speak with an agent or call (623) 223-8884.

Learn more about Medicare

Visit our Medicare Resource Center which provides helpful articles on everything you need to know about Medicare.

Have questions? We're here to help!

Call us at 623-223-8884 (TTY: 711)