Medicare Savings Program in Texas: Eligibility and Coverage

Need help to afford Medicare in Texas? Discover if one of Texas's four Medicare Savings Programs could help you pay for Medicare Part A and Part B premiums, deductibles, coinsurance, and copayments.

The Four Medicare Savings Programs in Texas

Do you need help paying your Texas Medicare premiums? If you are eligible, a Texas Medicare Savings Program (MSP) might be able to help. Medicaid administers MSPs to help people with limited income and resources. These programs help those who qualify to afford Medicare in Texas. 

You could get help paying your Medicare premiums if you qualify, including Medicare Part A and Part B deductibles, coinsurance, and copayments.

There are four Medicare Savings Programs managed by the Texas Health and Human Services Commission (HHSC). Each program has a different income eligibility limitation, but the maximum accessible financial resources are nearly the same. Continue reading to see if you qualify for one of these programs: 

  1. Qualified Medicare Beneficiary (QMB) Program.
  2. Specified Low-Income Medicare Beneficiary (SLMB) Program.
  3. Qualified Individual (QI) Program.
  4. Qualified Disabled and Working Individual (QDWI) Program.

Maximum Financial Resources

For three of the four programs, the financial resources required are consistent. To qualify for the QMB, SLMB, or QI program, you should have limited financial resources.

This means that when you add up all of your resources as an individual, those should value no more than $7,970. As a married couple, your maximum countable resources should be $11,960. Should you exceed these limitations, you do not qualify for three of Texas’s four Medicare Savings Programs.

The QDWI has even more stringent financial resources requirements. The maximum financial resources for an individual are $4,000 and $6,000 for a couple.

What should you include when accounting for your financial resources?

  • Bank accounts and Certificates of Deposit (CDs)
  • Individual Retirement Accounts (IRAs)
  • Investments in stocks and bonds
  • Real property (land or buildings)
  • Life insurance policies and burial funds
  • Oil, gas, or mineral rights
  • Jewelry and antiques
  • Cars and other vehicles
  • Boats and recreational vehicles

 

What can you exclude when adding up your financial resources?

  • Your Texas homestead—where you live and consider your principal place of residence
  • Life insurance, if the face value is $1,500 or less
  • Separately identifiable burial funds of $1,500 (less any excluded life insurance or irrevocable arrangement for burial) for you and your spouse
  • The value of any burial plots
  • One car

 

If you meet these financial resource requirements, continue reading to see if you qualify for one of Texas’s four Medicare Savings Programs.

Want expert advice from a local agent—or help to apply for a Medicare Savings Program in Texas? Call (623) 223-8884 or schedule an appointment online.

Qualified Medicare Beneficiary (QMB) Program in Texas

The Qualified Medicare Beneficiary (QMB) Program could pay for Part A & B premiums, deductibles, and coinsurance if you are entitled to Medicare Part A and meet income and financial resource requirements. 

As a QMB, you do not receive standard state Medicaid benefits. Instead, you would receive a QMB identification card to show your medical providers. This card would be provided by the Texas Health and Human Services Commission (HHSC). Your QMB eligibility would begin on the first day of the month after you are certified for QMB benefits.

Eligibility for the Qualified Medicare Beneficiary Program

To be eligible for the Qualified Medicare Beneficiary Program, you must be eligible for Medicare Part A and meet income & financial resource requirements.

Maximum Gross Monthly Income

Your maximum gross monthly income must be equal to or less than the limits set for individuals or couples. As of March 2021, the maximum gross income for an individual in Texas is $1,094, and for a couple, it’s $1,472. 

If you and your spouse are applying for QMB, you should use the maximum gross monthly income limit for a couple. If only one of you is eligible for QMB, use the individual income limit to see whether you’re qualified as an individual.  

What should you consider as income? 

  • Social Security benefits
  • Railroad, state, or local retirement benefits
  • Investment interest or dividends 
  • Gifts or contributions
  • Civil service annuities
  • Veteran or private pension benefits
  • Earnings, wages, royalties, and rental income 
  • The value of food, clothing, or shelter paid by someone else (including your spouse)

 

Maximum Financial Resources

To qualify for the QMB program, you need to have limited financial resources. This means that when you add up all of your resources as an individual, those should value no more than $7,970. As a couple, your maximum countable resources should be $11,960. 

See the top of this article for “Maximum Financial Resources” to see what should be included and excluded when accounting for your financial resources.

Specified Low-Income Medicare Beneficiary (SLMB) Program in Texas

If eligible, the Specified Low-Income Medicare Beneficiary (SLMB) Program will pay for your Medicare Part B premiums. If you receive Medicaid, you may also receive SLMB benefits. However, if you are SLMB-eligible, you will not get regular Medicaid benefits or a monthly medical identification card.

Your SLMB eligibility will begin the month of application, and if you meet all the criteria, medical coverage is eligible for three months before application. 

The requirements for SLMB eligibility are similar to that of the Qualified Medicare Beneficiary (QMB) Program—with one difference. You must have an income higher than 100% but less than 120% of the federal poverty level. Federal Poverty Level limits are updated annually by the Census Bureau. 

Eligibility for the Specified Low-Income Medicare Beneficiary Program

To be eligible for the Specified Low-Income Medicare Beneficiary (SLMB) Program, you must be entitled to Medicare Part A, meet income requirements, and have limited financial resources.

Maximum Gross Monthly Income

Are you wondering the maximum gross monthly income for greater than 100%, but less than 120% of the poverty level? As an individual, in 2021, you’d need a monthly income between $1,094.01 and $1,308. As a couple, your monthly income would need to be between $1,472.01 and $1,762. 

If you and your spouse apply for the SLMB program, you must use the couple’s monthly income range. However, if only one of you is eligible, use the individual monthly income range to determine if you’re eligible separately. 

What should you consider as income? 

  • Social Security benefits
  • Railroad, state, or local retirement benefits
  • Investment interest or dividends 
  • Gifts or contributions
  • Civil service annuities
  • Veteran or private pension benefits
  • Earnings, wages, royalties, and rental income 
  • The value of food, clothing, or shelter paid by someone else (including your spouse)

 

Maximum Financial Resources

To qualify for the SLMB program, you need to have limited financial resources. This means that when you add up all of your resources as an individual, those should value no more than $7,970. As a couple, your maximum countable resources should be $11,960. 

See the top of this article for “Maximum Financial Resources” to see what should be included and excluded when accounting for your financial resources. 

Qualifying Individual (QI) Program in Texas

The Qualifying Individual (QI) Program will cover your Medicare Part B premiums if you meet eligibility requirements. You cannot be eligible or receiving regular Medicaid and the QI program coverage at the same time. If you are QI-eligible, you will not get regular Medicaid benefits or a medical identification card.

Eligibility for the Specified Low-Income Medicare Beneficiary Program

To be eligible for the Qualifying Individual Program, you must be eligible for Medicare Part A and meet income and financial resource requirements.

To be eligible for the Qualifying Individual Program, you must have an income of at least 120% but less than 135% of the federal poverty level. Federal Poverty Level limits are updated annually by the Census Bureau.

Eligibility for QI coverage is decided for each calendar year, and your eligibility may begin the month that you apply for coverage. You are eligible for three months prior medical coverage under the QI program if you meet all the criteria. However, the three-month prior period cannot extend back into the previous calendar year.

Maximum Gross Monthly Income

Are you wondering the maximum gross monthly income for greater than 120%, but less than 135% of the poverty level? If you’re an individual, your monthly income range is a minimum of $1,308 to a maximum amount of less than $1,469. If you and your spouse need help together, you should have a minimum monthly income of $1,762, but no more than $1,980.

If you and your spouse are applying for the Qualifying Individual Program, you need to use the couple’s monthly income range. But if only one of you is eligible, use the individual monthly income range to see if you’re eligible on your own.

Maximum Financial Resources

To qualify for the QI program, you need to have limited financial resources. This means that when you add up all of your resources as an individual, those should value no more than $7,970. As a couple, your maximum countable resources should be $11,960.

See the top of this article for “Maximum Financial Resources” to see what should be included and excluded when accounting for your financial resources.

Not sure which Medicare Savings Program you’re eligible for—or which to apply to? Speak with a local agent who can guide you through your choices. Call (623) 223-8884 or schedule to speak with someone.

Qualified Disabled and Working Individual (QDWI) Program in Texas

The Qualified Disabled and Working Individual (QDWP) Program will pay for only your Medicare Part A premium if you are eligible. You cannot qualify for regular Medicaid and QDWI at the same time. 

Eligibility for the Qualified Disabled and Working Individual (QDWI) Program

To be eligible for the Qualified Disabled and Working Individual Program, you must be under 65 years of age, be entitled to benefits under Medicare Part A, not otherwise be eligible for Medicaid, and meet income and financial resource requirements.

Maximum Gross Monthly Income

If you are a couple applying QDWI, your monthly income should be a maximum of $2,904. For an individual, the maximum gross income is $2,147. Income must be less than or equal to the maximum gross income limits.

If you and your spouse are applying for the Qualified Disabled and Working Individual Program, you need to use the couple’s monthly income range. But if only one of you is eligible for the program, use the individual monthly income range to see if you’re eligible on your own. 

What should you consider as income? 

  • Social Security benefits
  • Railroad, state, or local retirement benefits
  • Investment interest or dividends 
  • Gifts or contributions
  • Civil service annuities
  • Veteran or private pension benefits
  • Earnings, wages, royalties, and rental income 
  • The value of food, clothing, or shelter paid by someone else (including your spouse)

 

Maximum Financial Resources

To qualify for the QDWI program, you need to have limited financial resources. This means that when you add up all of your resources as an individual, they should value no more than $4,000. As a couple, the maximum resources are $6,000.  

See the top of this article for “Maximum Financial Resources” to see what should be included and excluded when accounting for your financial resources. 

[Table] Medicare Savings Program in Texas: 2021 Eligibility and Coverage

Type of Medicare Savings Program Monthly Gross Income Eligibility Financial Resources Eligibility Date of Medicare Savings Program Enrollment Benefits Covered
Qualified Medicare Beneficiary (QMB) At or below 100% of Federal Poverty Level, plus $20 income disregard.

Single: $1,074-$1,094
Married: $1,452-$1,472
Single: $7,970
Married: $11,960
The first of the month following the month, eligibility is documented. Part A: Hospital deductible, Hospital copays, SNF copays, Monthly premium.

Part B: Annual deductible, Monthly premium, 20% coinsurance.
Specified Low-Income Medicare Beneficiary (SLMB) Between 100%-120% of Federal Poverty Level, plus $20 income disregard.

Single: $1,094- $1,308
Married: $1,472-$1,762
Single: $7,970
Married: $11,960
3 months retroactive from the date of application if you meet eligibility criteria during those months. Part B monthly premium
Qualifying Individual (QI) Between 121%-135% of Federal Poverty Level, plus $20 income disregard.

Single: $1,308-$1,469
Married: $1,762-$1,980
Single: $7,970
Married: $11,960
3 months retroactive from the date of application if you meet eligibility criteria during those months. Part B monthly premium
Qualified Disabled Working Individual (QDWI) Single: $4,379
Married: $5,892
Single: $4,000
Married: $6,000
3 months retroactive from the date of application if you meet eligibility criteria during those months. Part A monthly premium

How Do I Apply for Medicare Savings Programs in Texas?

Medicare Savings Programs help people who are already on Medicare. Not yet on Medicare? Enroll in Medicare Part A and then apply for a Medicare Savings Program in Texas.

Otherwise, if you have Part A and your income and financial resources are within the limits of the program you want to apply for, choose to apply by paper or online:

  • 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.”

 

Even if your income or financial resources are higher than the amounts listed in this article, you may be eligible.

Reach out to your local Medicare agent or schedule an appointment to discuss your eligibility, any question you may have, or assist you in applying for benefits. Call (623) 223-8884.

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