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).
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:
Each of these four programs covers some or all of the following out-of-pocket Medicare costs:
The Texas Health and Human Services Commission is responsible for managing Medicaid and the Medicare Savings Programs and determining 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 can be excluded from resource counts?
If you’re eligible for the QMB Program in Texas, Medicaid will pay for your Medicare premiums, deductibles, and coinsurance.
You’re eligible for the QMB Program in Texas if you meet the following criteria:
| Your Situation | Resource Limit | Monthly Income Limit |
|---|---|---|
| Individual | $9,090 | $1,215 |
| Couple | $13,630 | $1,643 |
An individual can receive both Medicaid and QMB benefits if they meet any of the following criteria:
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.
You’re eligible for the SLMB Program in Texas if you meet the following criteria:
| Your Situation | Resource Limit | Monthly Income Range |
|---|---|---|
| Individual | $9,090 | $1,215.01 to $1,458 |
| Couple | $13,630 | $1,643.01 to $1,972 |
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.
You’re eligible for the QI Program in Texas if you meet the following criteria:
| Your Situation | Resource Limit | Monthly Income Range |
|---|---|---|
| Individual | $9,090 | $1,458 to $1,640 |
| Couple | $13,630 | $1,972 to $2,219 |
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.
You’re eligible for the QI Program in Texas if you meet the following criteria:
| Your Situation | Resource Limit | Monthly Income Limit |
|---|---|---|
| Individual | $4,000 | $2,430 |
| Couple | $6,000 | $3,287 |
You can apply for Medicare Savings Programs:
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.
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.
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.
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!
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!
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.
© 2024 Chapter Medicare
Memoir, Inc. d/b/a Chapter is a privately-owned, data and technology-enabled advisory that helps older Americans navigate retirement. Insurance agency services are provided by Chapter Advisory LLC, a licensed health insurance agency and wholly owned subsidiary of Memoir, Inc. In California, Chapter Advisory LLC does business as Chapter Insurance Services (Lic. No. 6003691). The information on this site has been developed for general informational and educational purposes.
Chapter and its affiliates are not connected with or endorsed by any government entity or the federal Medicare program. Chapter Advisory LLC represents Medicare Advantage HMO, PPO, and PFFS organizations and stand alone prescription drug plans that have a Medicare contract. Enrollment depends on the plan’s contract renewal. While we have a database of every Medicare plan nationwide and can help you to search among all plans, we have contracts with many but not all plans. As a result, we do not offer every plan available in your area. Currently we represent 43 organizations which offer 16,706 products in your area [nationwide]. That said, we search and recommend all plans, even those we don’t directly offer, and the number of carriers and plans we offer in your specific zip code may be different. Please contact Medicare.gov, 1-800-Medicare, or your local State Health Insurance Program (SHIP) to get information on all of your options.
Average potential savings are based on premium, co-pay, and out of pocket savings estimates self-reported by consumers that worked with Chapter Advisory LLC to enroll in a Medicare Supplement, Medicare Advantage, and/or Part D Prescription Drug Plan. The average is limited to consumers that chose to self-report. Savings information is subject to periodic updates and corrections. There is no guarantee of savings and any savings may vary by policy type, state, or other factors.