If you’re on a fixed income in retirement, every expense matters. Health care costs, in particular, are a source of stress because they’re often unexpected—and they always come at the worst time.
Fortunately, people who struggle with health care costs may have options in Texas. Texas Medicare Savings Programs help people cover their out-of-pocket costs under Medicare. Depending on your financial situation, you may get help with your Medicare premiums, deductibles, and cost-sharing expenses.
Here’s what you need to know to qualify for Medicare Savings Programs in Texas.
What are Texas Medicare Savings Programs?
There are actually four different Texas Medicare Savings Programs, or MSPs:
- Qualified Medicare Beneficiary, or QMB. If you qualify for QMB status, the state of Texas pays your Part A and Part B premiums, deductibles, and cost-sharing amounts. You also automatically qualify for Extra Help with your Part D prescription drug coverage.
- Specified Low-Income Medicare Beneficiary, or SLMB. If you don’t meet the income test for QMB, you may qualify for SLMB. This MSP helps pay your Part B premiums but doesn’t help with Part A premiums or any Medicare cost-sharing expenses. You do qualify for Extra Help with Part D if you qualify for SLMB.
- Qualifying Individual, or QI. People who don’t qualify for Medicaid may qualify for QI status. The program covers your Part B premiums and automatically qualifies you for Extra Help for Part D. QI is offered on a first-come, first-served basis and you must reapply for QI status every year in Texas.
- Qualified Disabled and Working Individual, or QDWI. This program only pays your Part A premiums and is available to people who lost premium-free Part A because they returned to work. You cannot apply if you are eligible for Texas Medicaid.
How do I qualify for Texas Medicare Savings Programs?
All Texas MSPs are based on income and asset guidelines. Texas considers all your income and your financial resources to calculate eligibility. You’ll need to disclose:
- Your income (currently, an individual can earn no more than $2,082 a month and a married couple $2,819 a month to qualify)
- Checking and savings account balances
- Ownership of any stocks, bonds, or mutual funds
- 401(k) or IRA balances
Generally speaking, the state does not consider the following assets in determining MSP eligibility:
- Your primary residence
- One vehicle
- Burial plot and up to $1,500 in burial expenses
- Household and personal items
In the state of Texas, you cannot qualify for QMB or QI status if you are between the ages of 20 and 64 and institutionalized for mental illness. People of any age who are in prison or jail are automatically disqualified.
You can apply for Texas Medicare Savings Programs online at YourTexasBenefits.com or in person at your local Department of Health and Human Services.
Can I enroll in Medicare Advantage if I qualify for a Texas Medicare Savings Program?
If you are dual-eligible, meaning you qualify for both Medicare and Medicaid, you may qualify for a Medicare Advantage Special Needs Plan, or SNP. Most Texas Medicare Advantage SNPs for dual-eligible individuals are premium-free to plan members and have benefits that go beyond Original Medicare.
For example, Texas Medicare Advantage SNPs include Part D coverage for prescription drugs, and many include benefits for vision and dental care. You may even get expanded home health care coverage, wellness benefits, non-medical transportation assistance, personal emergency response service, access to a 24-hour nurse hotline, and care coordination. Most Texas dual-eligible SNPs offer very comprehensive coverage.
If you think you qualify for a Texas Medicare Savings Plan, your first step is to complete an application. You should also get in touch with a licensed Texas Medicare plan broker to learn more about your plan options to help you find the most affordable coverage available.