Medicare Savings Programs in Texas: QMB, SLMB, QI, and QDWI

Written & Reviewed by

Analic Mata-Murray

Managing Editor

Yolanda Taylor

Senior Healthcare Editor

Last updated: April 7, 2026

Bottom line: Texas does not run a separate state-only Medicare premium help program outside the four Medicare Savings Programs. If you qualify, the Texas Health and Human Services Commission (HHSC) can pay your Medicare premiums and, under the Qualified Medicare Beneficiary (QMB) program, can also stop most Medicare deductibles, coinsurance, and copay bills. The best first move is to apply through HHSC, not through a broker or health plan, and to set up Your Texas Benefits so you can track notices and upload proof.

Emergency help now

• If you already have QMB and a doctor or hospital billed you: tell the provider you are in QMB, show your Medicare and Medicaid/QMB proof, and ask them to correct the bill using guidance on Medicare’s official Medicare Savings Programs page. If the bill does not get fixed, call 1-800-MEDICARE and the HHSC Office of the Ombudsman at 1-877-787-8999.
• If Medicare premiums are draining your Social Security check: call 2-1-1 or 1-877-541-7905 and ask HHSC how to apply for a Medicare Savings Program in Texas or where to submit your form.
• If you were denied or your case is stuck: ask for an appeal or fair hearing right away by calling 2-1-1 and choosing option 2 after language selection, visiting a local eligibility office, or mailing a letter to HHSC at P.O. Box 149027, Austin, TX 78714-9027, as described in HHSC’s appeal and complaint guidance.

What Medicare Savings Programs are and why they matter for seniors in Texas

Start with HHSC. In Texas, Medicare Savings Programs are run by HHSC through the Medicaid for the Elderly and People with Disabilities system. Your Medicare Advantage plan, drug plan, broker, or doctor does not decide whether you get QMB, Specified Low-Income Medicare Beneficiary (SLMB), Qualifying Individual (QI), or Qualified Disabled and Working Individual (QDWI). The state decides, and you apply through HHSC, as explained on Medicare’s official MSP page and in the Texas Medicaid for the Elderly and People with Disabilities handbook.

Texas does not offer a separate extra MSP program beyond those four categories. That matters because many search results mix Texas with other states that use higher limits, no asset test, or special state-funded premium help. Texas still uses the standard MSP structure, and Texas still applies a resource test. If an older Texas PDF or a generic website shows outdated numbers, do not stop there. Use the current 2026 limits from the Social Security Administration’s MSP income and resource chart and still let HHSC make the final decision.

Quick facts

• Best immediate takeaway: if you qualify for QMB, you get the strongest help because it pays Part B and also protects you from Medicare-covered cost-sharing bills under the rules on Medicare.gov.
• Major rule: Medicare providers are not allowed to bill a QMB enrollee for Medicare-covered deductibles, coinsurance, or copays.
• Realistic obstacle: Texas still checks resources and HHSC can verify many financial accounts through its Asset Verification System bulletin.
• Useful fact: Medicare says people who enroll in a Medicare Savings Program generally can avoid a Part B late-enrollment penalty under its late-enrollment penalty guidance.
• Best next step: gather your Medicare card, income proof, recent resource proof, and spouse information before you apply.

Who qualifies for Medicare Savings Programs in Texas

Check three things first: Medicare status, income, and resources. In Texas, most applicants must live in Texas, have Medicare Part A or be eligible for it, fall within the income and resource limits for the program, and give HHSC enough proof to finish the case. If you are married, HHSC usually needs information on both spouses, even if only one spouse is asking for help.

The four Texas Medicare Savings Programs work like this, based on Medicare’s official program descriptions, the Social Security Administration’s MSP application guidance, and the Texas MEPD handbook:

Income limits for seniors in Texas

Use the current 2026 numbers. The screening limits below are based on the SSA’s 2026 MSP chart and Medicare’s 2026 MSP limits. Texas handbook pages often describe the same programs using federal poverty percentages and a separate $20 general income disregard, which is why some Texas worksheets can look $20 lower than consumer-facing Medicare charts for QMB, SLMB, and QI.

Important Texas note: the QDWI income figure is much higher because the official federal calculation includes earned-income disregards, as shown on the SSA 2026 MSP chart. Most older adults in Texas are looking at QMB, SLMB, or QI, not QDWI.

Asset limits and what counts toward the limit

Do not guess on assets. Texas still uses a resource test for MSPs, so a bank balance that puts you over the limit can matter. Under the Texas handbook, countable resources can include bank accounts, certificates of deposit, stocks, bonds, retirement accounts, extra real estate, some life insurance, mineral rights, boats, and extra vehicles. Texas says it generally excludes your homestead, one car, burial spaces, and some burial funds and small life-insurance amounts.

Expect verification. HHSC now uses an Asset Verification System as verification and later updated the policy to pull information on accounts such as checking, savings, certificates of deposit, money-market accounts, annuities, trusts, and individual retirement accounts. That does not mean you should skip paperwork. It means you should be ready to explain old balances, closed accounts, and one-time deposits.

Best programs and pathways in Texas

Qualified Medicare Beneficiary (QMB)

• What it is: the strongest Texas Medicare Savings Program for most low-income seniors.
• Who can get it or use it: Texans with Medicare Part A and low enough income and resources.
• How it helps: it pays the Part B premium and protects you from Medicare-covered deductibles, coinsurance, and copays.
• How to apply or use it: apply through HHSC and, after approval, show your Medicare card and Texas Medicaid/QMB proof every time you get care.
• What to gather or know first: Texas handbook notices may list QMB as MC-QMB, and the Texas handbook says QMB usually starts the first day of the month after HHSC decides you are eligible.

Specified Low-Income Medicare Beneficiary (SLMB)

• What it is: Texas premium help for people just above the QMB line.
• Who can get it or use it: Texans with Medicare Part A whose income is above QMB but within the SLMB range.
• How it helps: it pays the Part B premium only.
• How to apply or use it: use the same HHSC application route as QMB.
• What to gather or know first: Texas policy allows SLMB alongside some Medicaid programs, but you still need full financial proof.

Qualifying Individual (QI)

• What it is: Texas premium help for people above SLMB but still low-income.
• Who can get it or use it: Texans with Medicare Part A who are not otherwise receiving Medicaid.
• How it helps: it pays the Part B premium only.
• How to apply or use it: apply through HHSC, then reapply every year because Medicare says QI is yearly and first-come, first-served, with priority for people who had QI the year before.
• What to gather or know first: Texas notices may show MC-QI-1; do not assume it auto-renews.

Qualified Disabled and Working Individual (QDWI)

• What it is: a narrow work-related MSP, not the usual senior program.
• Who can get it or use it: disabled Texans under 65 who are working, lost premium-free Part A after returning to work, and are not otherwise eligible for Medicaid.
• How it helps: it pays the Medicare Part A premium only.
• How to apply or use it: apply through HHSC using the MSP route if you think your work history and Medicare status fit.
• What to gather or know first: QDWI does not automatically give you Extra Help for drug costs, so ask separately if you need Part D help.

Your Texas Benefits and HHSC case management

• What it is: Texas’s main portal and case system for benefit notices, uploads, and updates.
• Who can get it or use it: applicants, current beneficiaries, caregivers, and adult children helping a senior.
• How it helps: you can track letters, upload proof, report changes, and manage case details in Your Texas Benefits.
• How to apply or use it: even if you file on paper, create an account so you can respond quickly if HHSC asks for proof.
• What to gather or know first: if someone else will handle the case, use the official Form H1003 authorized representative form.

Free application help in Texas

• What it is: Texas’s State Health Insurance Assistance Program, called the Health Information, Counseling and Advocacy Program (HICAP), plus Area Agencies on Aging and Aging and Disability Resource Centers.
• Who can get it or use it: Medicare beneficiaries, caregivers, and adult children helping a parent.
• How it helps: HICAP and related counselors can help with Medicare, Medicaid, billing problems, claims issues, and applications.
• How to apply or use it: call 2-1-1, search 2-1-1 Texas for “Medicare Information/Counseling,” or use the official Texas HHS services finder for your county.
• What to gather or know first: bring your Medicare card, HHSC notices, income proof, and any wrong bill you need help fixing.

How to apply in Texas without wasting time

Pick the right route first. The Texas MEPD handbook says HHSC uses Form H1200 for all Medicaid for the Elderly and People with Disabilities programs and Form H1200-EZ for Medicare Savings Programs. HHSC materials also say that if you want to apply only for a Medicare Savings Program, H1200-EZ is the better Texas form. If you are also asking about other Medicaid help, start with the Form H1200 application page.

• Choose your filing path: MSP only usually means H1200-EZ; broader Medicaid help usually means H1200.
• Create a Your Texas Benefits account: this is the easiest way to see notices and upload proof after filing.
• Submit proof with the application if you can: it cuts down on delays.
• Watch for Form H1020: if HHSC needs more information, it may send a Request for Information or Action notice. Do not miss that deadline.
• Keep proof of submission: save fax confirmations, screenshots, and mail receipts.
• Put your case number on every page after you get one: HHSC says that helps track your documents.

How long approval usually takes: Texas does not publish a simple statewide MSP-only consumer processing time on a single current public page. In real life, timing varies by office workload, whether HHSC has to verify resources through the Asset Verification System, and whether you answer requests quickly. If weeks pass with no action, call 2-1-1 or 1-877-541-7905, choose option 2 for benefits help, and ask whether your case is waiting on proof.

Application and proof checklist

• ☐ Medicare card
• ☐ Social Security award letter or proof of current Social Security income
• ☐ Pension, retirement, railroad, veterans, or other income proof
• ☐ Recent bank statements and proof of other resources
• ☐ Life insurance, burial policy, IRA, annuity, or trust records if you have them
• ☐ Proof of Texas address and identity
• ☐ Marriage information and spouse’s financial records if married
• ☐ Any existing HHSC notice or Form H1020
• ☐ Form H1003 if a child, caregiver, or other helper will act for you

What happens after approval in Texas

Read your notice closely. Texas notices may show program codes such as MC-QMB, MC-SLMB, MC-QI-1, or MC-QDWI in the HHSC system described in the Texas handbook. The notice should tell you the program and effective date. For QMB, Texas policy says the benefit usually begins on the first day of the month after HHSC finishes the eligibility decision.

If you get QMB, tell every provider. Show your Medicare card and your Texas Medicaid or QMB proof at each visit. Under Medicare’s QMB billing rules, providers cannot bill you for Medicare-covered deductibles, coinsurance, or copays. If you have Original Medicare, keep your Medicare Summary Notices because they can help prove QMB status when a billing office gets it wrong.

If you are married: Texas uses the couple income limits when both spouses apply for the same MSP, but Texas policy also says that when only one spouse applies, part of the other spouse’s income may be considered. That is why married Texans should send complete information for both spouses, even when only one person needs help.

What to do if a doctor bills a QMB enrollee

• Do not ignore the bill. Call the provider’s billing office right away.
• Say clearly: “I am in the Qualified Medicare Beneficiary program, and Medicare providers cannot bill me for Medicare-covered cost-sharing.”
• Send proof: give the office a copy of your Medicare card and your Texas Medicaid or QMB proof.
• Ask the office to correct the claim: many bad QMB bills are billing-system errors, not true debts.
• If the provider will not fix it: use Medicare’s QMB billing guidance, call 1-800-MEDICARE, and if the Texas agency side is part of the problem, contact the HHSC Office of the Ombudsman.

Reality checks for Texas applicants

• Texas still checks resources. A small savings account may be fine, but an old certificate of deposit, IRA, or second vehicle can change the result.
• QI is not permanent. You must apply every year, and funding is limited.
• Mail and portal problems happen. Keep screenshots, fax logs, and copies of every page you send.
• One missing proof can stall everything. If HHSC asks for more information, answer by the deadline on the notice.

Common mistakes to avoid

• Applying through an insurance salesperson instead of HHSC.
• Assuming Texas has no asset test because another state dropped its test.
• Ignoring a Form H1020 request.
• Leaving off a spouse’s income or accounts.
• Paying a wrong QMB bill before asking the provider to fix it.
• Buying Medigap to solve costs you may already be able to stop with QMB; the Texas Department of Insurance Medicare supplement guide says you do not need Medicare supplement insurance if you are in the QMB program.

Best options by need

• I need the strongest protection from bills: QMB.
• I am a little over QMB but still low-income: SLMB or QI.
• I only need help with the Part B premium and I am not on Medicaid: QI may fit.
• I am under 65, disabled, back at work, and lost free Part A: ask about QDWI.
• I need a real person to help with forms: use HICAP, your Area Agency on Aging, or your Aging and Disability Resource Center.
• I live in a nursing home or assisted living and my billing or benefits problem is not getting fixed: contact the Texas long-term care ombudsman program at 1-800-252-2412.

What to do if denied, delayed, or blocked

• Read the reason line by line. Many Texas denials are fixable if the real problem was missing proof, a resource misunderstanding, or outdated case information.
• Ask what is missing. Call 2-1-1 or 1-877-541-7905, choose option 2, and ask whether HHSC is waiting on a document, an address update, or a spouse’s information.
• File an appeal or fair hearing fast. HHSC says you can do that by calling 2-1-1 and selecting option 2 after language selection, visiting a local eligibility office, or mailing a letter to Texas Health and Human Services Commission, P.O. Box 149027, Austin, TX 78714-9027.
• Use the ombudsman when normal channels fail. The HHSC Office of the Ombudsman can be reached at 1-877-787-8999, fax 1-888-780-8099, or by mail at P.O. Box 13247, Austin, TX 78711-3247. It helps with unresolved problems, but it is not a substitute for a formal appeal.
• Keep a paper trail. Save every notice, date, fax receipt, upload confirmation, and the name of every worker you speak with.

Plan B and backup options

• Ask HHSC to screen you for other Medicaid help too: some Texans qualify for full Medicaid or related aged and disabled programs, not just MSP.
• If drug costs are your biggest problem: you can also look at Medicare’s Extra Help information. QMB, SLMB, and QI usually trigger it automatically, but people outside those programs can still ask.
• If you were denied because of a temporary income spike: reapply when the income drops and send current proof.
• If you work and have a disability: review the official Texas Medicaid Buy-In brochure if QDWI or other disability-related coverage might fit better.

Local resources for Texas seniors

• HHSC benefits help: 2-1-1 or 1-877-541-7905. For benefits case help, choose option 2 after language selection.
• Your Texas Benefits portal: Your Texas Benefits.
• Find your Area Agency on Aging or Aging and Disability Resource Center: use the official Texas HHS services finder. This is where county and regional variation matters most in Texas.
• Find community Medicare counseling: use 2-1-1 Texas and search for “Medicare Information/Counseling.” The 2-1-1 Texas resource line says it is available 24 hours a day, 7 days a week, 365 days a year.
• HHSC Office of the Ombudsman: 1-877-787-8999, Monday through Friday, 8 a.m. to 5 p.m., or file or track an HHSC complaint online.
• Long-term care ombudsman for residents: 1-800-252-2412 or the Texas long-term care ombudsman page.

Diverse communities

Seniors with disabilities

Use accessibility and representation tools early. If a senior cannot manage the case alone, use the official Form H1003 authorized representative form. If you need accessibility help with Texas HHS information or systems, the HHSC Accessibility Center lists contact options, and Texas HHS notices also say people with hearing or speech disabilities can use 7-1-1 or any relay service. For independent living support, Texas also keeps a Centers for Independent Living directory.

Rural seniors with limited access

Use phone, mail, and regional counselors. Rural Texans do not have to rely on online forms alone. You can call 2-1-1, mail or fax proof to HHSC, and use the Texas HHS regional services finder to locate the Area Agency on Aging or Aging and Disability Resource Center that covers your county.

Frequently asked questions

Does Texas have its own Medicare Savings Program outside QMB, SLMB, QI, and QDWI?

No. Texas runs the standard four Medicare Savings Programs through HHSC. That is why the most important Texas-specific question is not “Which extra state program exists?” but “Which of the four federal MSP categories will HHSC approve me for?” Start with Medicare’s official program list and then apply through Texas HHSC.

What are the 2026 income limits for Medicare Savings Programs in Texas?

For 2026 screening, the current public federal limits used for most Texans are: QMB up to $1,350 a month for one person or $1,824 for a married couple; SLMB up to $1,616 or $2,184; QI up to $1,816 or $2,455; and QDWI up to $5,405 or $7,299, based on the SSA MSP limits chart. Texas still makes the final decision, and Texas policy materials may show QMB, SLMB, and QI figures that look $20 lower because of the standard income exclusion described in the Texas handbook.

What assets count in Texas?

Texas still applies a resource test for MSPs. Under the Texas MEPD handbook, HHSC can count bank accounts, certificates of deposit, stocks, bonds, retirement accounts, extra real estate, and some other property, while your homestead, one car, burial spaces, and some burial-related amounts may be excluded. Because HHSC now uses the Asset Verification System, it is smart to be very complete and honest on the application.

Does approval automatically give Extra Help with prescriptions?

If you get QMB, SLMB, or QI, yes. Medicare and SSA both say those three MSPs trigger automatic Extra Help for Part D drug costs. QDWI is different. It pays only the Part A premium and does not automatically give Extra Help.

How do I apply in Texas if I only want help with Medicare costs?

Official Texas materials say MSP-only applicants are often directed to Form H1200-EZ, while broader aged and disabled Medicaid applications use Form H1200. If you are not sure which form fits, call 2-1-1 or 1-877-541-7905 and ask HHSC which application you should use for your situation. Even if you file on paper, create a Your Texas Benefits account so you can upload documents and read notices.

What should I do if a Texas doctor or hospital bills a QMB enrollee?

Tell the provider you are in QMB and point them to Medicare’s official QMB billing rule. Give the office your Medicare and Texas Medicaid or QMB proof and ask them to fix the claim. If they refuse, call 1-800-MEDICARE. If the Texas agency side of the case is wrong or unclear, contact the HHSC Office of the Ombudsman.

How are married seniors treated in Texas?

If both spouses apply, Texas uses the couple income and resource limits for the same MSP. If only one spouse applies, Texas policy says HHSC may still count part of the other spouse’s income, so do not leave the spouse off the paperwork. Married Texans usually avoid delays by sending both spouses’ financial records the first time.

What if HHSC denies my application or takes too long?

First, read the notice and find out whether the problem was income, resources, or missing proof. Then call 2-1-1 or 1-877-541-7905 and choose option 2 for benefits help. If the decision still looks wrong, request an appeal or fair hearing using the methods listed in HHSC’s appeal guidance. If you are stuck in a loop, contact the HHSC Office of the Ombudsman.

Resumen en español

En Texas, los Programas de Ahorros de Medicare se administran por la Comisión de Salud y Servicios Humanos de Texas, no por su plan Medicare Advantage ni por un agente. Los cuatro programas son QMB, SLMB, QI y QDWI, y la explicación oficial en español está en la página oficial de Medicare sobre los Programas de Ahorros. Si usted tiene ingresos y recursos limitados, Texas puede pagar la prima de la Parte B y, en el caso de QMB, también protegerlo contra muchos cobros de deducibles, coseguros y copagos cubiertos por Medicare.

Para solicitar ayuda en Texas, use Your Texas Benefits o llame al 2-1-1 o al 1-877-541-7905 para pedir orientación o formularios. Si necesita ayuda gratis para llenar la solicitud, busque consejería de Medicare a través de 2-1-1 Texas o del localizador oficial de servicios de Texas HHS. Si ya tiene QMB y un médico le está cobrando, muestre su prueba de QMB y siga la guía de Medicare en español. Si HHSC le niega el caso o no responde, puede pedir una apelación y también comunicarse con la Oficina del Ombudsman de HHSC.

About This Guide

This guide uses official federal, state, and other high-trust nonprofit and community sources mentioned in the article.

Editorial note: This guide is produced based on our Editorial Standards using official and other high-trust sources, regularly updated and monitored, but not affiliated with any government agency and not a substitute for official agency guidance. Individual eligibility outcomes cannot be guaranteed.

Verification: Last verified April 7, 2026, next review August 7, 2026.

Corrections: Please note that despite our careful verification process, errors may still occur. Email info@grantsforseniors.org with corrections and we respond within 72 hours.

Disclaimer: This article is for informational purposes only. It is not legal, financial, medical, tax, disability-rights, immigration, or government-agency advice. Medicare, Medicaid, and Texas HHSC rules can change. Always confirm current details directly with the official program before acting.