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

Last updated: May 5, 2026

Bottom line: Texas uses the four Medicare Savings Programs: QMB, SLMB, QI, and QDWI. If HHSC approves you, one of these programs may pay Medicare premiums. QMB can also stop most Medicare-covered deductibles, coinsurance, and copay bills. Apply through Texas HHSC, not through a broker or health plan. For other state help, see our Texas senior benefits guide, and for the national overview, see our national MSP guide before you apply.

Quick-start table

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 or QMB proof, and ask them to correct the bill using Medicare’s MSP billing rules. If the bill does not get fixed, call 1-800-MEDICARE and the HHSC Ombudsman at 1-877-787-8999.
• If Medicare premiums are draining your check: call 2-1-1 or 1-877-541-7905. After you pick a language, choose option 2 and ask how to apply for a Texas Medicare Savings Program.
• If HHSC denied you: do not wait. Texas says many applicants have 90 days from the denial notice to ask for a fair hearing. Your notice should explain your appeal rights. Call 2-1-1 or use the fair hearing instructions on the notice.
• If you live in a nursing home or assisted living: a benefits issue may also affect billing at the facility. Ask the facility business office for a written account statement and call the long-term care ombudsman if the problem involves resident rights or facility billing pressure.

Contents

• What Medicare Savings Programs are
• Who qualifies in Texas
• Income limits for 2026
• Asset limits
• Best programs and pathways
• How to apply
• What happens after approval
• QMB bill problems
• Reality checks
• Denied, delayed, or blocked
• Backup options
• Local resources
• Phone scripts
• Resumen en español
• FAQ

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

Start with HHSC. In Texas, Medicare Savings Programs are run by the Texas Health and Human Services Commission, often called HHSC. Your Medicare Advantage plan, drug plan, broker, doctor, or hospital 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. Texas explains the programs in its MSP handbook, and Medicare explains that you apply through your state.

Texas does not have a separate state-only Medicare premium program outside these four categories. This matters because many online pages mix Texas with states that use higher limits, no asset test, or extra state-funded help. Texas still uses the standard Medicare Savings Program structure, and Texas still applies a resource test. If an old PDF or a generic page shows different numbers, do not stop there. Use the current 2026 limits and still let HHSC make the final decision.

These programs are not grants. They are Medicaid-based help for Medicare costs. Approval is not automatic. HHSC must review income, resources, Medicare status, Texas residency, and the documents it needs for your case.

Quick facts

• Best immediate takeaway: QMB gives the strongest help for most low-income Medicare beneficiaries because it pays the Part B premium and protects against most Medicare-covered cost-sharing bills.
• Major rule: Medicare providers are not allowed to bill a QMB enrollee for Medicare-covered deductibles, coinsurance, or copays.
• Texas reality: Texas still checks resources. Bank accounts, retirement accounts, and some extra property can matter.
• Drug help: QMB, SLMB, and QI usually trigger Extra Help for Medicare Part D drug costs. QDWI does not.
• Best next step: gather your Medicare card, income proof, recent bank records, 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 the official Texas program information in Appendix IX and federal MSP rules:

Income limits for seniors in Texas

Use the current 2026 numbers. The screening limits below are based on the Social Security Administration’s 2026 MSP chart. Texas policy may show QMB, SLMB, and QI income figures that look $20 lower because the federal consumer-facing chart includes the standard $20 general income exclusion. Do not reject yourself just because your income is slightly above a number on one chart. Apply and let HHSC decide.

Important Texas note: QDWI income looks much higher because the federal calculation includes earned-income disregards. Most older adults looking for help with Medicare costs in Texas are asking about QMB, SLMB, or QI, not QDWI.

Resource standards for 2026: CMS confirmed that the 2026 resource standards for QMB, SLMB, and QI are $9,950 for one person and $14,910 for a married couple in its 2026 standards bulletin. QDWI resource limits remain $4,000 for one person and $6,000 for a married couple.

Asset limits and what counts toward the limit

Do not guess on assets. Texas still uses a resource test for Medicare Savings Programs. A bank balance that puts you over the limit can matter. 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 generally excludes your homestead, one car, burial spaces, and some burial funds and small life-insurance amounts.

Expect verification. HHSC uses an Asset Verification System to check many financial accounts. The Texas policy update on the asset verification system includes accounts such as checking, savings, certificates of deposit, money-market accounts, annuities, trusts, and individual retirement accounts. This does not mean you should skip paperwork. It means you should be ready to explain old balances, closed accounts, and one-time deposits.

If you are close to the limit: do not move money around without advice. Transferring assets can cause problems for other Medicaid programs, especially long-term care Medicaid. Ask HHSC, a benefits counselor, or legal aid before making a large transfer.

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. After approval, show your Medicare card and Texas Medicaid or QMB proof every time you get care.
• What to know first: Texas notices may list QMB as MC-QMB. 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 know first: Texas may allow 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 apply again each year because QI is yearly and first-come, first-served, with priority for people who had QI the year before.
• What to know first: Texas notices may show MC-QI-1. Do not assume it will continue without renewal.

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 your work history and Medicare status fit.
• What to 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 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.
• How to use it: even if you file on paper, create an account so you can respond quickly if HHSC asks for proof.
• What to know first: if someone else will handle the case, use Form H1003 so HHSC can work with that person.

Free application help in Texas

• What it is: Texas benefits counseling, HICAP, Area Agencies on Aging, and Aging and Disability Resource Centers can help people understand Medicare, Medicaid, appeals, and forms.
• Who can use it: Medicare beneficiaries, caregivers, and adult children helping a parent.
• How it helps: trained counselors can help with Medicare, Medicaid, billing problems, claims issues, and applications.
• How to find it: call 2-1-1, search 2-1-1 Texas for Medicare counseling, or use the HHS services finder for your county.
• What to 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. Texas says Form H1200 is used for Medicaid for the Elderly and People with Disabilities or a Medicare Savings Program. Texas also has Form H1200-EZ, which serves as an application and renewal form for Medicare cost-sharing programs and some aged and disabled programs. If you only want help with Medicare costs, ask HHSC whether H1200-EZ is the best form for your case. If you are also asking about other Medicaid help, H1200 may be the better route.

• Choose your filing path: MSP only often means H1200-EZ; broader Medicaid help often means H1200.
• Create an online account: this is the easiest way to see notices and upload proof after filing.
• Submit proof early: income proof, bank statements, and Medicare information can reduce delays.
• Watch for Form H1020: if HHSC needs more information, it may send a Form H1020 notice. Answer by the deadline on the notice.
• Keep proof of submission: save fax confirmations, screenshots, copies, and mail receipts.
• Put your case number on pages: once you have a case number, write it on documents you send later.

How long approval usually takes: Texas does not publish one simple statewide MSP-only processing time for all applicants. Timing can vary by office workload, financial verification, and whether you answer requests quickly. If weeks pass with no action, call 2-1-1 or 1-877-541-7905, choose option 2, and ask whether your case is waiting on proof.

Application and proof checklist

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. The notice should tell you the program and effective date. For QMB, Texas policy usually starts coverage 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. Providers should not 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. When only one spouse applies, part of the other spouse’s income may still be considered. Married Texans can avoid delays by sending complete information for both spouses the first time.

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 for a corrected claim: many bad QMB bills are billing-system errors, not true debts.
• Escalate if needed: call 1-800-MEDICARE if the provider will not fix it. If the Texas agency side is part of the problem, contact the HHSC Ombudsman.
• Keep records: write down the date, time, name of the billing worker, and what they said.

Reality checks for Texas applicants

• Texas still checks resources. A small savings account may be fine, but an old certificate of deposit, IRA, extra vehicle, or life insurance cash value can change the result.
• QI is not permanent. You must apply again each 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 the case. If HHSC asks for more information, answer by the deadline on the notice.
• Back pay can take time. Even after approval, it may take time for the Part B premium to stop being taken from a Social Security check.
• Approval does not erase all medical bills. QMB protects you only from Medicare-covered cost-sharing. It does not pay bills for services Medicare does not cover.

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.
• Throwing away proof of fax, upload, or mail.
• Buying Medigap to solve costs you may already be able to stop with QMB. The Texas Department of Insurance Medigap guide says people in QMB do not need Medicare supplement insurance.

Best options by need

• I need the strongest protection from bills: QMB is the first program to ask about.
• I am a little over QMB but still low income: SLMB or QI may help with the Part B premium.
• I only need help with the Part B premium and I am not on Medicaid: QI may fit, but you must renew each year.
• I am under 65, disabled, back at work, and lost free Part A: ask HHSC 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: contact the Texas LTC ombudsman at 1-800-252-2412 if billing pressure or resident rights are part of the problem.

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, address update, or spouse information.
• Use your appeal rights. Texas fair hearing information says many people have 90 days from the denial notice to request a fair hearing. Ask right away if the decision looks wrong.
• Use the ombudsman when normal channels fail. The HHSC Ombudsman helps with unresolved HHS service 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: read Medicare’s Extra Help page. QMB, SLMB, and QI usually trigger Extra Help, but people outside those programs can still ask.
• If food costs are the problem: our food programs for seniors guide can help you look beyond Medicare costs.
• If rent or housing is the problem: use our housing and rent help guide for other paths.
• If utility bills are past due: our utility bill help guide explains common bill-help programs.
• If you need nonprofit help: see our list of charities helping seniors, then call local groups to confirm what they can do now.
• If property taxes are straining your budget: Texas homeowners can also review property tax relief in Texas for next steps.
• If you work and have a disability: review the Texas Medicaid Buy-In brochure if QDWI or another work-related coverage path may 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.
• Online benefits account: use Your Texas Benefits to apply, upload proof, and check notices.
• Area Agency on Aging: call 1-800-252-9240 or use the HHS services finder. Our Texas aging agencies page can also help you understand what these offices do.
• Texas benefits counseling: the benefits counseling program supports Texans age 60 and older and Medicare-eligible people with disabilities.
• HICAP support: Texas Legal Services Center describes HICAP as the State Health Insurance Assistance Program for Texans.
• HHSC Ombudsman: call 1-877-787-8999, Monday through Friday, 8 a.m. to 5 p.m., if normal channels do not fix an HHS service problem.
• Long-term care ombudsman: call 1-800-252-2412 if the issue involves a nursing home or assisted living resident.

Diverse communities

Seniors with disabilities

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

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 regional benefits counselors. Ask your Area Agency on Aging which office covers your county.

Phone scripts you can use

Calling HHSC to ask how to apply

“Hello, I am a Texas Medicare beneficiary. I want to apply for a Medicare Savings Program to help with Medicare premiums. Should I use Form H1200-EZ or Form H1200 for my situation? Can you tell me what proof I need and how to send it?”

Calling about a delayed case

“Hello, I applied for a Medicare Savings Program and have not heard back. Can you check whether my case is waiting on proof or an action from me? Please tell me the date of the last notice and what I need to send.”

Calling a provider about a QMB bill

“Hello, I received this bill, but I am in the Qualified Medicare Beneficiary program. Medicare providers should not bill me for Medicare-covered deductibles, coinsurance, or copays. How can I send my QMB proof so the claim can be corrected?”

Calling for local counseling help

“Hello, I need free help with a Texas Medicare Savings Program application or a Medicare billing problem. Can you connect me with a benefits counselor, HICAP counselor, Area Agency on Aging, or Aging and Disability Resource Center for my county?”

Resumen en español

En Texas, los Programas de Ahorros de Medicare son administrados por HHSC. No los decide su plan Medicare Advantage ni un agente de seguros. Los cuatro programas son QMB, SLMB, QI y QDWI. Si HHSC lo aprueba, uno de estos programas puede pagar primas de Medicare. QMB también puede protegerlo contra muchos cobros de deducibles, coseguros y copagos cubiertos por Medicare.

Para solicitar ayuda, llame al 2-1-1 o al 1-877-541-7905 y escoja la opción 2 después de elegir idioma. También puede usar Your Texas Benefits. Si solo quiere ayuda con costos de Medicare, pregunte si debe usar H1200-EZ. Si también necesita Medicaid u otra ayuda, pregunte si debe usar H1200.

Si ya tiene QMB y un médico le cobra, llame a la oficina de facturación. Diga que usted tiene QMB y que no deben cobrarle por costos compartidos cubiertos por Medicare. Envíe prueba de QMB y pida que corrijan la cuenta. Si no lo arreglan, llame a 1-800-MEDICARE. Si el problema es con HHSC, puede llamar al Ombudsman de HHSC al 1-877-787-8999.

Si fue negado, lea la carta. Puede pedir una audiencia imparcial si cree que la decisión está mal. No espere. Guarde copias de todo lo que envía, incluyendo fax, correo, y capturas de pantalla.

FAQ

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. The key question is which of the four categories HHSC may approve for your case.

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

For 2026 screening, QMB is up to $1,350 a month for one person or $1,824 for a married couple. SLMB is up to $1,616 or $2,184. QI is up to $1,816 or $2,455. QDWI is up to $5,405 or $7,299. Texas still makes the final decision.

What assets count in Texas?

Texas can count bank accounts, certificates of deposit, stocks, bonds, retirement accounts, extra real estate, and some other property. Your home, one car, burial spaces, and some burial-related amounts may be excluded.

Does approval automatically give Extra Help with prescriptions?

If you get QMB, SLMB, or QI, yes. Those programs usually trigger Extra Help for Medicare Part D drug costs. QDWI is different and does not automatically give Extra Help.

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

Ask HHSC whether Form H1200-EZ is the best form for your case. Some people use Form H1200 when they also want broader Medicaid help. You can call 2-1-1 or 1-877-541-7905 and choose option 2.

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

Tell the provider you are in QMB and ask them to correct the bill. Send proof of your Medicare and QMB status. If they refuse, call 1-800-MEDICARE and ask for help with QMB billing.

How are married seniors treated in Texas?

If both spouses apply, Texas uses the couple income and resource limits for the same program. If only one spouse applies, HHSC may still need financial information for both spouses.

What if HHSC denies my application or takes too long?

Read the notice, call HHSC benefits help, and ask what is missing or why the case was denied. If the decision looks wrong, request a fair hearing before the deadline on your notice.