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Texas Medicare cost help
Last updated: 24 September 2026
If Medicare premiums or medical bills are taking too much of your monthly income, a Medicare Savings Program may help. Texas Health and Human Services Commission (HHSC) decides eligibility for four programs: QMB, SLMB, QI, and QDWI. The rules can look confusing because Texas and federal screening charts do not display income in exactly the same way. This guide explains the difference and next steps.
Bottom Line
Do not rule yourself out from one income number. For 2026, Texas HHSC lists base monthly income figures of $1,330 for one person under QMB, less than $1,596 under SLMB, and less than $1,796 under QI, while federal Medicare screening figures are $1,350, $1,616, and $1,816. Texas says its figures do not include the $20 general income disregard. QDWI is even more different because federal screening also includes earned-income disregards. If you are close, apply and let HHSC count your income and resources.
The fastest starting point is Your Texas Benefits, or call Texas HHSC at 2-1-1 or 1-877-541-7905 and, after choosing a language, press 2.
Start Here
- Check the program that fits. QMB gives the broadest Medicare cost help. SLMB and QI mainly pay the Part B premium. QDWI is a narrower program for some working people with disabilities who lost premium-free Part A.
- Apply even if close. Texas applies income and resource counting rules that a simple chart cannot fully show. You can also use GFS’s Medicare savings checker as a preparation tool, not an eligibility decision.
- Keep proof. Save what you submit, your case number, HHSC letters, and the date you sent requested documents.
Quick Reference
| Your situation | Best first step | Why |
|---|---|---|
| Part B premium is hard to afford | Apply for an MSP | QMB, SLMB, or QI may pay the Part B premium. |
| You have QMB and got a Medicare cost-sharing bill | Contact the provider, then Medicare | Federal law generally bars providers from billing QMB members for Medicare Part A or B deductibles, coinsurance, and copayments. |
| You are working, disabled, under 65, and lost premium-free Part A | Ask about QDWI | QDWI may pay the Part A premium if its special rules are met. |
| You need free help with the application | Call Texas HICAP | Texas’s Medicare counseling program can help you understand MSP and Medicare questions. |
What Has Changed
- Texas HHSC’s current 2026 MSP table is effective March 1, 2026 and says its income figures do not include the $20 general income disregard. This update now explains why federal screening figures look slightly higher.
- The current H1200-EZ form is effective August 2026. Texas says it can be used for Medicare cost-sharing applications and recertifications.
- Texas’s current handbook, revised through September 1, 2026, confirms that QMB does not use the same retroactive start rule as SLMB and QI.
The Four Medicare Savings Programs in Texas
Medicare Savings Programs (MSPs) are Medicaid eligibility groups that help certain people pay Medicare costs. Texas HHSC decides eligibility. For national context, see GFS’s Medicare Savings Program guide.
| Program | Main help | Important rule |
|---|---|---|
| QMB | Part A premium if owed, Part B premium, and Medicare-covered Part A and B deductibles, coinsurance, and copayments | Providers generally cannot bill you for those Medicare-covered cost-sharing amounts while you have QMB. |
| SLMB | Part B premium | It does not provide the same QMB cost-sharing protection. |
| QI | Part B premium | You must reapply each year; funding is first-come, first-served, with priority for people who received QI the prior year. |
| QDWI | Part A premium only | It is for a narrow group of working people with disabilities under 65 who lost premium-free Part A and meet other rules. |
QMB: the broadest cost help
The Qualified Medicare Beneficiary (QMB) program can pay Medicare Part A and Part B premiums and Medicare-covered cost sharing. Texas HHSC says QMB by itself does not mean you receive full Medicaid benefits. Some people separately qualify for full Medicaid too. If that applies to you, the dual-eligible guide explains how Medicare and Medicaid can work together.
SLMB: Part B premium help
The Specified Low-Income Medicare Beneficiary (SLMB) program pays the Part B premium. Texas also allows MSP help with the limited Medicare Part B immunosuppressive-drug benefit, called Part B-ID, for people who meet its special rules.
QI: Part B help with annual renewal
The Qualifying Individual (QI) program also pays the Part B premium. Medicare says states approve QI applications on a first-come, first-served basis and give priority to people who had QI the prior year. Texas says a person cannot receive QI while receiving another Medicaid-funded program. Apply or renew promptly rather than waiting until late in the year.
QDWI: a narrow working-disability program
The Qualified Disabled and Working Individual (QDWI) program may pay the Part A premium for a person under 65 who is disabled, working, and lost premium-free Part A after returning to work. Texas also requires the person not to receive Medicaid. QDWI does not pay Part B or ordinary Medicare cost sharing.
2026 Texas Income and Resource Limits
The Texas MSP policy table gives the figures below. HHSC says they do not include the $20 general income disregard and applies additional counting rules for income, resources, and spouses.
| Program | One person monthly income | Couple monthly income | Resource limit |
|---|---|---|---|
| QMB | $1,330 or less | $1,804 or less | $9,950 one person; $14,910 couple |
| SLMB | Over $1,330 and under $1,596 | Over $1,804 and under $2,164 | $9,950 one person; $14,910 couple |
| QI | At least $1,596 and under $1,796 | At least $2,164 and under $2,435 | $9,950 one person; $14,910 couple |
| QDWI | $2,660 or less | $3,607 or less | $4,000 one person; $6,000 couple |
Do not use this table as a final eligibility test. HHSC applies income-counting and disregard rules. A spouse’s income can also affect the calculation.
Why Medicare.gov shows higher income figures
The federal 2026 screening limits include the $20 monthly general income exclusion. That produces federal screening figures of $1,350 for QMB, $1,616 for SLMB, and $1,816 for QI for one person. The corresponding couple figures are $1,824, $2,184, and $2,455. This is why the federal chart can look $20 higher than the Texas base table.
QDWI is different. Federal 2026 screening figures are $5,405 for one person and $7,299 for a couple because they include earned-income disregards. Texas’s base table shows $2,660 and $3,607 before those disregards. Do not self-deny from one number.
What Texas may count as a resource
Texas may count bank accounts, CDs, some real property, life insurance, burial funds, retirement accounts, stocks, bonds, and other property. Exclusions can include a qualifying Texas homestead, one car, burial spaces, certain small life insurance policies, and limited burial funds. Report what HHSC asks for and let the agency apply the exclusions.
How to Apply in Texas Without Wasting Time
You can apply through Your Texas Benefits online, through an HHSC benefits office, or with a paper form. The shorter Form H1200-EZ is an optional application and recertification form for Medicare cost-sharing programs. Texas also uses Form H1200 for Medicaid for the elderly and people with disabilities, including MSP applications.
If online systems are difficult, call 2-1-1 or 1-877-541-7905. After choosing a language, press 2 for benefit-program questions. You can also review GFS’s Texas benefits portals for a plain-language map of state starting points.
Documents and information to gather
- Medicare card and Social Security number.
- Current Social Security, pension, retirement, or veterans-benefit information.
- Recent pay information if you or your spouse works.
- Recent bank statements and information about other resources HHSC asks about.
- Life insurance or burial-fund information if applicable.
- Spouse information when HHSC asks for it.
- Your mailing address, phone number, and a safe way to receive HHSC notices.
Your Texas Benefits says HHSC may ask for proof of identity, income, expenses, and assets. Uploading documents with the application may speed the decision. If something is missing, file the application and respond promptly to HHSC’s request.
If someone helps you
A trusted helper can assist with forms. To let someone act for you with HHSC, Texas provides Form H1003 for an authorized representative. Do not share account access with an untrusted person.
Save proof of filing
Keep the filing date, confirmation or receipt, copies of documents, and your case number. If HHSC sends Form H1020 for missing information, use the deadline printed on it. Missing that deadline can lead to denial.
How Long Texas Has to Decide
Texas policy says HHSC should make an eligibility decision within 45 days for applicants age 65 or older. The same 45-day policy applies to people under 65 whose disability is already established under Social Security criteria. If HHSC must make a disability determination, the policy period is 90 days. The clock starts when HHSC receives a completed, signed application. These are agency processing rules, not a promise that every case or premium adjustment finishes on that exact day. See the official Texas processing deadlines.
If you are past the expected window, call with your case number and ask whether the case is waiting on a document, verification, disability decision, or another action. A missing-information notice can stop an otherwise strong application from moving forward.
What Happens After Approval
The start date depends on the program. Under Texas’s current effective-date rules:
- QMB: coverage starts the first day of the month after the month HHSC processes and disposes the case, unless Texas is maintaining continuous QMB coverage. QMB does not use the ordinary three-prior-month rule.
- SLMB: coverage can start the first day of the application month and may reach up to three months before the application month if all rules were met.
- QI: coverage can start the first day of the application month and may reach up to three prior months, but Texas limits how those prior months can cross into the previous calendar year.
Keep the approval notice. It shows the program and effective date. If your Part B premium is still being deducted after approval, do not assume the case failed. Call HHSC to confirm the MSP status and contact Social Security or Medicare if the deduction does not update after the state information is transmitted.
Extra Help with prescriptions
People who receive QMB, SLMB, or QI are automatically eligible for Medicare Part D Extra Help. Medicare’s 2026 Extra Help page lists a $0 plan premium, $0 deductible, and capped prescription copays for eligible people, subject to plan and drug rules. QDWI is not automatically deemed eligible for Extra Help, though a QDWI recipient may separately apply if they meet Extra Help rules. GFS has a separate Extra Help guide.
If You Have QMB and Get a Bill
Do not ignore a QMB cost-sharing bill, but do not assume you owe it. Federal law prohibits Original Medicare and Medicare Advantage providers and suppliers from billing a QMB member for Medicare Part A or Part B deductibles, coinsurance, and copayments for covered services. This rule applies even if the provider does not accept Medicaid or the state pays nothing toward the cost sharing.
The Centers for Medicare & Medicaid Services tells providers to correct improper QMB bills, recall bills sent to collections, and refund QMB cost-sharing money that was collected. See the official QMB billing fact sheet.
- Tell the billing office you had QMB on the date of service.
- Show your Medicare card and QMB/Medicaid proof or Medicare Summary Notice if available.
- Ask the provider to remove the Medicare cost-sharing charge and recall it from collections if needed.
- If the problem continues, call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.
QMB protection applies to Medicare-covered Part A and Part B cost sharing. It does not make every service free. Medicare notes that a small Medicaid copayment can sometimes apply. For more detail, see GFS’s QMB billing protections.
Common Mistakes to Avoid
- Using only the federal chart. Texas publishes state policy figures and applies its own counting rules. Use charts to screen, not to deny yourself.
- Assuming MSP means full Medicaid. QMB, SLMB, QI, and QDWI are Medicaid eligibility groups, but Texas states that MSP-only recipients do not automatically receive ordinary full Medicaid benefits.
- Ignoring resource rules. Texas still has a resource test for these MSPs in 2026. Some property is excluded, so report what HHSC asks for and let the agency apply the rule.
- Missing an H1020 deadline. Read every HHSC notice and send requested proof by the date printed on it.
- Waiting to renew QI. QI is annual and first-come, first-served. Start the renewal when Texas tells you to do so.
- Paying an improper QMB bill quietly. If the bill is Medicare cost sharing for a covered service, ask for correction before paying.
Reality Checks
Approval can take paperwork. HHSC may need proof from several sources. A fast reply to a document request can prevent avoidable delay.
Premium changes may lag. The MSP eligibility date and the date a Social Security deduction changes are not always the same day. Keep your approval notice and follow up.
QI funding is different. QI is first-come, first-served, so timely renewal matters.
QMB starts differently. In Texas, new QMB coverage generally starts after the decision month, while SLMB and QI can have prior-month coverage under certain conditions.
Denied, Delayed, or Overwhelmed
If HHSC denies your application, read the notice before filing a new one. The notice should tell you why and how to appeal. Texas’s fair hearing guidance says a person normally has 90 days from the denial notice date to request a fair hearing. Act sooner if possible and follow the deadline on your notice.
Before a hearing, program staff may correct an error or consider more information. You can generally reapply while an appeal is pending, but do not let a new application replace a timely appeal of an earlier decision.
If the problem is an unresolved HHSC service or case-handling complaint rather than the merits of an eligibility decision, the HHS Ombudsman can be reached at 1-877-787-8999. An ombudsman complaint does not replace a fair-hearing deadline.
Free Texas Help and Backup Options
Texas HICAP/SHIP: The Health Information, Counseling and Advocacy Program is Texas’s State Health Insurance Assistance Program. It provides free Medicare counseling. The Texas SHIP listing gives the statewide number 1-800-252-9240. GFS also explains how SHIP and SMP help works.
Area Agencies on Aging: Texas has regional Area Agencies on Aging (AAAs). Use the official Texas AAA directory to find the office serving your county, or use GFS’s Texas aging agencies guide.
Local HHSC office: If online or phone service is difficult, use the HHSC services directory to locate offices and services. Call before traveling.
If prescription costs are the bigger problem, consider Extra Help even if an MSP does not work out. An Extra Help application through Social Security can also start the state MSP process unless you opt out.
Phone Scripts You Can Use
Applying through HHSC
“I have Medicare and want to apply for a Medicare Savings Program. Can you tell me the fastest way to file and which documents HHSC needs from me?”
Checking a delayed case
“My Medicare Savings Program application was filed on [date]. My case number is [number]. Is anything missing, and what action is needed to finish the eligibility decision?”
Correcting a QMB bill
“I had QMB on the date of this Medicare-covered service. QMB members cannot be billed for Medicare Part A or Part B cost sharing. Please review my QMB status and remove this charge.”
Asking HICAP for help
“I need free help understanding QMB, SLMB, QI, or QDWI in Texas. Can a counselor help me compare the limits, application status, and Medicare costs I am being charged?”
Resumen en Español
Los Programas de Ahorros de Medicare en Texas pueden ayudar con primas y, con QMB, con ciertos deducibles, coseguros y copagos de servicios cubiertos. Texas HHSC decide la elegibilidad.
No se descarte por una sola cifra. Texas y las tablas federales muestran cantidades distintas porque aplican exclusiones de ingresos de manera diferente. Si está cerca del límite, solicite y deje que HHSC haga el cálculo.
Comience en Your Texas Benefits o llame al 2-1-1 o 1-877-541-7905. Guarde copias y responda a las cartas de HHSC a tiempo. Texas HICAP ofrece ayuda gratuita en 1-800-252-9240. Si recibe una denegación, revise de inmediato la apelación; Texas normalmente permite 90 días desde la fecha de la notificación para pedir una audiencia.
FAQ
Which 2026 Texas income limits should I use?
Use the Texas HHSC figures as the state policy starting point, but do not treat them as a simple gross-income cutoff. HHSC says its figures do not include the $20 general income disregard. Federal Medicare and SSA screening figures include that disregard, and QDWI federal figures also include earned-income disregards. If you are close, apply and let HHSC calculate eligibility.
Does QMB stop Medicare cost-sharing bills?
Yes, for Medicare-covered Part A and Part B cost sharing while you have QMB. Federal law bars Original Medicare and Medicare Advantage providers and suppliers from billing QMB members for those deductibles, coinsurance, and copayments, even when the provider does not accept Medicaid. A small Medicaid copayment can sometimes apply.
Does Texas still have an MSP resource test?
Yes. For 2026, Texas lists resource limits of $9,950 for one person and $14,910 for a couple under QMB, SLMB, and QI. QDWI uses $4,000 for one person and $6,000 for a couple. Some resources are excluded, including a qualifying homestead and one car.
How long can a Texas MSP decision take?
Texas policy calls for a decision within 45 days for applicants age 65 or older and for applicants under 65 whose disability is already established under Social Security criteria. The policy allows 90 days when HHSC must establish disability. Missing information can delay a case.
Can SLMB or QI cover earlier months?
Sometimes. Texas says SLMB can begin in the application month and may reach up to three prior months when all eligibility rules were met. QI has a similar three-prior-month rule, but Texas limits how it can cross into the previous calendar year. New QMB coverage generally starts after the decision month instead.
Does QDWI automatically include Extra Help?
No. QMB, SLMB, and QI recipients are automatically deemed eligible for Medicare Part D Extra Help. QDWI recipients are not automatically deemed eligible, but they can separately apply for Extra Help if they meet its rules.
About This Guide
Sources: This guide uses official federal, Texas state, Medicare, Social Security, and other high-trust sources linked in the article.
Editorial note
This guide is produced under the GFS Editorial Standards using official and other high-trust sources. GFS is not affiliated with a government agency and is not a substitute for official agency guidance. Individual eligibility outcomes cannot be guaranteed.
Corrections
Despite careful verification, errors may occur. Readers may email info@grantsforseniors.org with corrections.
Disclaimer
This article is for informational purposes only and is not legal, financial, medical, tax, disability-rights, immigration, or government-agency advice. Program rules, policies, funding, and availability can change. Readers should confirm current details directly with the responsible official program before acting.
Last updated: 24 September 2026 · Next review: 24 January 2027
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