Medicare is a federal health insurance program available to those 65 years or older and adults with disabilities. Medicare is split into four parts:
A – hospital insurance
B – physician/outpatient services
C – Medicare provided by private insurance companies
D – prescription drug coverage
If you need help affording Medicare in Texas, you have options. The state offers four Medicare Savings Programs that could help you pay for deductibles, premiums, and copayments.
The four programs are
- Qualified Medicare Beneficiary (QMB) Program
- Specified Low-Income Medicare Beneficiary (SLMB) Program
- Qualified Individual (QI) Program
- Qualified Disabled & Working Individual (QDWI) Program
The first three programs (QMB, SLMB, QI) require that you have limited financial resources to qualify. In 2022, this would be no more than $8,400 for an individual and $12,600 for a married couple. The QDWI program requires no more than $4,000 for an individual and $6,000 for couples.
How do I add up my financial resources?
Gather all information pertaining to
- Bank accounts and Certificates of Deposit
- Individual Retirement Accounts (IRAs)
- Real property (land/buildings)
- Stocks and bonds investments
- Oil, gas, or mineral rights
- Jewelry and antiques
- Vehicles (including boats and recreational vehicles)
You do not have to include
- Life insurance with a face value of $1,500 or less
- Your Texas homestead (primary TX residence, where you live)
- The value of any burial plots
- One car
- Separately identifiable burial funds of $1,500
Qualified Medicare Beneficiary Program (QMB)
This program could pay for Part A & B if you meet the income* and financial resource requirements. You do not receive standard state Medicaid benefits with QMB. Instead, you receive a QMB identification card to show your medical providers. QMB eligibility begins on the first day of the month after you are certified for QMB benefits.
*The maximum gross income for an individual in Texas is $1,153 and for couple’s, $1,546
Specified Low-Income Medicare Beneficiary Program (SLMB)
This program pays for Medicare Part B premiums. If you receive Medicaid, you may also qualify for SLMB benefits. However, if you are eligible for SLMB, you will not receive regular Medicaid benefits or a monthly medical ID card. SLMB eligibility begins the month of application; if you meet all the criteria, medical coverage is available for three months before application.
The requirements for this program are similar to QMB, but you must have an income higher than 100% and less than 120% of the Federal Poverty Level. To fit into this bracket, an individual would need a monthly income between $1,133 and $1,379. As a couple, your monthly income would need to be between $1,526 and $1,851.
If only one person in a couple is eligible, use the individual monthly income range to determine if you qualify separately.
Qualifying Individual Program (QI)
This program covers the Medicare Part B premiums of those who qualify. You cannot be eligible to receive both regular Medicaid and the QI program coverage simultaneously. If you are QI-eligible, you will not receive regular Medicaid benefits or a medical ID card.
Eligibility is decided each calendar year; your eligibility can begin the month that you apply. You are eligible for three months prior medical coverage. However, this three-month period cannot extend back into the previous calendar year.
To qualify, you must be eligible for Medicare Part A and meet income and financial resource requirements. The QI program requires an income of between 120% and 135% of the federal poverty level. For an individual, this would require a monthly income between $1,379 and $1,549. For couples, the range is $1,851 and $2,080.
Qualified Disabled and Working Individual Program (QDWI)
This program requires that you be under 65 years old and entitled to benefits under Medicare Part A.
For individuals, a maximum gross income of $4,615 is required. For couples, the maximum is $6,189.
How do I apply for Medicare Savings Programs?
If you are not yet on Medicare, you can enroll for Medicare Part A, then apply for one of the programs.
If you already have Part A and meet the requirements, you can complete the “Application for Benefits: Texas Health and Human Services Commission.”
PDF/paper application – can be physically mailed or faxed to a THHSC site near you
If you are denied access to any of these programs or further questions, contact Lone Star Legal Aid for assistance.
Lone Star Legal Aid (LSLA) is a 501(c)(3) nonprofit law firm focused on advocacy for low-income and underserved populations by providing free legal education, advice, and representation. LSLA serves millions of people at 125% of federal poverty guidelines, who live in 72 counties in the eastern and Gulf Coast regions of Texas, and 4 counties in Southwest Arkansas. LSLA focuses its resources on maintaining, enhancing, and protecting income and economic stability; preserving housing; improving outcomes for children; establishing and sustaining family safety, stability, health, and wellbeing; and assisting populations with special vulnerabilities, like those with disabilities, the aging, survivors of crime and disasters, the unemployed and underemployed, the unhoused, those with limited English language skills, and the LGBTQIA+ community. To learn more about Lone Star Legal Aid, visit our website at www.LoneStarLegal.org.
Media contact: media@lonestarlegal.org
