Dual Eligible in Texas: What Medicare and Medicaid Beneficiaries Get (2026)

Direct Answer: What Texas Dual Eligibles Get in 2026

It depends on which dual-eligible category applies. Full dual eligibles in Texas, generally at or below the SSI federal benefit rate of $994 per month in 2026, get complete Texas Medicaid through STAR+PLUS on top of Medicare: long-term care, dental, vision, hearing aids, and personal care, plus Medicaid pays Medicare's premiums, deductibles, and coinsurance. Partial duals (QMB, SLMB, QI) only get help with Medicare premiums and cost-sharing.

Texas Dual-Eligible Income Limits by Household Size (2026)

Texas Medicaid dual-eligible determinations use the 100% federal poverty level (FPL) standard for QMB and the closely related full-dual pathways, expressed as a monthly income ceiling with the standard $20 general income disregard added by federal law. Texas's non-MAGI aged and disabled Medicaid pathway does not use Modified Adjusted Gross Income (MAGI), the calculation used for family and marketplace Medicaid; instead it counts gross income against the SSI-linked or FPL-based standard shown below.

Texas is a 1634 state, meaning residents who qualify for and receive SSI cash assistance are automatically enrolled in full Medicaid, with the 2026 SSI federal benefit rate of $994 per month setting the individual income ceiling for that community-based pathway. Texas does not offer a separate MEDS-AD-style program that lets community-dwelling aged or disabled residents qualify for full Medicaid at a higher income, and Texas's Medically Needy spend-down program is limited to pregnant women and children under 19, not aged or disabled adults. That gap is one reason many Texas residents above the SSI level rely on QMB, SLMB, or QI instead of full Medicaid.

• Household of 1: $1,350/month ($16,200/year), 100% FPL plus the $20 disregard (QMB standard)
• Household of 2: $1,823/month ($21,876/year), the size used for most married-couple dual cases
• Household of 4: $2,770/month ($33,240/year), for dual-eligible cases that include dependents
• Each additional household member: add $473/month ($5,680/year), the same per-person amount used across all family size tiers
• Full sizes 1 through 8 plus the per-person increment, sorted by family size, appear in the household-size table above

What Full Dual Eligibles Get in Texas

Texas full dual eligibles receive the broadest combination of benefits available to Medicare beneficiaries. Medicare remains the primary payer for hospital care, doctor visits, and prescription drugs, but Texas Medicaid, delivered through the STAR+PLUS managed care program, steps in to cover Medicare's cost-sharing (the 2026 Part B deductible of $283, the Part A inpatient deductible of $1,736, and the 20% Part B coinsurance) and then layers on an entire second benefit package that Original Medicare does not offer at all.

STAR+PLUS added benefits for Texas full duals include nursing facility care and home and community-based waiver services for people who need help staying in their own home, routine dental cleanings and dentures, annual vision exams and eyeglasses, hearing exams and hearing aids, non-emergency medical transportation to appointments, and personal care assistance for activities of daily living. None of these services are covered by Original Medicare, which makes full dual status financially transformative for Texas residents who need long-term or supportive care.

What Partial Duals (QMB, SLMB, QI) Get in Texas

Texas partial duals, enrolled only in a Medicare Savings Program tier, get a narrower but still valuable benefit. QMB enrollees have Medicare pay their Part A and Part B premiums, and Texas Medicaid pays the Part A inpatient deductible, the Part B deductible, and the 20% Part B coinsurance, with federal law banning providers from billing QMB enrollees for these amounts. SLMB and QI enrollees receive help with the Part B premium only, worth $2,434.80 per year at the 2026 rate of $202.90 per month.

Partial duals in Texas do not get the extra STAR+PLUS benefit package that full duals receive: no long-term care coverage, no routine dental or vision, and no non-emergency transportation, unless they separately qualify for those services. All three Medicare Savings Program tiers automatically enroll members in Medicare Part D Extra Help, which caps prescription drug copays and eliminates the Part D premium for a benchmark plan, and the resource limits for QMB, SLMB, and QI are $9,950 for an individual and $14,910 for a couple in 2026.

Texas Integrated D-SNP Plans (2026): Combining Medicare and STAR+PLUS Medicaid

Texas ended its STAR+PLUS Medicare-Medicaid Plan dual demonstration on December 31, 2025, as required by a CMS final rule, and replaced it with Integrated Dual-Eligible Special Needs Plans (D-SNPs) starting January 1, 2026. Integrated D-SNPs are now operating in Bexar, Dallas, El Paso, Harris, and Hidalgo counties, and when a Texas resident chooses one of these plans for Medicare, they are automatically enrolled in the plan's aligned STAR+PLUS Medicaid coverage, so the member gets one ID card and one handbook for both programs.

Insurers offering Texas Integrated D-SNPs for 2026 include Wellcare By Superior HealthPlan, UnitedHealthcare's Dual Complete TX-Y1, and Blue Cross and Blue Shield of Texas's Dual Care Plus. These plans typically add extra benefits beyond what Original Medicare and standalone Medicaid provide separately, such as a monthly spending card for groceries and over-the-counter items, routine dental, vision, and hearing benefits, transportation to medical appointments, and a care coordinator. Texas residents outside the five aligned counties can still enroll in a standard D-SNP that coordinates with, rather than fully integrates, their STAR+PLUS Medicaid.

How to Apply for Dual Eligibility in Texas

Texas residents apply for dual-eligible status through the Health and Human Services Commission (HHSC), which determines Medicaid eligibility for both full Medicaid pathways and the Medicare Savings Program tiers. The process runs through YourTexasBenefits.com, the state's online benefits portal, using Form H1200 for full Medicaid or the shorter Form H1200-EZ for Medicare Savings Program tiers only, and typically takes 30 to 45 days for standard applications or up to 90 days when a disability or long-term care determination is required.

• Step 1: Confirm active Medicare Part A and, if applying for QMB/SLMB/QI, Part B enrollment
• Step 2: Gather income and asset documents (Social Security statements, bank records, pension statements)
• Step 3: Apply at YourTexasBenefits.com, by phone at 2-1-1 or 1-877-541-7905, or in person at an HHSC office
• Step 4: Specify which pathway you want: SSI-linked community Medicaid, STAR+PLUS institutional/waiver Medicaid, or an MSP tier
• Step 5: Wait for HHSC's determination, then choose a STAR+PLUS plan or an Integrated D-SNP plan if available in your county

Is Texas a Medicaid Expansion State? How It Affects Dual Eligibles

Texas is one of the 10 states that has not adopted the ACA's Medicaid expansion, which extends Medicaid to non-elderly, non-disabled adults earning up to 138% FPL. The other non-expansion states are Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Wisconsin, and Wyoming. Non-expansion status creates the ACA gap for working-age Texas adults who earn too much for traditional Medicaid but too little for ACA marketplace subsidies, which start at 100% FPL.

Texas's non-expansion status does not affect dual-eligible determinations directly, because dual eligibility runs through the aged, blind, and disabled Medicaid pathways rather than the ACA expansion group. A Texas resident qualifies for Medicare based on age (65 or older) or a qualifying disability, and Medicaid dual-eligible status is layered on afterward using the SSI-linked or STAR+PLUS institutional/waiver income rules described above, not the 138% FPL expansion threshold that applies to non-elderly adults in expansion states. Texas's tighter aged and disabled Medicaid rules, combined with the lack of a MEDS-AD-style middle pathway, do mean that fewer community-dwelling Texas seniors qualify for full Medicaid compared with some expansion states.

Common Reasons Texas Dual-Eligible Applications Are Denied

Texas dual-eligible applications are denied for a predictable set of reasons, most of which can be corrected and resubmitted. The most frequent issue is income slightly above the limit for the requested pathway, followed by countable assets exceeding the resource test or income above the institutional cap without a Qualified Income Trust in place. HHSC must issue a written denial explaining the specific reason, and applicants have the right to request a fair hearing within 90 days of the denial notice.

• Income above the limit for the requested pathway ($994/month SSI-linked, $1,350/month QMB individual)
• Countable assets above $2,000 individual/$3,000 couple (full Medicaid) or $9,950/$14,910 (QMB, SLMB, QI)
• Missing Medicare Part B enrollment when applying for QMB, SLMB, or QI
• Income above the $2,982/month institutional cap without a Qualified Income Trust (Miller Trust)
• QI funding exhausted for the federal fiscal year (first-come, first-served)
• Incomplete documentation not returned to HHSC within the stated response window

What is the difference between a full dual eligible and QMB-only in Texas?

A full dual eligible in Texas gets complete STAR+PLUS Medicaid coverage layered on top of Medicare, including long-term care, dental, vision, and personal care, plus help with Medicare cost-sharing. QMB-only enrollees get help with Medicare Part A and Part B premiums, deductibles, and coinsurance, but no additional Medicaid benefit package. Full dual status generally requires a lower income than QMB in the community-based pathway.

What is the income limit for full Medicaid in Texas for someone on Medicare?

Texas's SSI-linked community Medicaid pathway sets the 2026 individual income limit at $994 per month, matching the federal SSI benefit rate, because Texas is a 1634 state where SSI recipients are automatically enrolled in Medicaid. Institutional and STAR+PLUS waiver Medicaid uses a higher special income limit of $2,982 per month (300% of the SSI federal benefit rate) for people who meet a nursing-facility level of care.

Does Texas dual eligibility cover long-term care through STAR+PLUS?

Yes, but only for full dual eligibles, not partial duals like QMB-only enrollees. STAR+PLUS covers nursing facility care and home and community-based waiver services for people who meet both the $2,982/month special income limit (or use a Qualified Income Trust) and a medical level-of-care requirement, with a $2,000 individual asset limit.

Can I enroll in a D-SNP plan in Texas if I am dual eligible?

Yes. Any Texas resident with both Medicare and some level of Medicaid, full or partial, can enroll in a Dual-Eligible Special Needs Plan (D-SNP). Since January 1, 2026, residents of Bexar, Dallas, El Paso, Harris, and Hidalgo counties can enroll in an Integrated D-SNP that automatically aligns Medicare with STAR+PLUS Medicaid in a single plan and card.

Do I automatically get Medicaid if I qualify for Medicare in Texas?

No. Qualifying for Medicare in Texas, by turning 65 or through a qualifying disability, does not automatically enroll you in Medicaid. You must separately apply for Texas Medicaid or a Medicare Savings Program tier through HHSC and meet the income and asset limits for that specific pathway before you become dual eligible.

What assets can I keep and still qualify as a dual eligible in Texas?

Texas excludes your primary home, one vehicle, household goods, personal belongings, and a burial fund or plot from the asset count. Countable asset limits vary by pathway: $2,000 individual/$3,000 couple for full Medicaid, and $9,950 individual/$14,910 couple for QMB, SLMB, and QI in 2026.

Is Texas's non-expansion status a factor for dual-eligible enrollment?

No, not directly. Texas's decision not to expand Medicaid under the ACA affects non-elderly, non-disabled adults earning up to 138% FPL, who fall into the coverage gap. Dual-eligible determinations for Medicare beneficiaries run through separate aged, blind, and disabled Medicaid pathways that exist in every state regardless of expansion status.

How do I apply for dual eligibility in Texas?

Apply through YourTexasBenefits.com, by calling 2-1-1 or 1-877-541-7905 (select a language, then option 2), or in person at a local HHSC benefits office. Use Form H1200 for full Medicaid or Form H1200-EZ for Medicare Savings Program tiers only. Free application counseling is available from Texas HICAP through your local Area Agency on Aging.