Texas Medicare Savings Programs help people on Medicare with limited income pay for Medicare costs. In 2026 the standard Medicare Part B premium is $202.90 per month ($2,434.80 per year) and the Part B deductible is $283. A person who qualifies for any tier has the Part B premium paid by the state, and a person in the top tier (QMB) also has Medicare cost-sharing covered, including the 2026 Part A inpatient deductible of $1,736. The programs are run by the Texas Health and Human Services Commission (HHSC) and are paid for through Medicaid funding.
Texas is not a Medicaid expansion state, but the Texas Medicare Savings Programs exist anyway because federal law requires every state to offer them. Texas HHSC publishes limits only for an individual and a couple, so the family size that matters is you and your spouse. The 2026 limits below use the Federal Poverty Level (FPL) of $15,960 for one person. Texas HHSC income limits took effect March 1, 2026, and the resource limits took effect January 1, 2026. Federal 2027 resource limits have not been published yet.
Direct answer: who qualifies for Texas Medicare Savings Programs in 2026
Yes, if your 2026 countable income is below 135% of the Federal Poverty Level and your resources are within $9,950 (individual) or $14,910 (couple). Texas Medicare Savings Programs pay the 2026 Part B premium of $202.90 per month for incomes below $1,796 (individual) or $2,435 (couple). The top tier, QMB, also pays 2026 deductibles and coinsurance at incomes up to $1,330 (individual) or $1,804 (couple).
Texas Medicare Savings Programs income limits by household size (2026)
Texas Medicare Savings Programs use three income bands tied to the 2026 Federal Poverty Level of $15,960 for one person and $21,640 for two. QMB covers income up to 100% FPL, SLMB covers income above 100% FPL and below 120% FPL, and QI-1 covers income from 120% FPL up to below 135% FPL. For 2026, Texas HHSC lists these as monthly gross amounts that do not include the $20 general income disregard, so a person with Social Security or other unearned income can have about $20 more in gross income and still fit the band.
What Texas Medicare Savings Programs pay in 2026
Texas QMB pays the Part A premium if you owe one, the Part B premium of $202.90 per month in 2026, and Medicare deductibles and coinsurance, including the 2026 Part B deductible of $283 and the 20% Part B coinsurance in 2026. Medicare providers cannot bill QMB members for those Medicare cost-sharing amounts. Texas SLMB and QI-1 pay only the Part B premium, which saves $2,434.80 for the 2026 year. QMB coverage starts the month after approval, while SLMB and QI-1 can reach back up to 3 months before the application month.
Texas residents approved for any Medicare Savings Program tier are also treated as qualifying for Part D Extra Help (the Low Income Subsidy) for the rest of the calendar year, which lowers 2026 prescription drug costs under the $2,100 Part D out-of-pocket cap. A Medicare Savings Program is different from full Medicaid. Full Texas Medicaid for people on Medicare has a stricter asset test and its own rules, covered on the Texas dual-eligible page.
How to apply for Texas Medicare Savings Programs
Texas residents apply through HHSC, most easily online at YourTexasBenefits.com, where the Apply for Benefits link includes Medicare Savings Programs. The free Texas Medicare Help Line at 800-252-9240 and 2-1-1 Texas can point you to a benefit counselor who helps fill out the application. Texas has no enrollment window for these programs, so you can apply any month of 2026, but applying early matters because QMB starts the month after approval.
- Step 1: Confirm you have Medicare Part A (or Part B-ID for QMB, SLMB and QI-1 purposes) and gather your Medicare card, Social Security award letter, bank statements and proof of all income.
- Step 2: Apply online at YourTexasBenefits.com by choosing Apply for Benefits and selecting Medicare Savings Programs, or call the free Texas Medicare Help Line at 800-252-9240 for help with the application.
- Step 3: Answer the income and resource questions for yourself and your spouse, then upload or mail the proof HHSC requests. Missing proof is the most common reason for delay.
- Step 4: Complete the HHSC interview if one is scheduled and answer any follow-up notices before the deadline printed on them.
- Step 5: Read the written decision. If approved, HHSC tells Medicare, your Part B premium stops being deducted from Social Security, and QMB or SLMB coverage can reach back up to 3 months. If denied, you can request a fair hearing.
Documents needed for Texas Medicare Savings Programs
Texas HHSC verifies income, resources and Medicare entitlement before it approves a Medicare Savings Program, so having paperwork ready shortens the process. For a married applicant, household composition matters because HHSC counts the spouse's 2026 income and resources, even if the spouse is not on Medicare. Federal rules give states up to 45 days to decide most applications, and a missing document is the usual cause of a longer wait.
- Medicare card or Social Security award letter showing Medicare entitlement
- Proof of all income (Social Security, pension, annuity or wage statements)
- Bank, savings and investment statements for the applicant and spouse
- Proof of identity (driver license, state ID or passport)
- Proof of Texas residency (lease, utility bill or mail)
- Social Security number and proof of citizenship or qualified immigration status
- Household composition: marital status and spouse's income and resources
Is Texas a Medicaid expansion state? How Texas Medicare Savings Programs fit in
Texas is one of the 10 states that have not adopted Medicaid expansion (with AL, FL, GA, KS, MS, SC, TN, WI and WY), so Texas does not cover working-age adults up to 138% FPL, which is $1,835 per month for one person in 2026 in expansion states. Adults under 100% FPL in Texas fall into the ACA gap, with no premium tax credit and no Medicaid. Medicare Savings Programs are separate. Federal law requires every state, expansion or not, to run QMB, SLMB and QI-1, so a Texas resident on Medicare can qualify even though Texas never expanded Medicaid.
Texas Medicare Savings Programs also do not use MAGI (Modified Adjusted Gross Income), the method used for expansion adults and children. They follow SSI-related counting, which looks at gross income such as Social Security, pensions and wages, and at countable resources. Texas income and resource limits for 2026 are set for an individual or a couple, so household size beyond a spouse does not raise the limit.
Common reasons Texas Medicare Savings Program applications get denied
Texas applications are most often denied because countable income or resources are over the 2026 limits. A person with $1,850 per month in gross Social Security in 2026 is above the QI-1 line of $1,796 even after the $20 disregard, and a person with more than $9,950 in countable resources in 2026 is over the resource limit. Retirement accounts, savings, stocks and second properties can count, while the home you live in, one vehicle and household goods generally do not.
- Countable income is above the 2026 limit of 135% FPL ($1,796 per month for an individual or $2,435 for a couple)
- Countable resources exceed the 2026 limit of $9,950 (individual) or $14,910 (couple)
- Requested proof of income or bank balances was not returned by the deadline
- Not entitled to Medicare Part A or Part B-ID, or Medicare enrollment could not be verified
- QI-1 funding for the year ran out, since QI-1 is first come, first served
How to appeal a Texas Medicare Savings Program denial
Texas applicants who are denied or cut off can ask HHSC for a fair hearing by following the instructions and deadline on the written notice. Federal rules allow states to set a deadline of up to 90 days from the notice date, so act quickly. Before a hearing, call HHSC to ask whether a missing document or a reported income change can fix the decision. If the denial was for being slightly over the limit in 2026, you can reapply when your income or resources drop, since there is no waiting period.
Texas Medicare Savings Programs context: who runs them and how they relate to Medicare
Texas HHSC runs the Medicare Savings Programs under federal Medicaid rules, and Medicare.gov describes them as programs that help pay Medicare premiums, deductibles and coinsurance. Because the programs are Medicaid funded, the federal immigration limits for Medicaid that took effect October 1, 2026 apply, though Medicare entitlement already requires citizenship or lawful permanent residence. CMS has not yet published the 2027 resource limits, and Texas updates income limits each spring, so the 2026 figures here are current for now.
Frequently Asked Questions
What is the Texas Medicare Savings Program income limit for a family of 4 in 2026?
Texas Medicare Savings Programs have no family-of-4 limit in 2026. Texas HHSC sets limits only for an individual and a couple: QMB up to $1,330 or $1,804 per month, SLMB under $1,596 or $2,164, and QI-1 under $1,796 or $2,435. Children and other family members do not raise the limit. Only you and your spouse are counted.
What counts as income for Texas Medicare Savings Programs?
Texas counts gross monthly income such as Social Security, pensions, annuities, wages and interest, after a $20 general disregard. Texas MSP does not use MAGI (Modified Adjusted Gross Income). Some income, such as certain food and housing help, is excluded. For a married applicant, spouse income is counted in 2026. Compare the total with the HHSC limits to find your tier.
What documents do I need to apply for Texas Medicare Savings Programs?
Bring your Medicare card or Social Security award letter, proof of all income, bank and investment statements for you and your spouse, photo ID, proof of Texas residency, your Social Security number, and proof of citizenship or qualified immigration status. HHSC may ask for more, and returning requested proof by the notice deadline avoids a denial in 2026.
What happens if I am denied Texas Medicare Savings Programs?
You get a written notice with the reason and the deadline to request a fair hearing. Common causes in 2026 are income over $1,796 (individual) or $2,435 (couple) per month, resources over $9,950 or $14,910, or missing proof. You can appeal, fix the missing item, or reapply later when your income or resources change, because there is no waiting period.
Can I work and still get Texas Medicare Savings Programs?
Yes. Work income counts toward the limits, but Texas applies earned income disregards, so only part of wages is counted in 2026. A person who works can still fit QMB, SLMB or QI-1 if countable income stays under the limit for the tier. QDWI, a fourth tier, is designed for working people under 65 who lost premium-free Part A because of disability.
Is Texas a Medicaid expansion state, and does that matter for Medicare Savings Programs?
No, Texas has not adopted Medicaid expansion, so adults under 100% FPL fall into the ACA gap in 2026. It does not matter for Medicare Savings Programs. Federal law requires every state to run QMB, SLMB and QI-1, so Texas residents on Medicare can qualify using the limits in this page whether or not their state expanded Medicaid.
How long does the Texas Medicare Savings Program application take?
Federal rules give states up to 45 days to decide most applications, and Texas HHSC follows that standard. Applications finish faster when proof of income and bank balances is attached. If approved, QMB begins the month after approval, while SLMB and QI-1 can be retroactive up to 3 months in 2026. Applying early in a month does not change the start month.
What is the difference between Texas Medicare Savings Programs and full Medicaid?
Texas Medicare Savings Programs pay Medicare premiums and, for QMB, cost-sharing, while full Texas Medicaid for people on Medicare also covers services Medicare skips, such as long-term care. Full Medicaid has a stricter asset test. A person can have a Medicare Savings Program alone or together with full Medicaid as a dual-eligible beneficiary in 2026.
