Texas Medicare Savings Program 2026: QMB, SLMB and QI Limits

The Texas Medicare Savings Program pays your Medicare Part B premium — $202.90 a month in 2026 — and at the top level pays your deductibles and copays too. It is run by Texas Medicaid, not by Medicare, and roughly one in three people who qualify never apply. This Texas medicare savings program guide gives the 2026 limits as Texas applies them, the asset rule, how it triggers Part D Extra Help, and where to apply.

Limits below are from the National Council on Aging’s 2026 table built on the federal poverty guidelines, checked against Texas’s own rules; they reset each spring when the new guidelines take effect.

Texas Medicare Savings Program at a Glance (2026)

The Three Levels of the Texas Medicare Savings Program

• QMB (Qualified Medicare Beneficiary): pays the Part A and Part B premiums and the deductibles, coinsurance and copays. Providers who take Medicare may not bill a QMB enrollee for Medicare cost-sharing at all.
• SLMB (Specified Low-Income Medicare Beneficiary): pays the Part B premium only.
• QI (Qualifying Individual): also pays the Part B premium only, with a slightly higher income limit; funding is capped and first-come, first-served each year.

Texas labels: Texas uses the standard federal names and administers all of them through Medicaid for the Elderly and People with Disabilities (MEPD).. Whatever the name, one application covers all three; the office places you at the highest level you qualify for.

Texas Medicare Savings Program Income and Asset Limits

The federal floors for a single person in 2026 are $1,350 a month for QMB, $1,616 for SLMB and $1,816 for QI, each including a $20 disregard. Texas’s figures: Federal (QMB $1,350 / SLMB $1,616 / QI $1,816 single; $1,824 / $2,184 / $2,455 couple).

Assets: Federal ($9,950 single / $14,910 couple). The home, one vehicle, household goods and burial funds up to $1,500 do not count.

Texas follows the Supplemental Security Income counting rules used throughout MEPD. Gross Social Security, pensions, annuities, wages and similar money count, but a general income disregard and a further disregard for earned income are subtracted before HHSC compares your figure to the limit, so the published limits are not the whole picture. Income already counted in deciding another need-based benefit is excluded.

A spouse living with you does matter — part of that spouse’s income is deemed to you — though nothing is deemed from a spouse who receives SSI or TANF.

Texas draws a sharp line here, and it is the thing families most often get wrong. QMB is not retroactive: coverage begins the first day of the month after HHSC determines you eligible, so there is nothing to reimburse for earlier months. SLMB and QI-1, by contrast, can be approved for months before the application if you met every requirement in each of those months.

HHSC will even grant SLMB or QI-1 for prior months for someone who qualifies for QMB going forward. Ask specifically for prior coverage.

The QMB Billing Protection Most People Never Use

Federal law forbids any provider who accepts Medicare from billing a QMB enrollee for Medicare deductibles, coinsurance or copays. If a bill arrives, the enrollee does not owe it. Show the QMB card, cite the rule, and if it continues report it to 1-800-MEDICARE or the Texas SHIP. This one protection is worth more than the premium for anyone with regular hospital or specialist care.

Texas Medicare Savings Program and Part D Extra Help

You do not file a second application. Once HHSC approves QMB, SLMB or QI-1, that information is transmitted to the Social Security Administration, which then treats you as automatically eligible — the word used is “deemed” — for the Medicare Part D low-income subsidy, better known as Extra Help. Social Security mails a notice confirming it, and your Part D plan adjusts your drug costs accordingly.

If Extra Help has not appeared after a couple of months, call Social Security at 1-800-772-1213 rather than reapplying through HHSC.

Texas Prescription Help Beyond Medicare

Texas does not run a general state pharmaceutical assistance program for seniors; there is no Texas equivalent of the PACE-style senior drug plans some other states operate. — Texas runs its own drug-cost program for seniors alongside Extra Help. Ask The application goes to the Texas Health and Human Services Commission (HHSC), not to Medicare and not to Social Security. or the SHIP whether you qualify for both.

How to Apply for the Texas Medicare Savings Program

Where: The application goes to the Texas Health and Human Services Commission (HHSC), not to Medicare and not to Social Security. — application. Free help: The Texas State Health Insurance Assistance Program is called the Health Information, Counseling and Advocacy Program, or HICAP..

Bring the Medicare card, proof of all income, and — in states with an asset test — bank statements. A decision usually takes a few weeks; the Part B premium refund appears as a larger Social Security deposit once the change reaches Social Security.

Who Typically Qualifies for the Texas Medicare Savings Program

A widow living on one Social Security check. A retired couple whose combined income is modest once one pension stopped. A person under 65 on Medicare through disability. Anyone who receives Supplemental Security Income already qualifies at the top level. Homeowners qualify as easily as renters, because the home is never counted, and in the states without an asset test savings are not counted either.

The Texas Medicare Savings Program Calendar

New federal poverty guidelines are published in January or February; states adopt the new Texas medicare savings program limits in the weeks after, usually by March or April. A person who was just over the limit in December may be under it in April without their income changing. The Part B premium itself changes each January, so the value of the program rises with it. QI funding is allocated by calendar year and can run out; apply early rather than late.

If the Texas Medicare Savings Program Application Is Denied

The denial notice states the reason and the deadline to ask for a hearing. The three fixable reasons are missing proof of income, income counted that should have been excluded, and — in asset-test states — a burial fund or life insurance that should not have been counted. Fix the reason and reapply; nothing prevents a second application. The state SHIP will review a denial for free.

The Texas Medicare Savings Program Versus Full Medicaid

The program pays Medicare costs; it does not make you a Medicaid patient. You keep your doctors, your Medicare card and your plan. Full Medicaid, with its lower income limit, adds coverage Medicare does not have — long-term care above all. Many people qualify for the Texas medicare savings program first and for full Medicaid only later, when care needs and costs rise. The two applications go to the same office.

What to Do Next

If you qualify for a Texas medicare savings program, apply before you shop for plans: the premium help changes which Medigap or Advantage plan makes sense. Your SHIP counselor can do both in one visit.

Official Sources

• Texas Medicare Savings Programs
• The application goes to the Texas Health and Human Services Commission (HHSC), not to Medicare and not to Social Security.
• Medicaid.gov spousal impoverishment standards: medicaid.gov
• Medicare.gov Medicare Savings Programs: medicare.gov

This Texas medicare savings program guide was checked against the state Medicaid agency, CMS and the statute cited above in September 2026. Figures reset on their own calendars (most on January 1); if a number here disagrees with a notice you received, the notice wins — and please tell us. This page is general information, not legal, financial or medical advice.

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