Medicare Savings Programs in Texas: QMB, SLMB, QI, QDWI

Medicare Savings Programs in Texas help people with limited income and resources pay Medicare premiums, and for some people, deductibles and coinsurance too. Texas Health and Human Services Commission (HHSC) runs four of them through Medicaid: QMB, SLMB, QI, and QDWI. If you qualify for QMB, SLMB, or QI, you also get Extra Help with Part D drug costs without filing a separate application. This guide covers what each program pays, who qualifies, how to apply, and what changes once you're approved.

Key takeaways

• Texas has four Medicare Savings Programs (MSPs), not three: Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), Qualifying Individual (QI), and Qualified Disabled and Working Individual (QDWI).
• Income limits are set as a percent of the federal poverty level (FPL). The dollar figures change every year, so check HHSC's Appendix IX and Medicare.gov.
• Medicare.gov says to apply even if you think your income or resources are over the limit.
• You apply with HHSC on Form H1200-EZ. Applying for Extra Help through Social Security also starts an MSP application.
• With QMB, Medicare providers may not bill you for Medicare-covered deductibles, coinsurance, or copayments. That holds in Medicare Advantage plans too.

What are the Medicare Savings Programs in Texas?

Some websites say Texas has three MSPs. The HHSC handbook lists four. Here's how they compare.

Part B-ID is Medicare's immunosuppressive drug coverage for people who lost Medicare after a kidney transplant.

If you're approved for QMB, the state sends you a special ID card. Show it to your providers.

Who qualifies for a Medicare Savings Program in Texas?

In general terms, you need Medicare coverage, income within the program's FPL range, and countable resources under the limit. Your state decides which program you qualify for.

Medicare coverage

Under federal rules, SLMB and QI require both Part A and Part B. There are exceptions in Texas:

• Part B only. The state may find someone with only Part B eligible for QMB. See the special cases section below.
• Part B-ID only. People who have only Part B-ID can qualify for QMB, SLMB, or QI-1 without Part A. The help covers only Part B-ID costs.

Income and resources

Income limits are tied to the federal poverty level, which changes every year. Resource limits for QMB, SLMB, and QI are updated each year based on the Consumer Price Index. The Texas resource table says they change each January.

This guide doesn't print dollar figures because they go out of date. Look them up in HHSC handbook Appendix IX and on Medicare.gov's Medicare Savings Programs page.

Rules that don't apply

Texas doesn't apply transfer-of-assets, spousal impoverishment, or co-payment rules to its MSPs.

Why do Texas limits look different from Medicare.gov?

You may see one set of numbers on an HHSC page and a different set on Medicare.gov. There are a few reasons:

• The income disregard. The Texas handbook says its income limits don't include the general income disregard, a small amount of income that isn't counted. Medicare.gov's federal figures are presented differently.
• Yearly updates. Limits go up each year, and pages are updated at different times.
• Old pages. HHSC's consumer Medicare page has shown older limits. The current Texas figures are in handbook Appendix IX, Revision 26-2, which is effective for 2026.

Look at both official pages instead of comparing numbers on third-party sites. Medicare.gov also says you may qualify even if your income or resources are above the federal limits, and that you should apply even if you don't think you qualify.

What income and resources does Texas count?

Income Texas counts

• Social Security, railroad retirement, and state or local retirement
• Pensions and veterans benefits
• Interest and dividends
• Wages
• Royalties and rent
• Gifts
• The value of shelter that someone else pays for

Resources Texas counts

• Bank accounts and CDs
• Real property
• Life insurance and burial funds
• IRAs, stocks, and bonds
• Mineral rights
• Jewelry and antiques
• Vehicles, boats, and RVs

Resources Texas excludes

• The homestead you live in
• One car
• Burial spaces
• Life insurance with a small face value, up to a fixed limit in Appendix IX
• Separately identifiable burial funds, up to that same fixed limit, reduced by any excluded life insurance or irrevocable burial arrangement

Those last two limits are set rules, not amounts that change every year. Appendix IX lists them.

How do you apply for a Medicare Savings Program in Texas?

1. Get the right form. Form H1200-EZ (Application for Assistance – Aged and Disabled) is HHSC's form for Medicare Savings Programs. Form H1200 is the full application for all elderly and disability Medicaid programs.
2. Gather documents. CMS's model application lists what states may ask for: proof of income, proof of assets such as bank statements and life insurance policies, proof of Medicare, proof of where you live, and, if you're not a citizen, proof of eligible immigration status.
3. Submit and ask for a receipt. If you ask, HHSC will give you Form H1800 showing that you applied. Keep it.
4. Wait for the decision. CMS's model application says to expect a decision within 45 days.
5. Read your eligibility notice. It comes by mail and explains the decision and your appeal rights.

Starting through Social Security instead

Since 2010, federal law has required states to treat Extra Help application data from Social Security as an MSP application. The date you filed with Social Security counts as your MSP application date. So when you apply for Extra Help, HHSC also gets an MSP application for you.

You can apply for Extra Help on Form SSA-1020, online, or by phone at 1-800-772-1213 (TTY 1-800-325-0778).

When does coverage start, and is it retroactive?

Start dates in Texas depend on the program.

For example, if you file your QI-1 application in February, coverage can reach back to January but not into December of the year before. If you filed in December, the look-back can include earlier months of that year.

What happens to your Social Security check?

Once the state starts paying your premium, Social Security stops taking the Medicare premium out of your check. CMS calls this "state buy-in." Your monthly payment goes up.

You also get a refund for any premiums deducted for months covered by buy-in. That includes late-enrollment penalties. For premiums the state pays through its buy-in agreement, you're treated as if you enrolled on time.

How does Extra Help work with an MSP?

If you qualify for QMB, SLMB, or QI, you automatically get Extra Help with Part D drug costs. You don't need to apply to Social Security separately. Medicare.gov shows the current per-drug copay cap for 2026 on its Medicare Savings Programs page.

Applying for Extra Help doesn't enroll you in a drug plan, and Extra Help works only once you're enrolled in one. A HICAP counselor can explain Part D coverage and help you compare drug plans (Texas Medicare Help Line, 800-252-9240). Our guide on how to compare Medicare Part D plans walks through choosing one.

Can a doctor or hospital bill you if you have QMB?

No, not for Medicare-covered deductibles, coinsurance, or copayments. Medicare providers may not bill QMB enrollees for those. A small Medicaid copayment may apply.

These protections apply in Medicare Advantage plans too, not only Original Medicare. Show both your Medicare card and your Medicaid or QMB card every time you get care. With Original Medicare, your Medicare Summary Notice also shows your QMB status.

What to do if you get a bill anyway

1. Tell the provider you're in QMB. Show your cards again.
2. Ask for a refund. You have a right to a refund of anything you already paid.
3. Call 1-800-MEDICARE if bills keep coming. Medicare can confirm your QMB status and ask the provider to stop billing you and refund you.
4. Contact your plan if you're in Medicare Advantage. CMS says to ask the plan to stop the charges.
5. Report debt collectors. If a collector keeps calling, you can file a complaint with the Consumer Financial Protection Bureau (CFPB).

Do you have to reapply every year?

QI

Yes. Under federal rules, QI enrollees must reapply every year. States approve QI on a first-come, first-served basis, with priority for people who had QI the year before.

QI depends on funding. States enroll QIs only as far as their yearly federal allotment allows. The federal government fully funds QI Part B premiums.

Other programs and Extra Help

Read any mail from HHSC about your case, and respond if it asks you for something. Social Security also reviews Extra Help eligibility from time to time using Form SSA-1026B.

If state buy-in ends

Your Medicare stays in place, and you take over paying the premium. If the state paid your premium under its buy-in agreement, you owe the standard base premium even if you had a late penalty before. This doesn't apply to QDWI. The state pays QDWI Part A premiums a different way, so a Part A late penalty can come back when that help ends. Ask Social Security or HICAP what you'll owe.

Social Security may take up to three months of Part B premiums at once. If that's a hardship, it offers a waiver (Form SSA-632-BK) or an installment plan.

Special cases

How Texas counts income and resources for married couples

Texas uses the couple limit when both spouses apply for the same program. If they aren't both eligible, it tests each spouse separately against the individual limit. Part of a spouse's income may be counted for the applicant.

People under 65 with disabilities

QDWI is for people under 65 who have a disability, are working, and lost premium-free Part A because they returned to work. They must be entitled to enroll in Part A and not be getting Medicaid. Income must be no more than 200% of FPL. It pays only the Part A premium.

No premium-free Part A

CMS lists Texas as a "Part A buy-in" state. People found eligible for QMB there can enroll in premium Part A at any time of year without late penalties. This matters if you have Part B but don't get premium-free Part A.

Kidney transplant patients with Part B-ID only

You can qualify for QMB, SLMB, or QI-1 without Part A. The help is limited to Part B-ID costs.

SSI recipients

Since October 1, 2024, federal rules have required states to automatically enroll most people who get SSI-based Medicaid and premium-free Part A in QMB. In Texas, QMB status is added to SSI Medicaid automatically, starting the month after the Social Security data match.

How do MSPs work with Medicare Advantage and Medigap?

An MSP helps with Medicare costs. It doesn't replace your Medicare coverage. QMB billing protections apply whether you have Original Medicare or a Medicare Advantage plan.

If you have a Medigap policy or a Medicare Advantage plan and get approved for an MSP, talk with a HICAP counselor about how the pieces fit before you make any change. A licensed agent can then help you compare plans if you decide to make a change. Our guide to Medicare Advantage vs. Medigap explains how the two differ.

What if you're denied?

Your eligibility notice explains how to appeal and the deadline. Check the HHSC notice itself for Texas deadlines. A friend, relative, or lawyer can request the appeal for you or take part in it.

If your income or resources change later, you can apply again. Medicare.gov's advice to apply even if you're not sure you qualify still holds.

Where can you get free help in Texas?

• HICAP. The Texas Health Information, Counseling and Advocacy Program is Texas's free SHIP, a partnership of HHSC, Texas Legal Services Center, and the Area Agencies on Aging. Call the Texas Medicare Help Line at 800-252-9240. Counselors help with MSPs, Extra Help, Medigap, Medicare Advantage, and Part D.
• Medicare. Call 1-800-MEDICARE for QMB status and billing problems.
• Social Security. Call 1-800-772-1213 (TTY 1-800-325-0778) about Extra Help and premium deductions.

For a wider look at the state's Medicare rules, see Medicare in Texas: a plain-English guide.

What to do next

1. Look up current limits in HHSC Appendix IX and on Medicare.gov.
2. Gather proof of income, assets, Medicare, and where you live.
3. Apply on Form H1200-EZ, or apply for Extra Help through Social Security.
4. Ask for your Form H1800 receipt and watch your mail for the notice.
5. Call a HICAP counselor (Texas Medicare Help Line, 800-252-9240) to learn about Part D coverage and compare drug plans, since Extra Help works only once you're enrolled in one.

If you'd like an agent's help comparing drug or health plans, MeetBrokers is free to use. Every listed agent holds a state license that anyone can verify by National Producer Number. Profiles marked "unclaimed" come from public licensing records. Browse licensed Medicare agents in Texas, and read how to choose a Medicare agent first.

When you're ready, you can request help from a Texas Medicare agent you choose. Your request goes only to that agent. MeetBrokers is not connected with or endorsed by the U.S. government or the federal Medicare program.