Help with Medicare Costs in Texas for Low-Income Seniors

A Texas senior living on $1,300 a month from Social Security loses $202.90 of that to the Medicare Part B premium before paying for food, housing, or anything else. Add drug copays, a hospital deductible of $1,736, and doctor visit coinsurance, and Medicare itself becomes one of the biggest costs of being on Medicare.

Texas has programs that eliminate some or all of these costs. They're not easy to find or navigate, but they exist and they're funded.

The Three Medicare Savings Programs

Texas administers three MSP tiers through the Health and Human Services Commission (HHSC). Each tier covers different costs and has its own income threshold:

QMB (Qualified Medicare Beneficiary) — for individuals earning up to about $1,350/month gross. Covers:

• Part B monthly premium ($202.90)
• Part A hospital deductible ($1,736 per benefit period)
• Part B annual deductible ($283)
• All Medicare coinsurance and copays
• Part A monthly premium ($508) if your parent doesn't have premium-free Part A

SLMB (Specified Low-Income Medicare Beneficiary) — for individuals earning roughly $1,350–$1,616/month gross. Covers:

• Part B monthly premium only

QI (Qualifying Individual) — for individuals earning roughly $1,616–$1,816/month gross. Covers:

• Part B monthly premium only (funded by a federal block grant, first-come first-served)

All three tiers share the same resource limits: $9,950 for individuals, $14,910 for couples. Resources don't include the family home, one vehicle, burial plots, or designated burial funds (up to $1,500 each for the applicant and spouse, reduced by any excluded life-insurance face value).

Extra Help with Prescriptions

Every person approved for any Texas MSP tier automatically qualifies for full Extra Help — the Part D Low-Income Subsidy. No separate application needed. CMS receives the MSP certification from HHSC and activates the benefit.

Full Extra Help eliminates the Part D deductible (up to $590/year without it), reduces generic copays to roughly $1.55–$4.90, caps brand-name copays around $4.80–$12.15, and eliminates the coverage gap.

Even if your parent doesn't qualify for an MSP, they may qualify for Extra Help directly through SSA. Income limits for Extra Help are separate (up to 150% FPL) and slightly more generous.

How the Programs Stack

These programs layer on top of each other:

The combined savings for a QMB recipient with Extra Help can reach $6,000 or more per year — the Part B premium alone is $2,434.80 annually.

The 2026 Part D Out-of-Pocket Cap

Under the Inflation Reduction Act, all Medicare Part D enrollees — regardless of income — benefit from a $2,100 annual out-of-pocket cap on drug costs starting in 2026. This helps every senior, but it's especially valuable for those who don't qualify for Extra Help. Seniors with Extra Help already pay minimal copays and won't reach the cap.

How to Apply

Applications go through HHSC using Form H1200-EZ (the streamlined application for MSPs) via YourTexasBenefits.com, the mobile app, 2-1-1 by phone, or by mail. You'll need your parent's Medicare card, Social Security benefit statement, one month of bank statements, and a Texas ID.

HHSC evaluates the application against all MSP tiers. If your parent's income exceeds QMB limits, the caseworker checks for SLMB, then QI. Your parent doesn't need to apply separately for each tier.

The Texas Medicare Savings Programs & Extra Help Guide walks through the full cost-reduction stack — MSPs plus Extra Help plus the Part D cap — with income worksheets and a document checklist that covers every program in one application cycle.

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