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While Medicare and Medicaid are separate programs, you may be eligible for both. This could help you save on premiums, out-of-pocket costs, and/or long-term care.
Medicare is a United States federal health insurance program. It is designed to provide and reduce the cost of healthcare services for eligible beneficiaries in Texas and across the United States.
Texans have both public (Original Medicare) and private Medicare plan options. Original Medicare includes Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). Original Medicare does not cover 100% of costs, and most people have a private health plan such as Medicare Part C, Medicare Part D, or Medicare Supplement.
Medicare Part C (Medicare Advantage), Medicare Part D (Prescription Drug Coverage), and Medicare Supplement (Medigap) are your private health plan options. These are approved by the Centers for Medicare and Medicaid Services (CMS).
Learn more about your public and private Medicare plan options in Medicare Plans in Texas: Options & Important Deadlines.
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Local, licensed insurance agents with 25+ years of experienceIf you’re a Texan and meet the following criteria, you are eligible for Medicare in Texas.
If you meet the above criteria, you can apply for Medicare in Texas. Now, you’ll want to learn more about your public and private Medicare plan options—and choose a plan that meets your health and budget needs.
Not sure where to begin? Have a local Medicare agent guide you through your Medicare options. A local Connie Health agent can help you find the optimal plan. Call to speak with a local licensed agent (623) 223-8884 (TTY 711) or find your plan online.
Agent tip:
“Medicare does not typically cover assisted living or long-term care. You will still need Medicare to cover doctor services and hospital care even if you move to an assisted living or nursing home care facility. Family members may pay out-of-pocket to cover the costs or get long-term care insurance to pay for the cost of assisted living or nursing home care.“
Medicaid is a nationwide program funded by the federal government and administered and managed by states within federal guidelines. Medicaid improves the health of Texans who might otherwise go without health care. This includes those with low income or disabilities.
Although the program helps a wide range of Texans, we’re focusing on Medicaid’s help to Texans aged 65 and over, especially those with long-term care needs.
In Texas, Medicaid is administered by the Texas Health and Human Services Commission (HHSC). Most Medicaid plans in Texas are provided by Managed Care Organizations (MCO). Texas-managed Medicaid for those 65 and older and the disabled are often referred to as STAR+PLUS. When you have a STAR+PLUS plan, you receive Medicaid health care services such as doctor visits and long-term services and support for:
With STAR+PLUS, you get to choose your health plan, and many come with “value-added” or extra services such as dental, vision, hearing, and prescription bonuses. You can use the STAR+PLUS Comparison Charts to find the STAR+PLUS health plans offered in your county or service area.
Or you can reach out to a local Medicare agent who can support you through your Medicare and Medicaid journey. Call (623) 223-8884 to speak to a local licensed agent in your community. Or find your plan online.
Free, unbiased serviceCompare all major plans and carriers Local, licensed insurance agents with 25+ years of experienceTo be eligible for Medicaid in Texas, you must:
If you’re eligible for both Medicare and Medicaid, you’re likely to be what’s called “Dual-Eligible.”
Medicaid eligibility is tied to income and financial resource levels. Unlike Medicare, with Medicaid, you must recertify with Texas yearly to ensure you continue to qualify.
To be eligible for Medicaid, you must meet income requirements. Texas will count some of your income but not all of it. Your income includes regular benefit payments from Social Security retirement or disability payment, veterans benefits, you or your spouse’s pension, salaries or wages, and interest from CDs (Certificates of Deposit), bank accounts, or dividends from investments.
Things that are not counted as income include nutritional assistance from programs such as food stamps, housing assistance provided by the federal government, home energy assistance, and potentially some of your earnings from earned work that you perform.
When applying for Medicaid, financial assets include cash, stocks, bonds, investments, savings and checking accounts, and real estate that is not your primary residence.
Many assets are considered exempt and not countable for your eligibility. These items include your personal belongings, household furnishings, one car, irrevocable burial trusts, and your primary place of residence.
If you receive or are eligible for Medicare but cannot pay for your premiums, co-pays, or deductibles, you should read more about Medicare Savings Programs in Texas. Four Medicare Savings Programs could help you pay for Medicare Part A and/or Part B deductibles, coinsurance, and copayments.
There are three buckets of Medicaid long-term care programs that you or your loved one may be eligible for:
Each program bucket has slightly different eligibility requirements and benefits. Continue reading and review “[Tables] 2022 Texas Medicaid Income & Asset Limits for Long Term Care” for income and financial asset eligibility, plus the program’s coverage.
In Texas, some programs are entitlements, while others have limited enrollment. For example, nursing home care and regular Medicaid are entitlement programs available to you if you’re eligible.
However, Medicaid Waivers and Home Community-Based Services are available to a limited number of participants. These programs are not guaranteed. Read more about the three buckets below and long-term care programs in Texas.
Not sure which Medicaid program you should be applying for? Speak with a local Medicare agent by calling (623) 223-8884. You can also search for plans online.
An adult daycare program that facilitates care for up to 10 hours per day, Monday through Friday—during regular business hours. This helps you or your loved one receive care outside of a nursing home. Services may address physical, mental, medical, and social needs.
A limited enrollment managed care program that covers assisted living, adult foster care, and in-home support to help you stay in your home and avoid going to a nursing home. Sometimes Medicaid will pay for home care locations if it can be obtained at a lower cost than a nursing home. This is achieved through a Medicaid Waiver, also referred to as Home and Community-based Services (HCS) Waivers or Waiver Funded Services.
Provides help with daily living activities and health-related tasks. One of the main goals is to create continuity of services and support while helping you or a loved one learn to care for themself. It supports the caregiver with training on how to select, manage, and dismiss healthcare attendants.
Another program that provides personal care in the home. This program is also a non-skilled, nontechnical service provided to those eligible—who are functionally limited in their ability to perform daily activities. PHC provider agencies also provide Family Care (FC) services. This program, like Community First Choice, allows you to choose your caregivers. You may be able to select family members as your hired caregiver.
Provides non-medical personal care assistance, homemaker services, and transportation assistance to/from medical appointments. This non-technical, medically related personal care service is eligible to adults whose health problems cause them to be limited in performing daily living activities according to their doctor’s statement of medical need.
Are you single, married with both spouses applying for Medicaid, or married with one spouse applying? Review the tables that apply to you to learn about the maximum income and financial assets and the level of care for each of the three categories of Medicaid services in Texas.
Medicaid benefits could help you pay for your Part A and/or B premiums, copays, and deductibles. It could also help you or a loved one afford additional care, like long-term care. Gather benefit information, and ensure that you meet all of the eligibility requirements for the program you’re interested in applying for.
If your income or assets are over the limits or you’re unsure if you meet the eligibility criteria, a local Medicare agent can help. A local agent can guide you through your Medicaid eligibility and application options. They’ll help you understand your options and the optimal dual-eligible plan for your health and budget—if you’re eligible.
Want to apply for Medicaid on your own?
Receive help applying for Medicare and/or Medicaid. Be confident that you’re on the optimal plan for your health needs and budget. Call (623) 223-8884 or find your plan online.
Medicaid & CHIP Programs & Services.
Texas Medicaid Income & Asset Limits for Nursing Homes & In-Home Long Term Care.
Texas Medicaid STAR+PLUS Home and Community-Based Services Program.
Last update: February 10, 2023
To apply for Medicaid in Texas, complete an “Application for Benefits: Texas Health and Human Services Commission.” This is a link to the PDF version that you can complete and then physically mail or fax. Or you can apply for benefits online through “Your Texas Benefits.”
To be eligible for Medicaid in Texas, you must:
If you’re eligible for both Medicare and Medicaid, you’re likely to be what’s called “Dual-Eligible.”
Medicaid eligibility is tied to income and financial resource levels. Unlike Medicare, with Medicaid, you must recertify with Texas yearly to ensure you continue to qualify.
Read more by Richard Torres
I am a Spanish-speaking Texas Life and Health Insurance Licensed Agent and have been helping people with Medicare since 2016. I am a U.S. Army Veteran and served under Operation Enduring Freedom. I enjoy spending time with my family and coaching youth soccer and basketball.
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