Medicare in Texas follows the same federal eligibility rules as the rest of the country, but Texas also offers Medicare Savings Programs (MSPs) that can eliminate most or all of your out-of-pocket Medicare costs if you have limited income. Whether you are approaching 65, receiving Social Security Disability Insurance (SSDI), or looking for help paying Medicare premiums, this guide covers every eligibility path, the 2026 income limits, and exact steps to apply.
Who Qualifies for Medicare in Texas
Medicare has three main eligibility tracks: age, disability, and End-Stage Renal Disease (ESRD). You do not need to be a Texas resident for any specific number of years; you just need to meet the federal criteria and be a legal U.S. resident.
Age-Based Eligibility
You are eligible for Medicare at age 65 if you meet at least one of these:
- You are a U.S. citizen or have been a lawful permanent resident for at least 5 consecutive years
- You or your spouse worked and paid Medicare taxes for at least 10 years (40 quarters)
If you or your spouse have at least 40 quarters of Medicare-covered work, you pay no Part A premium. Texans with 30 to 39 quarters pay a reduced Part A premium of $311 per month in 2026. Those with fewer than 30 quarters pay the full $565 per month.
Disability-Based Eligibility (Under 65)
If you are under 65, you can qualify for Medicare after receiving SSDI benefits for 24 consecutive months. The 24-month waiting period starts from the date your SSDI payments begin, not from the date your disability started.
One exception: if you are diagnosed with Amyotrophic Lateral Sclerosis (ALS), Medicare begins the same month your SSDI benefits start, with no waiting period.
End-Stage Renal Disease (ESRD)
Texans of any age with ESRD (permanent kidney failure requiring dialysis or a transplant) can qualify for Medicare, regardless of age or work history, as long as they meet at least one of the following:
- You are entitled to Social Security or Railroad Retirement benefits
- You are the spouse or dependent child of someone eligible
Medicare coverage for ESRD generally begins on the first day of the fourth month of dialysis treatment. If you receive a kidney transplant, coverage can start the month you are admitted to the hospital for the procedure.
2026 Medicare Costs in Texas
Understanding what Medicare costs helps you evaluate whether you may need a Medicare Savings Program.
| Coverage | 2026 Amount |
|---|
| Part A premium (40+ quarters) | $0/month |
| Part A premium (30-39 quarters) | $311/month |
| Part A premium (under 30 quarters) | $565/month |
| Part A hospital deductible (per benefit period) | $1,736 |
| Part B standard premium | $202.90/month |
| Part B annual deductible | $283 |
Part B coinsurance is generally 20% of Medicare-approved costs after the deductible. These costs can add up quickly, which is why Texas Medicare Savings Programs matter so much for lower-income enrollees.
Texas Medicare Savings Programs 2026
Texas participates in four federally funded Medicare Savings Programs administered through Texas Health and Human Services (HHS). Each program covers different costs and has its own income limit.
2026 Income Limits by Program
| Program | Individual Income Limit | Couple Income Limit | What It Pays |
|---|
| QMB (Qualified Medicare Beneficiary) | ~$1,350/month | ~$1,824/month | Part A and B premiums, deductibles, and coinsurance |
| SLMB (Specified Low-Income Medicare Beneficiary) | ~$1,616/month | ~$2,184/month | Part B premium only |
| QI (Qualifying Individual) | ~$1,816/month | ~$2,455/month | Part B premium only (funded until slots run out) |
| QDWI (Qualified Disabled and Working Individual) | ~$1,997/month | ~$2,694/month | Part A premium only (for working disabled people under 65) |
These income figures reflect the federal minimums as of early 2026. Texas HHS may apply additional income disregards (including a standard $20 general income disregard), so your actual countable income may be lower than your gross income. Apply even if you think you might be slightly over the limit.
Resource Limits (Assets)
| Program | Individual | Couple |
|---|
| QMB, SLMB, QI | ~$9,660 | ~$14,470 |
| QDWI | $4,000 | $6,000 |
Resources that are typically not counted include your primary home, one vehicle, household furnishings, and burial funds up to a certain amount. Texas applies the federally established resource limits for MSPs; check with Texas HHS for the most current figures, as these are updated annually.
What QMB Covers
The Qualified Medicare Beneficiary program is the most comprehensive MSP. If you qualify, Medicaid pays your Part A and Part B premiums, deductibles, copayments, and coinsurance. Providers who accept Medicare are prohibited from billing QMB enrollees for cost-sharing. This can save eligible Texans more than $3,000 per year in out-of-pocket costs.
Medicare Part D (Prescription Drug Coverage)
Part D is optional coverage for prescription drugs offered through private insurance plans. In Texas for 2026, dozens of Part D plans are available. If you qualify for a Medicare Savings Program (QMB, SLMB, or QI), you also automatically qualify for the Extra Help program (also called the Low Income Subsidy), which can reduce Part D premiums and copays to near zero.
Key Part D facts for 2026:
- You must be enrolled in Part A and/or Part B to join a Part D plan
- Late enrollment penalties apply if you go without creditable drug coverage for 63 or more days after becoming eligible
- The annual out-of-pocket cap under the Inflation Reduction Act is $2,000 in 2026
Medicare Advantage (Part C) in Texas
Medicare Advantage plans bundle Part A, Part B, and usually Part D into one plan offered by private insurers. Texas has a large Medicare Advantage market, particularly in the Houston, Dallas-Fort Worth, San Antonio, and Austin metro areas. Many plans offer $0 or low monthly premiums, dental, vision, and hearing coverage not included in original Medicare.
To enroll in Medicare Advantage, you must:
- Be enrolled in Part A and Part B
- Live in the plan's service area
- Not have ESRD (with some exceptions after 2021 under the CHRONIC Care Act)
When to Enroll: Key Enrollment Periods
Missing an enrollment window can mean delayed coverage or permanent premium penalties.
| Enrollment Period | When It Applies | Coverage Start |
|---|
| Initial Enrollment Period (IEP) | 7-month window around your 65th birthday (3 months before, your birthday month, 3 months after) | Varies by when you enroll within IEP |
| Special Enrollment Period (SEP) | Leaving employer coverage after 65 | Within 8 months of losing coverage |
| General Enrollment Period (GEP) | Jan 1 to Mar 31 each year if you missed IEP | Coverage starts July 1 |
| Annual Enrollment Period (AEP) | Oct 15 to Dec 7 each year | Jan 1 of the next year |
If you or your spouse are still working at 65 and covered by an employer health plan with 20 or more employees, you can delay Part B without penalty and enroll during a Special Enrollment Period when that coverage ends.
How to Apply for Medicare in Texas: Step-by-Step
Step 1: Check Your Eligibility
Confirm you meet age (65+), disability (SSDI for 24 months), or ESRD criteria. Use the Benefits Navigator screener to check which programs you may qualify for based on your situation.
Step 2: Gather Documents
You will need:
- Social Security number
- Proof of U.S. citizenship or lawful permanent residence
- Work history records if you are buying into Part A
- If applying due to disability: your SSDI award letter
- If applying due to ESRD: documentation of dialysis or transplant
Step 3: Apply for Medicare
You can apply for Medicare through three channels:
Online: Visit SSA.gov and complete the Medicare application. The online process takes about 10 minutes for most applicants.
By phone: Call Social Security at 1-800-772-1213 (TTY: 1-800-325-0778), Monday through Friday, 8 a.m. to 7 p.m.
In person: Visit your local Social Security Administration office. Find locations at SSA.gov/locator. Bring original documents or certified copies.
If you already receive Social Security retirement benefits, you will be enrolled in Medicare Parts A and B automatically at 65 and will receive your Medicare card by mail.
Step 4: Apply for a Medicare Savings Program (If Eligible)
Applying for an MSP is separate from enrolling in Medicare. You apply through Texas Health and Human Services.
Online: Apply at YourTexasBenefits.com. Create an account, then complete the benefits application and include Medicare-related costs.
By phone: Call 2-1-1 (Texas's statewide help line) or 1-800-252-9240 (Texas HICAP Medicare counseling line).
In person: Visit your local Texas HHS office. Find locations at HHS.Texas.gov.
You will need to provide:
- Proof of Medicare enrollment (Medicare card or award letter)
- Proof of income (Social Security award letter, pay stubs, pension statements)
- Bank statements and asset documentation
- Proof of Texas residency
Step 5: Enroll in Part D and Review Plan Options
Each fall during the Annual Enrollment Period (October 15 to December 7), compare Part D and Medicare Advantage plans at Medicare.gov/plan-compare. Enter your ZIP code, current medications, and preferred pharmacies to see personalized cost estimates.
Step 6: Get Free Medicare Counseling Through HICAP
Texas's State Health Insurance Assistance Program (SHIP) is called HICAP (Health Information, Counseling and Advocacy Program). HICAP counselors are trained volunteers with no financial interest in what you choose. Services are free.
Call 1-800-252-9240 or visit the Texas SHIP locator at shiphelp.org to find a local counselor. You can also reach your nearest Area Agency on Aging through the Texas HHS website.
Special Situations for Texas Residents
If You Are Still Working at 65
If you or your spouse are covered by an employer group health plan with 20 or more employees, your employer plan pays first and Medicare pays second. You can delay Part B enrollment without penalty. Once coverage ends, you have an 8-month Special Enrollment Period to join Part B.
If You Have Low Income and No Medicare Work Credits
If you do not have enough work history to qualify for premium-free Part A, and your income is low, you may still qualify for the QDWI program (if you have a qualifying disability and are working) or for Medicaid through Texas HHS. Medicaid can sometimes cover hospital and medical services for very low-income Texans who do not yet qualify for Medicare. Visit benefitsusa.org/states/tx to see all Texas programs you may qualify for.
Veterans in Texas
Texas has a large veteran population. Veterans with VA health benefits can use both VA and Medicare, but the programs do not coordinate benefits. VA coverage pays for care at VA facilities; Medicare covers care at non-VA providers. Enrolling in Medicare Advantage while using VA benefits requires care to avoid conflicts with which plan covers what.
Frequently Asked Questions
What is the income limit to qualify for Medicare in Texas?
Medicare itself has no income limit. Anyone who meets the age (65+), disability (SSDI after 24 months), or ESRD criteria can enroll regardless of income. Income limits apply only to the Texas Medicare Savings Programs that help pay your Medicare costs.
Does Texas have a Medicare Savings Program that covers Part A and Part B?
Yes. The Qualified Medicare Beneficiary (QMB) program covers both Part A and Part B premiums, deductibles, and coinsurance for individuals with income up to approximately $1,350 per month (single) or $1,824 per month (couple) in 2026.
Can I apply for Medicare and a Medicare Savings Program at the same time?
You apply for Medicare through Social Security and apply for a Medicare Savings Program separately through Texas HHS (YourTexasBenefits.com or 2-1-1). You should apply for both as soon as you are eligible to avoid gaps in coverage.
What is the Part B premium in Texas for 2026?
The standard Part B premium is $202.90 per month in 2026. If your income from two years prior (2024) exceeded certain thresholds, you may pay an Income-Related Monthly Adjustment Amount (IRMAA) surcharge on top of the standard premium.
How long does it take to get Medicare coverage after I apply?
If you enroll during the first three months of your Initial Enrollment Period (the three months before your 65th birthday), coverage starts the first day of your birthday month. If you enroll during your birthday month or the three months after, there is a delay of one to three months before coverage begins.
What if I miss my Medicare enrollment window?
If you miss your Initial Enrollment Period and do not have a qualifying exception (like active employer coverage), you must wait for the General Enrollment Period (January 1 to March 31) and pay a permanent late enrollment penalty: 10% added to your Part B premium for each full 12-month period you were eligible but not enrolled.
Is Extra Help for Part D the same as the Medicare Savings Program?
They are related but separate. Qualifying for QMB, SLMB, or QI automatically qualifies you for Extra Help (the Low Income Subsidy for Part D). Extra Help significantly reduces Part D plan premiums and drug copays. You can also apply directly for Extra Help through Social Security even if you do not qualify for an MSP.
Where can I get free Medicare help in Texas?
Call the Texas HICAP line at 1-800-252-9240. HICAP provides free, unbiased Medicare counseling through trained volunteers across Texas. You can also call 2-1-1 or use the Benefits Navigator screener at benefitsusa.org/screener to see which programs you may qualify for.
