Can You Have Both Medicare and Medicaid in Texas?

Yes, you can have both Medicare and Medicaid in Texas at the same time, and roughly 1.2 million Texans already do.¹ Holding both programs is called “dual eligibility,” and it matters because Medicaid picks up the costs Medicare leaves behind: monthly premiums, deductibles, copays, and the long-term care Medicare barely touches. To get there, you have to independently qualify for each program, and Texas Medicaid’s income thresholds are tighter than most people expect.

Qualifying for Medicare

Medicare eligibility is set federally and doesn’t change from state to state.² You qualify if you fall into one of these groups:

Age 65 or older with enough work history to qualify for Social Security or Railroad Retirement benefits.
Under 65 with a disability, after receiving Social Security Disability benefits for 24 months.
Any age with ALS (Lou Gehrig’s disease), with no waiting period.
Any age with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant).

Qualifying for Texas Medicaid

Texas Medicaid adds its own rules on top of Medicare. You must be a U.S. citizen or qualified noncitizen and a Texas resident.³ And you have to fall within income and resource limits that vary depending on whether you need coverage at home or in a nursing facility.

Community Medicaid (Living at Home)

For 2026, the monthly income limit for community Medicaid is $994 for a single person and $1,491 for a married couple when both spouses are applying. Resources are capped at $2,000 for an individual and $3,000 for a couple. Bank accounts, investments, and most property count toward the resource limit, but your primary home and one vehicle are typically excluded.⁴⁵

Nursing Home Medicaid

If you need nursing facility care, the income limit is much higher: $2,982 per month for a single person in 2026, which equals 300 percent of the SSI federal benefit rate. The resource limit stays at $2,000.⁶ Even at that higher threshold, the cap catches many retirees off guard. A monthly Social Security check of $3,100 would technically disqualify you, even though it’s nowhere near enough to pay a nursing home bill that commonly runs $6,000 to $9,000 per month.

The Miller Trust Fix

Texas solves the income gap with a Qualified Income Trust, often called a Miller Trust. If your income exceeds the nursing home cap, you deposit part or all of your monthly income into an irrevocable trust. Because the money passes through the trust rather than going directly to you, it doesn’t count toward Medicaid eligibility. The trust must name the State of Texas as the residuary beneficiary, meaning anything left in it when you die goes back to the state up to the amount Medicaid spent on your care.⁷ Setting one up correctly matters. A trust that doesn’t meet the technical requirements won’t save your eligibility, so an attorney experienced in Medicaid planning is worth the cost.

Full vs. Partial Dual Eligibility

Not every dual eligible receives the same benefits. Texas recognizes two categories, and the difference is significant.¹

Full dual eligibility means you qualify for the complete package of Texas Medicaid benefits on top of Medicare. That includes long-term care, personal attendant services, dental, vision, and non-emergency transportation. Medicaid also pays your Medicare premiums, deductibles, and copays. This is the version most people picture.

Partial dual eligibility means you qualify only for a Medicare Savings Program, which helps pay some or all of your Medicare costs but does not give you full Medicaid benefits. You won’t get Medicaid long-term care or extras like dental. The income limits for partial eligibility are higher than for full Medicaid, so many Texans who earn too much for full Medicaid can still get help paying Medicare premiums.⁸

Medicare Savings Programs in Texas

Medicare Savings Programs (MSPs) are the most overlooked benefit available to lower-income Medicare beneficiaries in Texas. The standard Part B premium alone is $202.90 per month in 2026, and MSPs can wipe that cost out.⁹ Texas offers three tiers with progressively higher income limits:¹⁰

Qualified Medicare Beneficiary (QMB) covers Part A premiums, Part B premiums, deductibles, copayments, and coinsurance. Monthly income limit: $1,305 individual, $1,763 couple. Resource limit: $9,950 individual, $14,910 couple.
Specified Low-Income Medicare Beneficiary (SLMB) covers only the Part B premium. Income range: $1,305.01 to just under $1,565 individual, $1,763.01 to just under $2,115 couple. Same resource limits as QMB.
Qualifying Individual (QI) also covers only the Part B premium. Income range: $1,565 to just under $1,761 individual, $2,115 to just under $2,380 couple. You cannot have any other Medicaid coverage and be enrolled in QI.

Texas applies a $20 monthly general income disregard on top of these posted limits, effectively raising the cutoff slightly. QMB is the most valuable tier: if you qualify, Medicare providers cannot bill you for copays or deductibles at all.¹¹ Many Texans who would qualify never apply because they don’t realize these programs exist separately from full Medicaid.

How the Two Programs Work Together

When you have both Medicare and Medicaid, Medicare always pays first. It covers hospital stays, doctor visits, lab work, and other services up to its limits. Medicaid then steps in as the secondary payer and picks up what Medicare leaves behind.¹²

For fully dual-eligible Texans, the wraparound coverage is comprehensive. Medicaid pays your monthly Part B premium and, if applicable, your Part A premium. It covers the Part A hospital deductible, daily coinsurance for extended hospital stays, and the 20 percent coinsurance Part B charges after your deductible. In practice, out-of-pocket cost for most Medicare-covered services drops to zero.¹¹

Prescriptions work similarly. Medicare Part D handles most medications, and dual-eligible beneficiaries automatically qualify for the Low Income Subsidy (“Extra Help”), which pays Part D premiums, deductibles, and most copays. If a drug isn’t on your Part D plan’s formulary, Texas Medicaid may cover it separately.

Most dual-eligible Texans receive their Medicaid benefits through STAR+PLUS, the state’s managed care program, which coordinates medical services and long-term care supports under one plan. Dual Eligible Special Needs Plans (D-SNPs) are a separate option: Medicare Advantage plans designed specifically for people with both programs, bundling Parts A, B, and D with Medicaid cost-sharing in a single plan.¹³

Long-Term Care: The Biggest Reason to Pursue Dual Eligibility

Medicare covers very limited skilled nursing care, up to 100 days in a facility after a qualifying hospital stay, with coinsurance kicking in after day 20. It does not cover custodial care, the day-to-day help with bathing, dressing, eating, and moving around that most people actually need as they age.

Texas Medicaid fills that gap:

Nursing facility care provides full coverage of long-term nursing home stays for those who meet medical and financial eligibility.
Community Based Alternatives (CBA) is a waiver program that provides nursing-home-level care in your own home or an assisted living facility, including personal attendant services, home modifications like wheelchair ramps and grab bars, and adaptive aids.
Community Attendant Services (CAS) provides help with daily living activities for people whose health conditions limit their ability to care for themselves at home.

Home-based care is almost always cheaper than a nursing home, and most people prefer staying home. Demand for the waiver programs regularly exceeds capacity, so waitlists are common.¹⁴

How to Apply

If you already have Medicare and believe you meet the income and resource thresholds, applying for Medicaid is a separate process through the Texas Health and Human Services Commission (HHSC). Have the following ready:

Social Security numbers, dates of birth, and proof of identity for all household members.
Proof of citizenship or qualified noncitizen status, such as a birth certificate, U.S. passport, or naturalization certificate.
Income records: recent pay stubs, tax returns, Social Security benefit statements, and pension or annuity statements.
Resource documentation: bank statements, property deeds, vehicle titles, and life insurance policies.
Your Medicare card showing your Medicare number and the parts you’re enrolled in.
Proof of Texas residency, such as a utility bill or lease agreement.

You can apply online through Your Texas Benefits, by mail, by fax, or in person at a local HHSC office. Calling 2-1-1 connects you with staff who can walk you through it.¹⁵ HHSC must decide within 45 days if you’re 65 or older or already have Social Security-established disability, and within 90 days if HHSC must evaluate disability itself.¹⁶

If HHSC denies your application or reduces your benefits, you have 90 days from the effective date of the action to request a fair hearing, orally or in writing.¹⁷ If you’re already receiving Medicaid and HHSC moves to reduce or end your benefits, requesting the hearing before the effective date on your notice lets your benefits continue at their current level while the appeal is pending.¹⁸ Common fixable denials involve missing documentation or miscalculated income, so review the notice carefully before accepting the decision.

Estate Recovery: What Families Should Know

There’s a significant catch to Medicaid long-term care coverage. Under the Medicaid Estate Recovery Program (MERP), Texas can seek reimbursement from your estate after you die for long-term care services you received after age 55, including nursing home care, waiver programs like CBA and STAR+PLUS long-term services, and certain hospital and prescription drug costs.¹⁹ Your estate includes your home, bank accounts, and other property you leave behind, though the state won’t collect against life insurance policies with a named beneficiary or payable-on-death accounts.

MERP does not apply when you are survived by a spouse, a child under 21, or a child of any age who is blind or permanently disabled. Texas also waives recovery when the estate is worth $10,000 or less, or when total Medicaid costs were $3,000 or less. An unmarried adult child who lived full-time in your home for at least one year before your death is protected as well, and hardship waivers exist for situations like a family farm serving as the primary income source for heirs.¹⁹ Estate recovery is one of the strongest reasons to work with an elder law attorney before or during the application process, not after a family member has already passed.

1
Texas Health and Human Services. Options for Medicare and Medicaid Dual Coverage
2
Centers for Medicare & Medicaid Services. Original Medicare Part A and B Eligibility and Enrollment
3
Texas Health and Human Services. Medicaid for the Elderly and People with Disabilities Handbook – D-5200 Citizenship
4
Social Security Administration. How Much You Could Get from SSI
5
Medicaid.gov. January 2026 SSI and Spousal CIB
6
Texas Health and Human Services. Appendix L, 2026 Income and Resources Reference Chart
7
Texas Health and Human Services. Medicaid for the Elderly and People with Disabilities Handbook – F-6800 Qualified Income Trust
8
Centers for Medicare & Medicaid Services. People Dually Eligible for Medicare and Medicaid Fact Sheet
9
Centers for Medicare & Medicaid Services. 2026 Medicare Parts A and B Premiums and Deductibles
10
Texas Health and Human Services. Appendix IX, Medicare Savings Program Information
11
Centers for Medicare & Medicaid Services. Beneficiaries Dually Eligible for Medicare and Medicaid
12
Medicare.gov. How Medicare Works with Other Insurance
13
Texas Health and Human Services. Dual Eligible Special Needs Plans – Medicare Advantage Plans
14
Texas Health and Human Services. STAR+PLUS Medicare-Medicaid Plans for Dual Eligible Members
15
Texas Health and Human Services. Benefits Application Next Steps
16
Texas Health and Human Services. Medicaid for the Elderly and People with Disabilities Handbook – B-6400 Processing Deadlines
17
Texas Health and Human Services. Texas Works Handbook – B-1020 Time Period for Requesting Fair Hearing
18
Medicaid.gov. Understanding Medicaid Fair Hearings
19
Texas Health and Human Services. Your Guide to the Medicaid Estate Recovery Program