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 is called dual eligibility, and it matters because Medicaid picks up costs Medicare leaves behind: monthly premiums, deductibles, coinsurance, and the long-term care Medicare barely covers. Qualifying takes more than wanting the coverage. You have to independently meet the rules for each program, and Texas Medicaid’s income and resource limits are tighter than most people expect.

Who Qualifies for Both

The two programs are evaluated separately. Medicare eligibility is federal and doesn’t change from state to state.² You qualify if you are:

Age 65 or older with enough work history for Social Security or Railroad Retirement.
Under 65 and have received Social Security Disability benefits for 24 months.
Any age with ALS (no waiting period).
Any age with End-Stage Renal Disease.

Texas Medicaid adds its own requirements. You must be a U.S. citizen or qualified noncitizen and a Texas resident.³ Then you have to fall within income and resource limits that depend on the type of coverage.

2026 Community Medicaid Limits

For Texans living at home or in assisted living, the 2026 monthly income limit is $994 for a single person and $1,491 for a married couple when both spouses are applying. The resource cap is $2,000 for an individual and $3,000 for a couple. Resources include bank accounts, investments, and most property; your primary home and one vehicle are typically excluded.⁴⁵

2026 Nursing Home Medicaid Limits

If you need nursing facility care, the income limit rises to $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 The higher cap still catches retirees off guard. A monthly Social Security check of $3,100 disqualifies you on paper, even though it’s nowhere close to a nursing home bill that commonly runs $6,000 to $9,000 per month.

The Miller Trust Workaround

Texas addresses that gap with a Qualified Income Trust, often called a Miller Trust. If your income exceeds the nursing home Medicaid cap, you deposit part or all of your monthly income into an irrevocable trust. Because the money passes through the trust rather than to you directly, it doesn’t count toward eligibility. The trust must name the State of Texas as the residuary beneficiary, meaning any funds left when you die return to the state up to the amount Medicaid spent on your care.⁷ 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 all dual eligibles receive the same benefits, and the difference is significant.¹

Full dual eligibility means you qualify for the complete Texas Medicaid benefit package 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 with Medicare costs but does not give you full Medicaid benefits. No long-term care coverage, no dental, no vision. The income limits are higher, so many people who earn too much for full Medicaid still qualify for premium help.⁸

Medicare Savings Programs in Texas

Medicare Savings Programs are the most overlooked benefit available to low-income Medicare beneficiaries in Texas. The Part B premium alone is $202.90 per month in 2026, the Part A hospital deductible is $1,736 per benefit period, and the Part B deductible is $283 per year.⁹ Texas offers three tiers:

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.
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. Same resource limits. You cannot have any other Medicaid coverage and enroll in QI.

These limits track the federal poverty level and adjust annually.¹⁰ Texas also applies a $20 monthly general income disregard on top of the posted limits, slightly raising the effective cutoff.

QMB is by far the most valuable tier. If you qualify, Medicare providers cannot bill you for copays or deductibles at all. Many people who would qualify never apply because they don’t realize these programs exist separately from full Medicaid.¹¹

What Medicaid Pays That Medicare Doesn’t

Medicare always pays first, covering hospital stays, doctor visits, lab work, and other medical services up to its limits. Medicaid then picks up whatever Medicare leaves behind.¹² For fully dual-eligible Texans, that wraparound is comprehensive. Medicaid pays the Part B premium, the Part A premium if you owe one, the Part A hospital deductible, extended-stay coinsurance, and the 20 percent Part B coinsurance. Your out-of-pocket cost for most Medicare-covered services effectively drops to zero.¹¹

Prescription drugs work the same way. Medicare Part D handles most medications, and dual-eligible beneficiaries automatically qualify for the Low Income Subsidy known as Extra Help, which pays Part D premiums, deductibles, and most copays. When a drug isn’t on your Part D plan’s formulary, Texas Medicaid may cover it separately.

Long-Term Care

This is where Medicaid’s value becomes enormous. Medicare covers only 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, which is the day-to-day help with bathing, dressing, eating, and moving around that most people actually need as they age.

Texas Medicaid fills the gap. Full nursing facility coverage is available for those who meet medical and financial rules. Waiver programs such as Community Based Alternatives deliver nursing-home-level care in your home or an assisted living facility, including personal attendants, home modifications like ramps and grab bars, and adaptive aids. Community Attendant Services helps with daily living for people whose health limits their ability to care for themselves at home. Demand for the waiver programs regularly exceeds capacity, and waitlists are common.¹³

How Coverage Is Delivered: STAR+PLUS and D-SNPs

Most dual-eligible Texans receive their Medicaid benefits through STAR+PLUS, the state’s managed care program. Instead of navigating two programs, STAR+PLUS combines medical services and long-term care supports under a single plan that coordinates doctor visits, hospital care, prescriptions, and Medicaid services like personal attendants, adult day care, and nursing home coverage.

Dual Eligible Special Needs Plans, or D-SNPs, are another option. These are Medicare Advantage plans built for people with both programs. They bundle Medicare Parts A, B, and D coverage with extra benefits, and Texas Health and Human Services pays the plan a capitation rate to cover Medicare cost-sharing. One plan handles nearly all of your healthcare coordination.¹⁴

Check whether your current doctors and hospitals are in a plan’s network before enrolling. Switching plans mid-treatment can disrupt care, and not every D-SNP operates in every Texas service area.

Applying and Appealing

If you already have Medicare and think you meet the Medicaid limits, apply through the Texas Health and Human Services Commission. You can submit 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 the process.¹⁵

Have your Social Security number, Medicare card, proof of citizenship or qualified immigration status, proof of a Texas address, and income and resource documentation ready. HHSC must issue a decision within 45 days for applicants age 65 or older and for those whose disability has already been established through Social Security. If HHSC’s Disability Determination Unit still needs to evaluate your disability, the window extends to 90 days.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, either orally or in writing.¹⁷ If you are already receiving Medicaid and get a notice reducing or ending your benefits, ask for the hearing before the effective date on the notice. That keeps your benefits at their current level while the appeal is pending. There may be as few as 10 days between the notice and the effective date, so act quickly.¹⁸ The most common denials come from income or resources slightly over the limit, missing documentation, or miscalculated income. Review the notice carefully before accepting it.

What Heirs Should Know About Estate Recovery

There is a catch to Medicaid long-term care coverage that families often learn about too late. Under the Medicaid Estate Recovery Program, Texas can seek reimbursement from your estate after you die for long-term care services you received after age 55. This includes nursing home care, waiver programs, and certain hospital and prescription drug costs.¹⁹

Your estate includes your home, bank accounts, and other property you leave behind. The state will not collect against life insurance with a named beneficiary or bank accounts designated payable-on-death to another person. Recovery also doesn’t 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 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 also protected. Hardship waivers exist for cases such as family farms that are 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 Medicaid application, 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. STAR+PLUS Medicare-Medicaid Plans for Dual Eligible Members
14
Texas Health and Human Services. Dual Eligible Special Needs Plans – Medicare Advantage Plans
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