How to Apply for Both Medicare and Medicaid in Texas

If you have Medicare and money is tight, you may be able to get help from Medicaid at the same time. People who have both are called "dual eligible." Being dual eligible can mean your Medicare premiums get paid for you, your out-of-pocket costs drop, and your prescriptions cost less.

The part that stops most people is the paperwork. Medicare and Medicaid are two different programs, run by two different offices, with two different applications. Nobody explains that clearly when you turn 65.

This guide walks through how it actually works in Texas: which program to apply for, where to apply, what to have ready, and what happens after you send it in.

What "Dual Eligible" Means

Medicare is federal. It is the health coverage most people get at 65, or earlier if they have a qualifying disability. Part A covers hospital care. Part B covers doctor visits and outpatient care.

Medicaid is a joint federal and state program. In Texas it is run by the Texas Health and Human Services Commission, usually called HHSC. Medicaid is based on your income and on what you own.

You can have both. When you do, Medicare pays first and Medicaid helps with what Medicare leaves behind. That might be your monthly premium (the amount you pay each month to keep coverage), your deductible (what you pay before coverage kicks in), or your copays.

There are two levels of help, and they are not the same

This is the single most useful thing to understand before you apply.

1. Full Medicaid

Full Medicaid gives you actual Medicaid coverage on top of Medicare. It can cover services Medicare does not, such as long-term care and some help at home. In Texas, adults 65 and older and adults with disabilities who get full Medicaid usually receive it through a managed care program called STAR+PLUS.

The income and asset limits for full Medicaid are the strictest of any of these programs.

2. Medicare Savings Programs

Medicare Savings Programs, or MSPs, are a narrower kind of Medicaid help. They do not give you full Medicaid benefits. What they do is pay Medicare costs for you. There are four:

QMB sits at roughly the federal poverty level. SLMB and QI allow somewhat more income than that. Texas updates the exact dollar limits every year, usually early in the year, so check the current figures on the HHSC website or ask when you apply rather than relying on a number you read somewhere last year.

Two things people get wrong here:

Your gross income is not the number that decides it. Texas subtracts certain amounts before comparing your income to the limit, so your countable income is often lower than what shows on your Social Security statement. Apply even if you look slightly over.

Your house and car usually do not count against you. Assets like bank accounts and CDs are counted. Your primary home, one vehicle, your household furnishings and a burial fund are generally not.

What to gather before you start

Having these ready is the difference between a smooth application and three months of back-and-forth letters:

• Your Medicare card and your Social Security card
• Proof of citizenship or eligible immigration status
• Proof of all income for you and your spouse: Social Security award letters, pension statements, pay stubs, annuity statements
• Recent statements for every bank account, CD, and investment account
• Life insurance policies, if you have any, showing the face value
• Information on any property you own besides your home
• Your address and phone number, and the same for anyone helping you apply

If someone is applying on your behalf, such as an adult child or a legal representative, send proof of that authority with the application.

Four Ways to Apply in Texas

You only need to do one of these. Pick whichever is easiest for you.

1. 1

   Online via YourTexasBenefits.com

   Go to YourTexasBenefits.com and create an account. This is the fastest route for most people, and you can upload your documents to the same account later instead of mailing them.

2. 2

   By Phone via Texas 2-1-1

   Call 2-1-1. Pick your language, then press 2. A representative can take the application over the phone and answer questions as you go. If you are deaf, hard of hearing, or have a speech disability, use your relay service to reach the same line.

3. 3

   By Paper Mail (Form H1200)

   The form is H1200, Application for Assistance. If you are only applying for a Medicare Savings Program, there is a shorter version called H1200-EZ. You can download either from the HHSC website, or call 2-1-1 and ask them to mail you a paper copy.

   Send the completed form to your local benefits office, or fax it to 1-877-447-2839. Call 2-1-1 to get the right mailing address.

4. 4

   In Person at an HHSC Office

   Walk into any HHSC benefits office. Staff can help you fill out the form on the spot, and many offices have computers if you would rather apply online with someone nearby. Call 2-1-1 or use YourTexasBenefits.com to find the office closest to you.

   One tip that saves a lot of time: on the form, Section A asks which programs you are applying for. Check every box that could apply to you, including the Medicare Savings Program box. HHSC reviews you against the programs you check. If you only check one, you may be turned down for that one and never screened for another you would have qualified for.

What Happens After Applying?

Texas generally has up to 45 days to make a decision on most applications, and longer when a disability determination is part of the review. You may get a call or a letter asking for a document you missed. Answer those quickly, because a missing bank statement is the most common reason an application stalls.

You will get a written notice with the decision. If you are approved for QMB, coverage generally starts the first day of the month after you are certified. Other programs have different start dates, and some can pay back a few months, so read your notice and ask if anything is unclear.

If you are denied and you think the decision is wrong, the notice will explain how to appeal. There is a deadline on that, so do not set it aside.

What Changes Once You Are Approved?

Your drug costs go down automatically.

Being on Medicaid or a Medicare Savings Program qualifies you for Extra Help, the federal program that lowers Part D prescription costs. You do not file a second application for it. Your Medicaid approval triggers it.

Providers cannot bill you for Medicare cost sharing under QMB.

If you have QMB and a provider who takes Medicare sends you a bill for a deductible or copay on a Medicare-covered service, that is not allowed. Keep the bill and get help sorting it out.

A different type of Medicare plan opens up.

Dual eligible people can enroll in a Dual Eligible Special Needs Plan, often called a D-SNP. These are Medicare Advantage plans built specifically for people with both Medicare and Medicaid, and they coordinate the two programs instead of leaving you to manage them separately.

You get extra chances to change plans.

Most people can only switch Medicare Advantage or Part D plans during set windows, mainly the Annual Enrollment Period from October 15 to December 7. Dual eligible people have additional opportunities during the year to move into certain D-SNPs. The rules depend on the plan type and have been changing over the last two years, so this is worth asking about rather than guessing.

You have to renew.

Medicaid is not permanent. Texas will send renewal paperwork, and coverage can end if it goes unanswered. Open every envelope from HHSC.

Our team at Clutch City Insurance can also walk you through it. We help people sort out where they stand, what to apply for, and what their Medicare options look like if they are approved. That conversation is free, and there is no obligation to enroll in anything.

Call us at 713-870-5044, Monday through Friday, 8:30am to 5pm. Our agents speak 17 languages, including Mandarin, Cantonese, Vietnamese, Spanish, Hindi, Urdu, Arabic, Korean and ASL, so you can have this conversation in the language you think in. If getting to our office on Westheimer is difficult, we can come to you.