Medicare and Medicaid Together in Texas: How the Two Programs Fit

Medicare and Medicaid sound alike, but they're different programs. Medicare is the federal health insurance program for people 65 and older and some younger people with disabilities. Medicaid is a joint federal and state program for people with limited income and resources, and in Texas it's run by Texas Health and Human Services (HHS).

Plenty of Texans qualify for both. People in this group are often called "dual eligible." If that's you, the two programs work together, and understanding how can save you money and headaches.

Who pays for what

For most people with both programs, Medicare is your main health coverage. You see Medicare doctors and hospitals for regular care. Medicaid then helps in two ways:

• With Medicare's costs, such as premiums, deductibles, and coinsurance, depending on the level of Medicaid you have.
• With services Medicare doesn't cover, which for many Texans includes help at home with daily activities.

There are two broad levels of help, and the difference matters.

Level	What it generally means
Full Medicaid	Full Texas Medicaid benefits on top of Medicare, often through STAR+PLUS
Medicare Savings Program only (such as QMB or SLMB)	Texas pays some Medicare costs, like the Part B premium, but you don't get full Medicaid benefits

STAR+PLUS: Texas Medicaid for older adults and people with disabilities

Texas HHS describes STAR+PLUS as a Medicaid managed care program for adults who have disabilities or are age 65 or older. You get your Medicaid benefits through a STAR+PLUS health plan.

If you have Medicare too, Texas HHS says you can generally still be in STAR+PLUS, and you keep getting your regular health care through your Medicare doctor. Exceptions include people who get Medicaid 1915(c) waiver services or live in facilities for people with intellectual and developmental disabilities.

What STAR+PLUS can add for people with Medicare is long-term services and supports. Texas HHS lists examples such as help in your home with basic daily activities, personal assistance services, day activity and health services, and short-term care to give family caregivers a break.

QMB: a powerful protection

The Qualified Medicare Beneficiary (QMB) program is one of Texas's Medicare Savings Programs. Medicare says QMB helps pay Part A premiums (if you don't have premium-free Part A), plus Part B premiums, deductibles, coinsurance, and copayments for services and items Medicare covers.

There's a second protection people often miss: Medicare says providers aren't allowed to bill QMB members for Medicare-covered services and items, including deductibles, coinsurance, and copayments. You may still get a bill for a small Medicaid copayment if one applies.

To learn how to apply for QMB and the other programs, read our guide to help paying the Part B premium in Texas.

Drug coverage and Extra Help

Medicare's Extra Help program lowers prescription drug costs. Medicare says you get Extra Help automatically if you have full Medicaid or if a Medicare Savings Program helps pay your Part B premium. With Extra Help in 2026, you pay no more than $12.65 for each drug covered by your Medicare drug plan.

Your plan choices, and how often you can change

People with both programs generally have a few ways to get Medicare:

• Original Medicare plus a stand-alone Part D drug plan.
• A Medicare Advantage plan.
• A Dual Eligible Special Needs Plan (D-SNP). Medicare says D-SNPs contract with your state Medicaid program to help coordinate your Medicare and Medicaid benefits, and every Special Needs Plan must include Part D drug coverage.

Most people can only change plans at certain times of year. But Medicare says if you have Medicaid or get Extra Help, you can make changes once a calendar month, with the change starting the first day of the next month. You can switch to a different Medicare drug plan, or drop a Medicare Advantage plan with drug coverage and return to Original Medicare with a stand-alone drug plan. If you have full Medicaid, you can also join or switch to an integrated D-SNP once a month.

Being able to change often doesn't mean you should. Before you switch, make sure your doctors, pharmacy, and any home care providers work with the new plan. Changing your Medicare plan can affect how your Medicaid services are coordinated, so ask questions first.

Texas tips

• Keep every card together. Your Medicare card, any Medicare plan card, and your Medicaid or STAR+PLUS card. In hurricane country or during a heat emergency, put copies and a medication list in your go-bag.
• Watch your mail. Texas HHS may send letters asking you to renew or send information. Answer them by the deadline so you don't lose help you still qualify for.
• Ask for Spanish help if you need it. 1-800-MEDICARE can provide an interpreter, and you can ask counselors for help in Spanish.

Free, unbiased help

The Texas Health Information, Counseling and Advocacy Program (HICAP) offers free one-on-one Medicare counseling. Call 1-800-252-9240. Your local area agency on aging can also help; Texas has 28, listed in the Texas HHS directory. You can also call 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048.

New to Medicare because of a disability? See Medicare under 65 in Texas.