Medicare Eligibility in Texas: Requirements, Costs, and Free Help

Medicare eligibility in Texas follows the same federal rules as every other state — you qualify at age 65 with 10 years of work history, or earlier if you have a qualifying disability, end-stage renal disease, or ALS. What makes Texas distinct is what happens after you’re enrolled: the state’s Medicare Savings Programs can eliminate your monthly Part B premium entirely if your income is under $1,796 per month, and Texas offers free one-on-one Medicare counseling through HICAP — the state’s dedicated Medicare assistance program — at no cost to you.

This guide covers every Medicare eligibility rule that applies to Texas residents in 2026, including the 2026 income limits for each Texas Medicare Savings Program, how to apply through YourTexasBenefits.com, and where to find free local help.

Who Qualifies for Medicare in Texas

The basic eligibility requirements for Medicare are the same in Texas as they are across the country.

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Age 65 — the standard path. Most Texans become eligible for Medicare at 65. To receive premium-free Part A (hospital insurance), you or your spouse must have worked and paid Medicare payroll taxes for at least 10 years — 40 quarters of coverage. You must also be a U.S. citizen or a lawful permanent resident who has lived in the United States for at least five years. Part B (medical insurance) is available to all enrollees for a monthly premium — in 2026, the standard Part B premium is $202.90 per month.

Under 65 with a disability. Texans who have received Social Security Disability Insurance (SSDI) benefits for at least 24 consecutive months qualify for Medicare automatically. Coverage begins the 25th month of SSDI payments. The waiting period starts from the month your first SSDI payment arrives — not from when your disability began or when you applied.

End-stage renal disease (ESRD). Permanent kidney failure requiring regular dialysis or a kidney transplant qualifies a Texan for Medicare at any age, without completing the 24-month SSDI waiting period. Medicare coverage for ESRD generally begins three months after a regular course of dialysis begins. Enrollment is not automatic for ESRD — you must contact Social Security at 1-800-772-1213 or visit your local Social Security office to sign up.

ALS (Lou Gehrig’s disease). ALS triggers immediate, automatic Medicare enrollment at any age. The month your SSDI payments begin is the month Medicare coverage starts. No application is required beyond your SSDI claim.

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Texas Kidney Health Care Program — Help During the ESRD Waiting Period

Texans diagnosed with end-stage renal disease face a three-month waiting period before Medicare kicks in. During that time, the Texas Kidney Health Care Program (KHHP), administered by Texas Health and Human Services, can help cover the cost of dialysis, kidney transplants, and Medicare premiums. The program is specifically designed to bridge the gap between diagnosis and Medicare coverage for low-income Texans with ESRD.

To learn more, contact Texas HHS at hhs.texas.gov/services/health/kidney-health-care or call 2-1-1 to be connected to local resources.

When to Sign Up for Medicare in Texas

The enrollment rules are federal — they apply to all Texans the same way.

Your Initial Enrollment Period (IEP) is a seven-month window: three months before the month of your 65th birthday, your birthday month itself, and three months after. Enrolling during the three months before your birthday month gets you the earliest possible coverage start date.

If you are already receiving Social Security retirement benefits when you turn 65, Texas Social Security Administration offices will automatically enroll you in Medicare Parts A and B, and your card will arrive in the mail before your birthday. If you are not yet collecting Social Security — for example, because you are still working — you need to sign up yourself at ssa.gov, by calling 1-800-772-1213, or in person at any Texas Social Security office.

Still working at 65? If you have active coverage through your own or a spouse’s current employer group health plan, you can delay Medicare enrollment without penalty. You then have eight months to enroll after that employer coverage ends. COBRA and retiree insurance do not count as active employer coverage for this purpose — if those are your only options at 65, enroll during your IEP.

If you miss your IEP with no qualifying employer coverage exception, you can sign up during the General Enrollment Period (January 1 through March 31 each year), but coverage won’t start until July 1 and you will owe a permanent late enrollment penalty on your Part B premium.

Texas Medicare Savings Programs — 2026 Income Limits

Texas residents enrolled in Medicare who have limited income may qualify for a Medicare Savings Program (MSP), administered through Texas Health and Human Services. These programs pay some or all of your Medicare costs on your behalf — and every Texan enrolled in any MSP automatically qualifies for Extra Help (Low Income Subsidy) on Part D prescription drugs, capping drug copayments at $12.65 for brand-name and $5.10 for generic medications in 2026.

Texas participates in all four federally established MSPs. The income limits below are effective January 1, 2026, per the Texas HHSC MEPD Bulletin 26-04. Note: The standard $20 general income disregard is applied separately — meaning the first $20 of your monthly income is not counted when your eligibility is calculated, effectively raising these thresholds by $20.

Resource limits for QMB, SLMB, and QI-1: Individual — $9,430. Couple — $14,130. Your primary home and one vehicle are not counted toward the resource limit.

QDWI resource limits are stricter, based on current SSI limits. Contact Texas HHS for the current QDWI asset threshold.

About QI-1: The Qualifying Individual program is funded on a first-come, first-served basis each year, with priority given to people who had QI-1 coverage in the prior year. If you believe you qualify, apply as early as possible in the calendar year.

If your income is close to a limit, apply anyway. Income that seems above the limit may still qualify once Texas applies the $20 general income disregard and other allowable exclusions. Texas HHSC workers calculate eligibility using your actual countable income — not your total gross income.

How to Apply for a Texas Medicare Savings Program

Online: Apply at YourTexasBenefits.com — Texas’s online portal for Medicaid, CHIP, SNAP, and Medicare Savings Programs. Create an account, select “Apply for Benefits,” and answer the MSP-related questions. You can also check the status of an existing application and upload documents through the same portal.

By phone: Call 2-1-1 (Texas’s statewide health and human services helpline) and ask to be connected to Medicare Savings Program assistance. Available 24 hours a day, 7 days a week.

In person: Visit your local Texas HHS office. Find the nearest location at hhs.texas.gov/about/find-us.

Through HICAP: Texas’s free Medicare counseling program (described below) can help you complete the MSP application and identify which program you’re most likely to qualify for before you apply.

HICAP — Texas’s Free Medicare Help Program

Texas’s State Health Insurance Assistance Program is called HICAP — the Texas Health Information, Counseling and Advocacy Program. It is a partnership between the Texas Health and Human Services Commission, Texas Legal Services Center, and local Area Agencies on Aging. Certified HICAP counselors serve every region of the state and provide completely free, unbiased, one-on-one help to any Medicare beneficiary — or anyone approaching Medicare eligibility — regardless of age or income.

HICAP counselors can help you with all of the following at no charge:

• Understanding your Medicare eligibility and choosing when to enroll
• Comparing Original Medicare versus Medicare Advantage (Part C) plans available in your area
• Choosing a Medicare Part D prescription drug plan
• Applying for Medicare Savings Programs and Extra Help (Low Income Subsidy)
• Filing Medicare appeals and complaints
• Understanding your rights as a Medicare beneficiary
• Coordinating Medicare with other coverage including VA benefits, TRICARE, and employer plans
• Answering questions about Medigap (Medicare Supplement) insurance

How to reach HICAP:

• Visit shiphelp.org and select Texas to find your local HICAP office and schedule an appointment
• Call 1-877-839-2675 (national SHIP helpline) to be connected to HICAP in your area
• Dial 2-1-1 and ask for Medicare counseling — Texas 2-1-1 can connect you to HICAP in your county

There is no charge for HICAP services. Counselors are trained and certified but are not insurance agents and have no financial interest in the plans or programs they discuss with you.

Texas and Medicaid Expansion — What It Means for You

Texas has not expanded Medicaid under the Affordable Care Act. This is a significant gap that affects Texans under 65 who are not disabled and do not have dependent children: if your income is too high for traditional Texas Medicaid but too low to qualify for ACA marketplace subsidies, you may fall into the coverage gap with limited options.

This does not affect Medicare eligibility. If you are 65 or older and meet the standard work history requirements, you qualify for Medicare regardless of Texas’s Medicaid expansion status. And if you receive Medicare and have limited income, you can still qualify for Texas’s Medicare Savings Programs regardless of whether Texas has expanded Medicaid.

However, the coverage gap matters for Texans under 65 who are waiting out the 24-month SSDI period before Medicare begins. During that window, Texas Medicaid is not available to most adults without dependents unless they receive SSI. If you are in this situation, contact HICAP or dial 2-1-1 to ask about available resources in your area.

How Much Does Medicare Cost in Texas?

Medicare premiums are set federally — the same for all U.S. residents — but your actual cost depends on your work history, income, and whether you qualify for a Medicare Savings Program.

Part A: Free if you or your spouse worked 40 or more quarters paying Medicare taxes. If you worked 30–39 quarters, the Part A premium in 2026 is $284 per month. Fewer than 30 quarters: $565 per month.

Part B: The standard premium in 2026 is $202.90 per month. If your reported income from two years ago exceeded $109,000 (single) or $218,000 (married filing jointly), you pay a higher IRMAA surcharge on top of the standard premium.

Part D: Varies by plan. Texas has a large selection of stand-alone Part D plans and Medicare Advantage plans with drug coverage. If you qualify for a Medicare Savings Program, you automatically receive Extra Help, which eliminates or greatly reduces your Part D premium and caps drug copayments.

Medicare Savings Programs eliminate or reduce these costs for qualifying Texans. The QMB program — available to individuals earning up to $1,330 per month — covers all Medicare premiums, deductibles, coinsurance, and copayments. That is over $2,400 in annual savings on Part B premiums alone, plus all cost-sharing for covered services.

Frequently Asked Questions

What are the income limits for Medicare Savings Programs in Texas in 2026?

Texas uses 2026 federal poverty level guidelines for its Medicare Savings Programs. The QMB program covers individuals earning up to $1,330 per month and couples earning up to $1,804 per month. SLMB covers individuals up to $1,596 and couples up to $2,164. QI-1 covers individuals up to $1,796 and couples up to $2,435. These figures are from Texas HHSC’s MEPD Bulletin 26-04, effective January 1, 2026. A $20 income disregard is applied separately, which effectively raises each threshold by $20. Resources must be under $9,430 (individual) or $14,130 (couple) for QMB, SLMB, and QI-1.

How do I apply for Medicare in Texas?

If you are already receiving Social Security benefits at least four months before turning 65, you will be automatically enrolled in Medicare — your card will arrive by mail. If not, apply at ssa.gov, call 1-800-772-1213, or visit any Texas Social Security Administration office. To apply for Medicare Savings Programs (help paying Medicare costs), use YourTexasBenefits.com, call 2-1-1, or visit your local Texas HHS office. HICAP counselors can guide you through both processes at no cost — find them at shiphelp.org or by calling 1-877-839-2675.

What is HICAP in Texas?

HICAP stands for the Texas Health Information, Counseling and Advocacy Program. It is Texas’s State Health Insurance Assistance Program (SHIP) — a federally funded, state-operated program that provides free, unbiased Medicare counseling to all Texas Medicare beneficiaries and those approaching eligibility. HICAP counselors are certified and trained but not insurance agents, so they have no financial stake in the plans they help you compare. Find your local HICAP office at shiphelp.org or call 1-877-839-2675.

Does Texas have Medicaid for people under 65 who aren’t yet on Medicare?

Texas has not expanded Medicaid under the ACA, so most adults under 65 who aren’t disabled and don’t have dependent children don’t qualify for Texas Medicaid regardless of income. SSI recipients are automatically enrolled in Texas Medicaid. If you are in the 24-month SSDI waiting period before Medicare begins, options are limited — contact 2-1-1 or HICAP for help identifying any programs available in your situation.

What does the QMB program cover in Texas?

The Qualified Medicare Beneficiary (QMB) program in Texas covers your Medicare Part A and Part B premiums, deductibles, coinsurance, and copayments. Providers are prohibited by federal law from billing QMB enrollees for any Medicare-covered services. You also receive automatic Extra Help on Part D drugs, capping your copayments at $12.65 for brand-name and $5.10 for generic medications in 2026. QMB enrollment begins the first day of the month following the month you are certified. To qualify, your monthly income must be at or below $1,330 (individual) or $1,804 (couple), and resources must be under $9,430 (individual) or $14,130 (couple).

Does Medicare cover kidney dialysis in Texas?

Yes. End-stage renal disease — permanent kidney failure requiring regular dialysis or a transplant — qualifies you for Medicare at any age in Texas. Coverage generally begins three months after you begin a regular course of dialysis. Unlike most Medicare paths, ESRD enrollment is not automatic — you must sign up by contacting Social Security at 1-800-772-1213 or visiting a Texas SSA office. During the three-month waiting period before Medicare begins, the Texas Kidney Health Care Program may help cover dialysis and transplant costs for qualifying Texans.

Can I get Medicare if I’m still working in Texas?

Yes — working does not disqualify you from Medicare. If you have active coverage through your own or a spouse’s current employer group health plan, you can delay Medicare enrollment past 65 without penalty. Once that employer coverage ends, you have eight months to enroll through a Special Enrollment Period. COBRA and retiree insurance do not count as active employer coverage — if those are your only options at 65, enroll during your seven-month Initial Enrollment Period to avoid a permanent late penalty on your Part B premiums.

Is Extra Help for prescription drugs the same as a Medicare Savings Program in Texas?

They are separate programs that work together. Texas Medicare Savings Programs are administered by Texas HHS and help pay Medicare premiums and cost-sharing. Extra Help — also called the Low Income Subsidy — is a federal Social Security Administration program that reduces or eliminates Part D prescription drug costs. The connection is this: enrolling in any Texas Medicare Savings Program automatically qualifies you for Extra Help, without a separate application. If you don’t qualify for an MSP, you can still apply for Extra Help separately at ssa.gov or by calling Social Security at 1-800-772-1213.

Key Texas Medicare Contacts

Bottom Line

Medicare eligibility in Texas follows federal rules — age 65 with sufficient work history, or earlier via disability, ESRD, or ALS. Once you’re enrolled, Texas’s Medicare Savings Programs can significantly reduce or eliminate your out-of-pocket Medicare costs if your income is limited. In 2026, the QMB program covers all Medicare cost-sharing for individuals earning up to $1,330 per month — and every MSP enrollee automatically gets Extra Help on drug costs. HICAP counselors are available statewide at no charge to help you understand your options, compare plans, and apply.

For help with SNAP and other food assistance benefits in Texas, use our SNAP Eligibility Calculator. To find your Texas EBT contact information, see our state-by-state EBT phone number guide.

Last updated: 2026 | Medicare eligibility rules and Texas MSP income limits reflect 2026 federal CMS guidelines and Texas HHSC MEPD Bulletin 26-04, effective January 1, 2026. Verify current income limits and program details at hhs.texas.gov or by calling 2-1-1 before applying. Texas Medicare Savings Programs are administered by the Texas Health and Human Services Commission (HHSC).