Appendix IX, Medicare Savings Program Information

Revision 24-3; Effective Sept. 1, 2024

Note: The following information is effective March 1, 2024.

Eligibility as a Qualified Medicare Beneficiary (QMB)

Medicare Entitlement

Must be entitled to Medicare Part A or enrolled in Medicare Part B immunosuppressive drug (Medicare Part B-ID).

Income — Maximum gross monthly income

• $1,255 Individual
• $1,704 Couple

Income can equal the maximum gross monthly income or be less than this limit. Use the couple income limit when both spouses are applying for the same program. If both are not eligible, use the individual income limit to test eligibility for each spouse separately. A portion of the spouse's income can be considered as part of the applicant's income.

Income limit amounts do not include the $20 general income disregard.

What counts as income?

• Social Security benefits
• Railroad retirement benefits
• State or local retirement benefits
• Interest or dividends
• Gifts or contributions
• Civil service annuities
• Veterans benefits
• Private pension benefits
• Royalty and rental payments
• Earnings or wages
• Value of food, clothing or shelter paid by someone else

Resources — Maximum countable resources

• $9,430 Individual
• $14,130 Couple

What is a resource?

• Bank accounts and certificates of deposit (CDs)
• Real property
• Life insurance policies
• Burial funds
• Individual retirement accounts (IRAs)
• Stocks and bonds
• Oil, gas or mineral rights
• Jewelry and antiques
• Cars and other vehicles
• Boats and recreational vehicles

What can be excluded?

• Texas homestead where a person lives that they consider their principal place of residence
• Life insurance if the face value is $1,500 or less
• Separately identifiable burial funds of $1,500, less any excluded life insurance or irrevocable arrangement for burial, for the applicant and the applicant's spouse
• Car
• Burial spaces

Benefits

QMB covers Medicare premiums for Parts A, B, and B-ID, deductibles, and coinsurance fees for Medicare services. A QMB-eligible person does not get regular Medicaid benefits. The state sends a special identification card to people who are eligible for QMB for them to show their medical service providers.

Eligibility as Specified Low-Income Medicare Beneficiaries (SLMB)

Medicare Entitlement

Must be entitled to Medicare Part A or enrolled in Medicare Part B-ID.

Income

The income range for a person is equal to a minimum monthly amount of $1,255.01 to a maximum monthly amount of less than $1,506.

The income range for a couple is equal to a minimum monthly amount of $1,704.01 to a maximum monthly amount of less than $2,044.

Use the couple income range when both spouses are applying for the same program. If both are not eligible, use the individual income range to test eligibility for each spouse separately. A portion of the spouse's income can be considered as part of the applicant's income.

Income limit amounts do not include the $20 general income disregard.

What counts as income?

• Social Security benefits
• Railroad retirement benefits
• State or local retirement benefits
• Interest or dividends
• Gifts or contributions
• Civil service annuities
• Veterans benefits
• Private pension benefits
• Royalty and rental payments
• Earnings or wages
• Value of food, clothing or shelter paid by someone else

Resources — Maximum countable resources

• $9,430 Individual
• $14,130 Couple

What is a resource?

• Bank accounts and CDs
• Real property
• Life insurance policies
• Burial funds
• IRAs
• Stocks and bonds
• Oil, gas or mineral rights
• Jewelry and antiques
• Cars and other vehicles
• Boats and recreational vehicles

What can be excluded?

• Texas homestead where a person lives that they consider their principal place of residence
• Life insurance if the face value is $1,500 or less
• Separately identifiable burial funds of $1,500, less any excluded life insurance or irrevocable arrangement for burial, for the applicant and the applicant's spouse
• Car
• Burial spaces

Benefits

SLMB covers only the payment of Medicare Part B or Part B-ID premiums. An SLMB-eligible person does not get regular Medicaid benefits or a monthly medical identification card.

Eligibility for the Qualifying Individuals Program (QI-1)

Medicare Entitlement

• Must be entitled to Medicare Part A or enrolled in Medicare Part B-ID.
• Must not otherwise be receiving Medicaid.

Income

The income range for a person is equal to a minimum monthly amount of $1,506 to a maximum monthly amount of less than $1,695.

The income range for a couple is equal to a minimum monthly amount of $2,044 to a maximum monthly amount of less than $2,300.

Use the couple income range when both spouses are applying for the same program. If both are not eligible, use the individual income range to test eligibility for each spouse separately. A portion of the spouse's income may also be considered as part of the applicant's income.

Income limit amounts do not include the $20 general income disregard.

What counts as income?

• Social Security benefits
• Railroad retirement benefits
• State or local retirement benefits
• Interest or dividends
• Gifts or contributions
• Civil service annuities
• Veterans benefits
• Private pension benefits
• Royalty and rental payments
• Earnings or wages
• Value of food, clothing or shelter paid by someone else

Resources — Maximum countable resources

• $9,430 Individual
• $14,130 Couple

What is a resource?

• Bank accounts and CDs
• Real property
• Life insurance policies
• Burial funds
• IRAs
• Stocks and bonds
• Oil, gas or mineral rights
• Jewelry and antiques
• Cars and other vehicles
• Boats and recreational vehicles

What can be excluded?

• Texas homestead where a person lives that they consider their principal place of residence
• Life insurance if the face value is $1,500 or less
• Separately identifiable burial funds of $1,500, less any excluded life insurance or irrevocable arrangement for burial, for the applicant and the applicant's spouse
• Car
• Burial spaces

Benefits

QI-1 covers only the payment of Medicare Part B or Part B-ID premiums. A QI-1-eligible person does not get regular Medicaid benefits or a medical identification card. A person cannot receive QI-1 benefits if receiving benefits under any other Medicaid-funded program.

MSP and Medicare Part B-ID

A person diagnosed with end-stage renal disease (ESRD) who receives a kidney transplant remains eligible for Medicare coverage for 36 months after the month of the transplant. Medicare coverage ends after the 36th month unless the person is otherwise entitled to Medicare based on age or disability.

ESRD Medicare beneficiaries who lose Medicare entitlement after a successful kidney transplant may be eligible for Medicare Part B-ID, a limited Part B benefit that only covers immunosuppressive drugs. Part B-ID does not cover any other items or services, including hospital stays, physician services, supplies or medications. Part B-ID beneficiaries are not entitled to Medicare Part A.

Part B-ID beneficiaries cannot be eligible for Medicare on another basis or eligible for any other type of comprehensive health care coverage that covers immunosuppressive drugs, including Medicaid and the Children’s Health Insurance Program (CHIP). A person enrolled in Medicare Part B-ID may be eligible for Community Attendant Services (CAS) or the Healthy Texas Women (HTW) program because these types of assistance do not cover immunosuppressive drugs.

Eligible Part B-ID beneficiaries receive a new Medicare card that indicates Medicare coverage for immunosuppressive drugs only.

Part B-ID beneficiaries with limited income and resources may be eligible for assistance with all or some of the Medicare Part B-ID premiums, coinsurance and cost sharing under QMB, SLMB or QI-1. They must meet all other MSP eligibility criteria, excluding entitlement to Medicare Part A.

If approved for QMB Part B-ID, Medicare Part B-ID beneficiaries receive assistance with the Medicare Part B-ID premiums, deductibles and co-insurance costs associated to immunosuppressive drugs only. For QMB Part B-ID recipients, the Medicaid card will show Part B-ID only in the upper right hand corner. SLMB or QI-1 Part B-ID recipients will receive assistance with Medicare Part B-ID premiums only.

Qualified Disabled and Working Individuals Program (QDWI)

Entitlement

• Must be entitled to enroll in Medicare Part A.
• Must be under 65 and not otherwise receiving Medicaid.

Income — Maximum gross monthly income

• $2,510 Individual
• $3,407 Couple

Income can be less than or equal to the maximum limit. Use the couple income limit when both spouses are applying for the same program. If both are not eligible, use the individual income limit to test eligibility for each spouse separately. A portion of the spouse's income may also be considered as part of the applicant's income.

Income limit amounts do not include the $20 general income disregard.

What counts as income?

• Social Security benefits
• Railroad retirement benefits
• State or local retirement benefits
• Interest or dividends
• Gifts or contributions
• Civil service annuities
• Veterans benefits
• Private pension benefits
• Royalty and rental payments
• Earnings or wages
• Value of food, clothing or shelter paid by someone else

Resources — Maximum countable resources

• $4,000 Individual
• $6,000 Couple

What is a resource?

• Bank accounts and CDs
• Real property
• Life insurance policies
• Burial funds
• IRAs
• Stocks and bonds
• Oil, gas or mineral rights
• Jewelry and antiques
• Cars and other vehicles
• Boats and recreational vehicles

What can be excluded?

• Texas homestead where a person lives that they consider their principal place of residence
• Life insurance if the face value is $1,500 or less
• Separately identifiable burial funds of $1,500, less any excluded life insurance or irrevocable arrangement for burial, for the applicant and the applicant's spouse
• Car
• Burial spaces

Benefits

QDWI covers only Medicare Part A premiums. A QDWI-eligible person does not get regular Medicaid benefits or a medical identification card.