Medicare

• Do you need help finding and sorting through all the Medicare options available in Texas?
• Are you looking for free benefits counseling from a trusted and unbiased source?
• Do you need help paying Medicare premiums, co-pays and prescription medicines?

The Texas Health Information, Counseling and Advocacy Program can help you.

What is the Texas Health Information, Counseling and Advocacy Program?

If you are eligible for Medicare, the Texas Health Information, Counseling and Advocacy Program can help you enroll, find information and provide counseling about your options. This partnership between the Texas Health and Human Services Commission, Texas Legal Services Center and the Area Agencies on Aging trains and oversees certified benefits counselors across the state.

What services does the partnership provide?

Services offered by the partnership are:

• Medicare and Medicaid information and education.
• Help with original Medicare eligibility, enrollment, benefits, complaints, rights and appeals.
• Explain Medicare Supplemental (Medigap) insurance policy benefits and comparisons.
• Explain Medicare Advantage (Part C) and provide comparisons and help with enrollment and disenrollment.
• Explain Medicare Prescription Drug (Part D) coverage, help compare plans and search for other prescription help.
• Information about long-term care insurance.

The partnership also helps with the following programs. Benefit counselors are specially trained to help you understand plans and apply to one that works best for you. They advocate for you with these programs and help you get the services you need.

Medicare Savings Programs

Medicare Saving Programs helps pay for all or some of Medicare monthly payments, co-pays and deductibles (money owed to the doctor if Medicare doesn’t cover the entire bill).

Eligibility as a Qualified Medicare Beneficiary (QMB)

• Must be entitled to Medicare Part A

Income (maximum gross monthly income)

• $1,255 (individual limit)
• $1,643 (couple limit)

Resource Limits

• $9,090 (individual limit)
• $13,630 (couple limit)

Eligibility as a Specified Low-Income Medicare Beneficiary (SLMB)

• Must be entitled to Medicare Part A

Income (maximum gross monthly income)

• $1,255.01 to $1,458 (individual limit)
• $1,643.01 to $1,972 (couple limit)

Resource Limits

• $9,090 (individual limit)
• $13,630 (couple limit)

Eligibility for the Qualifying Individuals Program (QI-1)

• Must be entitled to Medicare Part A.
• Must not otherwise be receiving Medicaid.
  • Income range for a person is equal to a minimum monthly amount of $1,458 to a maximum monthly amount of less than $1,640.
  • Income range for a couple is equal to a minimum monthly amount of $1,972 to a maximum monthly amount of less than $2,219.

Resource Limits

• $9,090 (individual limit)
• $13,630 (couple limit)

Qualified Disabled and Working Individuals Program (QDWI)

• Must be entitled to enroll in Medicare Part A.
• Must be 64 or younger and not otherwise receiving Medicaid.

Income – Maximum gross monthly income (effective March 1, 2023)

• $2,430 individual limit (resource limit $4,000)
• $3,287 couple limit (resource limit $6,000)

Low-Income Subsidy

The Low-Income Subsidy (also called "Extra Help") is available under the Medicare Prescription Drug (Part D) coverage. Medicare recipients with limited income and assets may qualify for extra help with the costs of their prescription medicines. Visit the National Council on Aging for qualification and benefit information.

Medicare Preventive Services

Maintaining health and wellness is important, and Medicare preventive services are available at no cost. The National Council on Aging provides a list of Medicare Preventive Services that are available through the Affordable Care Act.

Who is Eligible?

Medicare beneficiaries and their representatives of any age are eligible. Medicare beneficiaries include those deemed eligible by being 65 or older or considered to have a disability by the Social Security Administration.

How can I Obtain Services?

Call 800-252-9240 or visit our directory for an office near you.