Medicare and Texas Medicaid: STAR+PLUS and the Medicare Savings Programs

Some Texans qualify for both Medicare and Medicaid — often called being “dual eligible.” When that happens, Medicare pays first, and Texas Medicaid may help with costs Medicare leaves behind, like premiums, deductibles and coinsurance, plus services Medicare does not cover at all, such as long-term care at home or in a nursing facility.

How Medicaid works for seniors in Texas

Texas Medicaid is administered by the Texas Health and Human Services Commission (HHSC). Texas did not expand Medicaid, so for adults 65 and over eligibility is based on income and resources under the state’s aged-and-disabled rules, and it is determined by HHSC — not by an insurance agency. You apply at YourTexasBenefits.com, by phone at 2-1-1, or at a local HHSC office. Once eligible, most seniors receive their Medicaid benefits through STAR+PLUS, a managed-care program in which a health plan coordinates Medicaid services, including long-term services and supports, while Medicare continues to pay first for medical care.

Programs that can lower your costs

• Medicare Savings Programs (MSPs) — QMB, SLMB and QI — pay the Part B premium ($202.90 in 2026) and, for QMB, Medicare’s deductibles, copays and coinsurance as well. Texas’s income limits change each year and Texas uses the federal resource limits. You apply through HHSC, and you do not have to be on full Medicaid to qualify.
• Extra Help (Low-Income Subsidy) lowers what you pay for Part D premiums, deductibles and copays. If you qualify for an MSP or Medicaid you get Extra Help automatically; otherwise apply through Social Security.
• Dual Special Needs Plans (D-SNPs) are Medicare Advantage plans designed for people with both Medicare and Medicaid; they coordinate the two programs, usually at $0 plan premium, and often add extras while keeping your Medicaid benefits intact. In Texas many D-SNPs are offered by the same companies that run STAR+PLUS plans, so the two sides can be aligned.

Free, unbiased state counseling on all of this is available from Texas HICAP — the Health Information, Counseling and Advocacy Program, Texas’s State Health Insurance Assistance Program — at 800-252-9240. When you are ready to talk through the Medicare side, we are here at (702) 706-6564.

How we help

We help you understand whether a D-SNP is available and a good fit where you live, how a Medicare Savings Program and Extra Help could reduce your costs, and how to keep your Medicaid benefits working alongside Medicare. Eligibility decisions rest with HHSC and CMS; our job is to make the Medicare side clear.

ECOS Medicare Solutions is a private insurance agency and is not connected with or endorsed by Texas Medicaid, the Texas Health and Human Services Commission, or the federal Medicare program.