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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
$1,330 Individual
$1,804 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 shelter paid by someone else
Resources — Maximum countable resources
$9,950 Individual
$14,910 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?
A 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
A 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 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 $1,330.01 to a maximum monthly amount of less than $1,596.
The income range for a couple is equal to a minimum monthly amount of $1,804.01 to a maximum monthly amount of less than $2,164.
Use the couple income range when both spouses are applying for the same program. Use the individual income range to test eligibility for each spouse separately if both are not eligible. 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
The value of shelter paid by someone else
Resources — Maximum countable resources
$9,950 Individual
$14,910 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?
A 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
A 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 $1,596 to a maximum monthly amount of less than $1,796.
The income range for a couple is equal to a minimum monthly amount of $2,164 to a maximum monthly amount of less than $2,435.
Use the couple income range when both spouses are applying for the same program. Use the individual income range to test eligibility for each spouse separately if both are not eligible. 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
The value of shelter paid by someone else
Resources — Maximum countable resources
$9,950 Individual
$14,910 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?
A 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
A 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 shows Medicare coverage for immunosuppressive drugs only.
Part B-ID beneficiaries with limited income and resources may be eligible for help 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 help 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 receive help 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 receiving Medicaid.
Income — Maximum gross monthly income
$2,660 Individual
$3,607 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. Use the individual income limit to test eligibility for each spouse separately if both are not eligible. 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 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?
A 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
A car
Burial spaces