The difference between Medicare and Medicaid comes down to who qualifies. Medicare is federal health insurance for people 65 or older and some younger people with disabilities. Texas Medicaid is a need-based program for people with limited income and assets, and for Texas seniors who qualify it pays for the long-term care that Medicare does not normally cover.

The fastest way to tell them apart: Medicare is based on your age or disability, while Texas Medicaid is based on your income and assets. In 2026, a single Texan applying for Medicaid long-term care is tested against a countable-income limit of $2,982 per month and a countable-asset limit of $2,000.,

This guide explains how each program works in Texas, what each one covers, the 2026 eligibility figures, and how to qualify for both at the same time.

Medicare at a Glance

Medicare is a federal program run by CMS, with the same standards for costs and coverage in every state. The main pathway is age: at 65, a person who is entitled to or eligible for monthly Social Security benefits gets premium-free Medicare Part A on their own or a spouse's work record. A former or late spouse's record can count too, within Social Security's limits: a former spouse generally must have been married at least 10 years and not be married now, and a surviving spouse generally must not have remarried before age 60. Forty quarters of work (about 10 years) is the usual way to qualify, but it is not the only one, so if you have fewer, ask Social Security to check your record. Someone who doesn't qualify for premium-free Part A may still be able to buy it, but only by also signing up for Part B, and only as a U.S. citizen or as a lawful permanent resident who has lived in the U.S. for the 5 straight years before applying. People under 65 qualify after 24 months of Social Security disability benefits, without that wait if they have ALS, and at any age with end-stage renal disease, provided they (or a spouse or parent) have the required work record or are entitled to Social Security or Railroad Retirement benefits.

Medicare's parts cover different services and carry different costs. Part A covers inpatient hospital stays, and most beneficiaries pay no Part A premium. Part B has a standard monthly premium of $202.90 in 2026 and a $283 annual deductible, after which you generally pay 20% coinsurance for most Part B services. Drug coverage is separate: once you have Parts A and B, you can separately enroll in a Part D drug plan or a Medicare Advantage plan.

The largest gap is long-term care. Original Medicare does not pay for non-skilled custodial care, meaning daily help with bathing, dressing, eating, and using the bathroom when that is the only care needed, except as part of hospice care for someone who is terminally ill. It also excludes most routine dental, vision, and hearing care. That gap is what Medicaid fills: it offers benefits Medicare does not normally cover, like nursing home care and personal care services.

Texas Medicaid at a Glance

Texas Medicaid is a joint federal and state program administered by HHSC. For adults 65 and older, eligibility for long-term care turns on income and assets rather than age, and HHSC also checks other requirements such as citizenship, Texas residency, and a medical need for the care.

In 2026, the monthly special income limit for Texas Medicaid long-term care is $2,982 for an individual and $5,964 for a couple, which is simply twice the individual limit. The individual figure equals 300% of the individual Supplemental Security Income (SSI) federal benefit rate, $994 in 2026. The test is countable income, not gross income, so the first question is which of your income sources HHSC actually counts. Where countable income does exceed the limit, Texas offers a Qualified Income Trust (QIT), which HHSC says is "sometimes referred to as a Miller Trust": income diverted into the trust is not counted when HHSC determines eligibility for institutional or home and community-based waiver services.

The countable asset (resource) limit is $2,000 for an individual and $3,000 for a couple, and which one applies is not about who is applying but about the living arrangement. Texas applies the $2,000 individual limit to a person who is single, to a person whose spouse lives in a different household, and to the institutional spouse under spousal-impoverishment policy. The $3,000 couple limit applies to married adults who live in the same household with their spouses. So a married couple who both enter a nursing facility are not tested together at $3,000; each is tested at the $2,000 individual limit. "Countable" assets exclude several things you keep: the home that is your or your spouse's principal residence (subject to a $752,000 home-equity limit from January 1, 2026, which does not apply when your spouse, your child, or your adult child with a disability lives in the home), one automobile regardless of value, household goods, and personal effects. You meet the asset test only once your countable assets are at or below the limit that applies to you.

Texas Medicaid also covers everyday medical care. STAR+PLUS, its managed-care program for adults 65 and older and adults with disabilities, delivers regular checkups, hospital care and services, medicine and vaccines, specialists, and mental health care, plus the long-term services and supports Medicare does not pay for. Members who qualify for the STAR+PLUS Home and Community Based Services waiver, which is for people who meet a nursing-facility level of care, can receive that long-term care in the community instead of a nursing facility. Under the member's individual service plan, the health plan coordinates services that include personal assistance services, nursing, therapies, adaptive aids, medical supplies, minor home modifications, emergency response, home-delivered meals, respite care, assisted living or adult foster care, and dental services. You reach the STAR+PLUS HCBS program through an HHSC interest list, not a direct application: a person is assessed once their name reaches the top. Someone already on Medicaid and enrolled with a STAR+PLUS health plan may be able to bypass the list through the upgrade process, and a nursing-facility resident who wants to move home can use the Money Follows the Person process.

A Texas Eligibility Example

Consider a single 78-year-old widow in Texas with $1,900 per month in Social Security income and $1,500 in a checking account. Her income is below the $2,982 monthly limit and her countable assets are below the $2,000 limit, so she meets both financial tests for Texas Medicaid long-term care; her home and one car do not count against her.,

Now suppose her income were $3,200 per month, above the $2,982 limit. She would not be automatically disqualified. Two things could still get her past the income test: some income may not be countable in the first place (certain Veterans Affairs benefits, for instance, do not count toward Medicaid eligibility), and where countable income genuinely exceeds the limit, HHSC says the proper use of a Qualified Income Trust can overcome it for institutional or home and community-based waiver services.

The Difference Between Medicare and Medicaid, Side by Side

The table below sets the two programs against each other on the points that matter most to a Texas family: who runs them, what they test for, whether they cover long-term care, and the 2026 cost and eligibility figures.,,,,,

Medicare Texas Medicaid
Run by Federal government (CMS) Texas HHSC, with federal funding
Based on Age or disability Income and assets
Income test No Yes ($2,982/mo, single applicant)
Asset test No Yes ($2,000, single applicant)
Covers long-term custodial care No Yes
Monthly cost Part B: $202.90 (2026) Usually $0 for covered medical care; small copays possible
Where to apply Social Security Administration YourTexasBenefits.com or paper Form H1200

Does Medicare Cover Nursing Home Care in Texas?

Medicare covers nursing home care only on a short-term, post-acute basis. A beneficiary generally must first have a qualifying inpatient hospital stay of at least three consecutive days (the day you leave the hospital doesn't count), have a doctor or other health care provider decide they need daily skilled care, and then enter a Medicare-certified facility, generally within 30 days of leaving the hospital, for skilled care related to that stay. Time under observation or in the emergency room doesn't count toward the three days. The rule has exceptions, though: a doctor in an Accountable Care Organization approved for a 3-day-rule waiver, or a Medicare Advantage plan, may waive the hospital stay, and re-entering a skilled nursing facility within 30 days of leaving one doesn't require a new qualifying stay. Under Original Medicare, Part A then covers up to 100 days of skilled nursing facility care per benefit period: days 1 through 20 at $0 a day after the $1,736 Part A deductible (usually already paid during the qualifying hospital stay), days 21 through 100 with a daily coinsurance of $217 in 2026, and nothing after day 100. Medicare does not pay for ongoing long-term custodial nursing home care. Medicare.gov points to two other routes: Medicaid, for someone who meets the state's eligibility rules (in Texas, through STAR+PLUS or nursing facility Medicaid), and private long-term care insurance. Otherwise, the family pays the full cost.

Can You Have Both Medicare and Medicaid?

Yes. People enrolled in both programs are "dual eligible." There are two groups: full-benefit duals, who have Medicare plus full Medicaid, and partial-benefit duals, who have Medicare plus help only through a Medicare Savings Program. Medicare is the primary payer and pays first; Texas Medicaid is the secondary payer and can cover Medicare premiums and cost-sharing and pay for services Medicare does not, most importantly long-term custodial care.

For people in the Qualified Medicare Beneficiary (QMB) group, federal law prohibits Medicare providers, suppliers, and pharmacies from billing them for Medicare Part A and Part B cost-sharing, including deductibles, coinsurance, and copayments, even when Medicaid pays nothing toward that cost-sharing. If a provider keeps billing you, call 1-800-MEDICARE (1-800-633-4227); Medicare can confirm your QMB status and ask the provider to stop billing you and refund what you have already paid.

Medicare Savings Programs: Medicaid Help With Medicare Costs

A Medicare Savings Program (MSP) is a Medicaid eligibility group that pays your Medicare costs rather than your full medical bills, and you can be in one without qualifying for full Texas Medicaid. Watch the direction of the limits, though, because it is the opposite of what most people assume: MSP income limits are lower than the $2,982 long-term-care limit above, not higher. Someone over $2,982 a month is far above every MSP limit, so an MSP is not the fallback for an applicant who exceeds the long-term-care cap. For long-term care, the tool HHSC points to is a Qualified Income Trust. The three programs and their 2026 federal monthly income limits (individual, then couple), which include the $20 general income disregard, are:

  • QMB (Qualified Medicare Beneficiary): income up to $1,350 per month ($1,824 for a couple); pays the Part B premium (and the Part A premium if you don't get Part A premium-free), deductibles, and coinsurance.
  • SLMB (Specified Low-Income Medicare Beneficiary): income $1,350 to $1,616 per month ($1,824 to $2,184 for a couple); pays the Part B premium.
  • QI (Qualified Individual): income $1,616 to $1,816 per month ($2,184 to $2,455 for a couple); pays the Part B premium. QI is not guaranteed from year to year: you must reapply every year, approvals are first-come, first-served with priority for people who had QI the year before, and you can't get QI while receiving any other Medicaid-funded benefit.

Texas HHSC publishes the same limits $20 lower (QMB at $1,330 for an individual and $1,804 for a couple, for example), because its table leaves that disregard out. Texas uses the couple figures when both spouses are applying for the same program, and part of a spouse's income can count toward the applicant's. All three programs cap countable resources at $9,950 for an individual and $14,910 for a couple, and a Texas home you live in and a car don't count toward that. If your income or resources look a little over these limits, apply anyway: states can effectively raise them by disregarding certain income and resources. In Texas, Medicare Savings Programs have their own shorter application, Form H1200-EZ.,

How to Apply and Get Help in Texas

Whether you are signing up for Medicare, applying for Texas Medicaid or a Medicare Savings Program, or trying to sort out which program pays for what, these are the offices that can help.

Social Security Administration Sign up for Medicare and apply for premium-free Part A or Part B. 1-800-772-1213https://www.medicare.gov/basics/get-started-with-medicare/sign-up/how-do-i-sign-up-for-medicare ssa.gov/medicare/sign-up
Texas Medicaid (Your Texas Benefits) Apply for Texas Medicaid online at YourTexasBenefits.com, or send a paper Form H1200 by mail or fax or take it to a benefits office. Call 2-1-1 with questions about the form, to find a benefits office, or to check your application's status; it is a help line, not a way to file. Medicare Savings Programs use the shorter Form H1200-EZ., 2-1-1 (or 877-541-7905 if 2-1-1 won't connect)https://www.hhs.texas.gov/services/health/medicaid-chip/medicaid-chip-members/choosing-a-health-plan yourtexasbenefits.com
Texas SHIP: the Health Information, Counseling and Advocacy Program (HICAP) Free, unbiased Medicare counseling from certified benefits counselors: eligibility and enrollment, comparing Medigap and Medicare Advantage and Part D plans, rights and appeals, and applying for a Medicare Savings Program or Extra Help. 800-252-9240 (Texas HICAP) hhs.texas.gov/services/health/medicare
Texas Health and Human Services Commission Texas's Medicaid agency. Call its Medicaid Helpline about which services Medicaid pays for or a bill from a Medicaid provider; for a problem with your STAR+PLUS health plan, call the HHS Ombudsman Managed Care Help line at 1-866-566-8989. 1-800-335-8957 (Medicaid Helpline)https://www.hhs.texas.gov/services/health/medicaid-chip/medicaid-chip-members/choosing-a-health-plan hhs.texas.gov

For help comparing your options, start with our Texas Medicaid programs guide and our Texas Medicaid application guide.

Frequently Asked Questions

What is the difference between Medicare and Medicaid?

Medicare is federal health insurance for people 65 or older and some younger people with disabilities. Texas Medicaid is a joint federal-state program based on income and assets, run by HHSC. Original Medicare excludes long-term custodial care (outside hospice) and most routine dental, vision, and hearing care. Texas Medicaid covers that long-term care for people who qualify, and for members of the STAR+PLUS waiver its services include personal assistance services in the community and dental services.

Can I have both Medicare and Medicaid in Texas?

Yes. People with both are "dual eligible." Medicare pays first, and Texas Medicaid can pay your Medicare premiums, deductibles, and copays and add benefits Medicare does not cover, such as long-term care. If you are in the QMB group, providers cannot bill you for Medicare cost-sharing.

Does Medicare cover nursing home care in Texas?

Only short-term skilled care, generally after a qualifying hospital stay of at least three days (a waiver or a quick re-entry can stand in for it), up to 100 days per benefit period, with a $217 daily coinsurance for days 21 through 100 in 2026. Medicare does not cover long-term custodial nursing home care. For ongoing stays, Texas Medicaid can pay if you qualify, as can a private long-term care insurance policy; otherwise the family pays.

What is the income limit for Texas Medicaid long-term care in 2026?

In 2026, the monthly special income limit is $2,982 for an individual and $5,964 for a couple (twice the individual limit), and the test is countable income, not gross. The countable asset limit is $2,000 for an individual, which is also the limit Texas applies to the institutional spouse under spousal-impoverishment policy; the $3,000 couple limit is for married adults living in the same household. Where countable income does exceed the limit, HHSC says a Qualified Income Trust (sometimes called a Miller Trust) can overcome it for institutional or waiver services.

Do Medicare Savings Programs have higher income limits than Texas Medicaid?

No, and this catches families out. The 2026 federal MSP limits for an individual are $1,350 (QMB), $1,616 (SLMB), and $1,816 (QI), all well below the $2,982 long-term-care limit., An MSP is not a fallback for someone whose income is too high for long-term-care Medicaid; it is a separate group that pays Medicare's own costs and does not give regular Medicaid benefits. QMB pays the Part B premium (and the Part A premium if you owe one), deductibles, and coinsurance; SLMB and QI pay the Part B premium. In Texas you apply on the shorter Form H1200-EZ.,

How do I apply for Medicaid in Texas?

Apply online at YourTexasBenefits.com, or on a paper Form H1200 sent by mail or fax or taken to a benefits office. 2-1-1 answers questions about the form and tells you your application's status, but it is not a way to file. See our full Texas Medicaid application guide for the documents you need.

Learn More

MedicaidTexas Medicaid Programs for SeniorsTexas Medicaid programs for seniors 65+ include STAR+PLUS, CAS, HCBS waivers, and PACE. Find out what each one covers, who qualifies, and how to enroll. MedicaidHow to Apply for Texas MedicaidHow to apply for Medicaid in Texas in 2026: the four ways to apply, the documents seniors need, the income-cap trap, timelines, and where to get free help. MedicaidWhat Texas Medicaid CoversTexas Medicaid covered services for seniors 65+: doctor visits, hospital care, drugs, vision, limited dental. See what STAR+PLUS covers and what it won't. MedicaidTexas Medicaid Managed Care PlansCompare Texas Medicaid managed care plans for STAR+PLUS seniors. Find which MCOs serve your area, how to switch plans, and what to look for when choosing. MedicaidTexas STAR+PLUS Waiver ProgramTexas STAR+PLUS covers Medicaid managed care for seniors 65+. The HCBS income limit is $2,982/month, and 12,100 people were on its interest list in August 2026. MedicaidTexas Medicaid Long-Term Care & Nursing HomesTexas Medicaid pays for nursing home care under regular Medicaid, not a capped waiver. See the 2026 income and asset limits and what the at-home spouse keeps. MedicareMedicare vs. Medicaid: the national guideMedicare vs. Medicaid: Medicare is federal insurance for people 65+; Medicaid is state-run help for limited incomes. See costs, nursing homes and having both.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

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