The difference between Medicare and Medicaid comes down to who qualifies. Medicare is federal health insurance based on age (65) or disability, regardless of income. Texas Medicaid is a need-based program for people with limited income and assets, and for Texas seniors it pays for the long-term care that Medicare does not 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 must have countable income at or below $2,982 per month and countable assets at or below $2,000. Medicare has no income or asset test at all.

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, and income does not affect eligibility. The main pathway is age: a person 65 or older who is eligible for Social Security retirement benefits qualifies for premium-free Medicare Part A based on their own or a spouse's work history of at least 40 quarters (about 10 years). People under 65 also qualify after 24 months of Social Security disability benefits, immediately if they have ALS, or at any age with end-stage renal disease.

Medicare's parts cover different services. Part A covers inpatient hospital stays; most beneficiaries pay no Part A premium. Part B covers doctor visits and outpatient care for a standard monthly premium of $202.90 in 2026, with a $283 annual deductible. Part D covers prescription drugs through private plans.

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. It also excludes most routine dental, vision, and hearing care. That long-term-care gap is the main reason Texas families turn to Medicaid.

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 depends on income and assets, not age alone.

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 effective January 1, 2026), one automobile regardless of value, household goods, and personal effects. Assets above the limit generally must be spent down before Medicaid coverage begins.

Texas Medicaid covers medical care that overlaps heavily with Medicare's, and for adults 65 and older it is delivered through the STAR+PLUS managed-care program: 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 at home instead: 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. For a family caring for an aging parent, that long-term-care coverage is often the most important benefit.

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 there: 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 eligible seniors
Where to apply Social Security Administration YourTexasBenefits.com or 2-1-1

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 and then enter a Medicare-certified facility for skilled care related to that stay. Medicare Part A then covers up to 100 days of skilled nursing facility care per benefit period: days 1 through 20 in full, 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. For that, Texas families rely on Medicaid (such as STAR+PLUS or nursing facility Medicaid), private pay, or long-term care insurance.

Can You Have Both Medicare and Medicaid?

Yes. People enrolled in both programs are "dual eligible," and it is one of the strongest coverage positions for a Texas senior. 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.

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 over every MSP limit too, so an MSP is not the fallback for an applicant who exceeds the long-term-care cap. A Qualified Income Trust is. The three programs and their 2026 monthly income limits (individual, then couple) are:

These are the federal MSP limits, the same in every state, and all three carry a resource limit of $9,950 for an individual and $14,910 for a couple. You apply for an MSP through the same Texas Medicaid channel as full Medicaid.

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
Texas Medicaid (Your Texas Benefits) Apply for Texas Medicaid and Medicare Savings Programs online, by mail with Form H1200, or by phone at 2-1-1. 2-1-1 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; ask about covered services, STAR+PLUS long-term care, and report QMB improper-billing violations. 2-1-1 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 based on age (65 or older) or disability and is not income-tested. Texas Medicaid is a joint federal-state program based on income and assets, run by HHSC. Medicare covers hospitals, doctors, and prescriptions but excludes long-term custodial care and most routine dental, vision, and hearing care. Texas Medicaid covers that long-term care, and for people on the STAR+PLUS waiver it also covers personal assistance services and dental services at home.

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 after a qualifying hospital stay, 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 you need Texas Medicaid, private pay, or long-term care insurance.

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 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. QMB pays Part A and Part B premiums, deductibles, and coinsurance; SLMB and QI pay the Part B premium. You apply through the same Texas Medicaid channel.

How do I apply for Medicaid in Texas?

Apply at YourTexasBenefits.com, by mail with Form H1200, or by phone at 2-1-1. 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. See 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 waiver income limit is $2,982/month, and Community First Choice has no waitlist. 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.

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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