The Difference Between Medicare and Medicaid in Texas (2026)

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.4

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.5

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.6 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 a single applicant and $5,964 for a married couple when both apply. This figure equals 300% of the individual Supplemental Security Income (SSI) federal benefit rate.1 An applicant whose countable income exceeds the limit can still qualify by routing the excess income through a Qualified Income Trust, also called a Miller Trust.1

The countable asset (resource) limit is $2,000 for a single applicant and $3,000 for a married couple when both apply. "Countable" assets exclude several things you keep: your primary home (subject to a $752,000 home-equity limit in 2026), one automobile, household goods, and personal effects.2 Assets above the limit generally must be spent down before Medicaid coverage begins.

Texas Medicaid covers the services Medicare covers, plus long-term care in a nursing facility or at home through the STAR+PLUS managed-care program, along with dental, vision, hearing, personal care assistance, and non-emergency medical transportation. 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.1,2

Now suppose her income were $3,200 per month, above the $2,982 limit. She would not be automatically disqualified. Texas allows her to deposit the income into a Qualified Income Trust so the excess no longer counts, which lets an applicant over the income cap still qualify.1

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.1,2,5

Does Medicare Cover Nursing Home Care in Texas?

Medicare covers nursing home care only on a short-term, post-acute basis. After a qualifying inpatient hospital stay of at least three days, Medicare Part A 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 100.7 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.7

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.3

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.8

Medicare Savings Programs if You Make Too Much for Full Medicaid

Even if you do not qualify for full Texas Medicaid, you may qualify for a Medicare Savings Program (MSP), which has higher income limits than full Medicaid. The three programs and their 2026 monthly income limits for a single applicant are:9

• QMB (Qualified Medicare Beneficiary): income up to $1,350 per month; pays Part A and Part B premiums, deductibles, and coinsurance.9
• SLMB (Specified Low-Income Medicare Beneficiary): income $1,350 to $1,616 per month; pays the Part B premium.9
• QI (Qualified Individual): income $1,616 to $1,816 per month; pays the Part B premium.9

All three have a resource limit of $9,950 for a single applicant and $14,910 for a couple. You apply for an MSP through the same Texas Medicaid channel as full Medicaid.9

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.

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

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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.