How Medicare works alongside employer coverage: enrollment timing at 65, who pays first, Part D creditable coverage, and HSA rules for employees who keep working.
A person whose Medicaid or Extra Help eligibility starts, ends or changes can make a plan change within 3 months of the change or of the notice, whichever is later. That includes leaving a Medicare Advantage plan for Original Medicare or dropping or switching a drug plan.
A full-benefit dual can join or switch to an integrated D-SNP once per calendar month, to line up with their Medicaid managed care plan. Not every D-SNP is integrated, and partial duals don’t get this window.
Not the way they used to. Since 2025 the quarterly window is gone; instead, someone with Medicaid or Extra Help can join or switch a standalone Part D plan once per calendar month, which can also take them out of Medicare Advantage back to Original Medicare. It is not a monthly right to switch from one Medicare Advantage plan to another.
A full dual has Medicare plus full Medicaid benefits; a partial dual has Medicare plus only a Medicare Savings Program that helps with premiums and, for QMB, cost-sharing. The difference decides whether Medicaid covers services like nursing home care.
Medicare pays first for Medicare-covered services, and Medicaid pays last, after Medicare and any other insurance. Prescription drugs come through a Medicare Part D plan, not Medicaid.
Usually the month after Social Security acknowledges the state has added the person to its buy-in rolls. In Texas, any premiums withheld after the buy-in date should come back as an upward adjustment, typically by the third month after certification.
QMB applies to services furnished after the end of the month in which the state determines the person eligible, so in practice it starts the first day of the next month. It is not retroactive to earlier months.
Yes. Medicare Advantage plans must write into their provider contracts that enrollees eligible for both Medicare and Medicaid are not liable for Part A and B cost-sharing when the state is responsible for it.
Tell the provider or collector the person is in QMB and can’t be charged Medicare cost-sharing. If they already paid, they’re entitled to a refund through the state Medicaid office, and 1-800-MEDICARE can step in if the provider won’t stop.
No. Medicare providers may not bill someone in QMB for Medicare deductibles, coinsurance or copays on Medicare-covered services, even when the state pays the provider less than the full cost-sharing.
QDWI pays only the Part A premium for people under 65 with a disability who lost premium-free Part A because they went back to work. Unlike QMB, SLMB and QI, it is not one of the programs that makes someone automatically eligible for Extra Help.
QI is funded on a first-come, first-served basis, so the person must apply every year, with priority going to people who had QI the year before. QI can’t be combined with any other Medicaid coverage.
Through the state: in Texas, Texas Health and Human Services (HHSC) decides which Medicare Savings Program a person qualifies for. An Extra Help application filed with Social Security also sends the person’s information to the state to start an MSP application unless the person opts out.
For 2026 the federal monthly income limits are $1,350 for QMB, $1,616 for SLMB and $1,816 for QI for an individual ($1,824, $2,184 and $2,455 for a married couple). The resource limit for all three is $9,950 individual and $14,910 couple.
QMB pays the Part A premium (if one is owed), the Part B premium, and Medicare deductibles, coinsurance and copays. SLMB and QI pay only the Part B premium. All three automatically qualify the person for Extra Help.
Contact the drug plan and give it proof of Extra Help, telling the plan how many days of medicine the person has left. If that doesn’t fix it, call 1-800-MEDICARE, which can confirm the person’s Extra Help level and get the plan to correct it.
No. Extra Help lasts through December 31 even if income changes mid-year. People who get it automatically through Medicaid, a Savings Program or SSI keep it through year end, and through the next year too if they qualified between July 1 and December 31.
Yes. If someone qualifies for Extra Help and has no Medicare drug plan, Medicare enrolls them in one, and a notice tells them which. They can pick a different plan, and Medicare’s LI NET program gives temporary coverage until they are enrolled.
For 2027, Extra Help people pay a $0 premium and $0 deductible, then up to $5.80 per generic and $14.40 per brand-name drug, and $0 once total drug costs reach $2,400.
No. Medicare.gov says people who get Extra Help do not pay a Part D late enrollment penalty while they have it.
For 2026, a $0 plan premium and $0 deductible, then up to $5.10 for each generic and $12.65 for each brand-name drug at a network pharmacy, and $0 once total drug costs reach $2,100. People with full Medicaid who are also in QMB pay no more than $4.90 per drug.
Apply through Social Security, online or by calling 1-800-772-1213 to set up an appointment. The application can be filed any time, before or after the person joins a Part D plan, and it can also start a Medicare Savings Program application with the state.
No. The home, one car, a burial plot, up to $1,500 set aside for burial expenses, furniture and household and personal items are not counted. Checking, savings and retirement accounts, stocks and bonds are.
For 2026, Extra Help is for a single person with income up to $23,940 and resources up to $18,090, or a married couple living together with income up to $32,460 and resources up to $36,100. People on full Medicaid, a Medicare Savings Program or SSI get it automatically without meeting these tests separately.
Yes, they can have both. TRICARE pays after most other health insurance, so the employer plan pays first and TRS pays second.