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Medicaid and Medicare: Dual Eligibility
If you qualify for both Medicare and Medicaid, you are "dual eligible," and Texas is changing how that works for Bexar County residents starting January 1, 2027. Here is what that change means, plus how Medicare Savings Programs, Extra Help, and D-SNP plans fit together.
The 2027 Bexar County change
Texas Health and Human Services Commission (HHSC) has announced that, beginning January 1, 2027, Bexar County will expand its Integrated D-SNP Model: dual-eligible members' Medicaid (STAR+PLUS) plan and their Medicare Dual-Eligible Special Needs Plan (D-SNP) will need to be run by the same company, a "Medicare-led exclusively aligned enrollment" model. This replaces the previous Dual Demonstration Program, which ended December 31, 2025.
In practice, this can mean some Bexar County dual-eligible members need to pick a new D-SNP, a new STAR+PLUS plan, or both, so that one company handles both sides of their coverage. Watch for a notice from HHSC in the mail, and call us if you want help understanding whether this affects you and what your options are.
Source: Texas Health and Human Services Commission (hhs.texas.gov), 2027 Integrated D-SNP expansion.
What does "dual eligible" mean?
It means you qualify for both Medicare and Medicaid. Medicare is still your primary coverage, Medicaid helps pick up costs Medicare does not cover, such as premiums, deductibles, copays, or coinsurance, depending on which specific program you qualify for.
Medicare Savings Programs: QMB, SLMB, and QI
Medicare Savings Programs help pay Medicare costs for people with limited income, even if you don't qualify for full Medicaid.
- QMB (Qualified Medicare Beneficiary): the broadest program, covering your Part A premium (if any), Part B premium, deductibles, coinsurance, and copays.
- SLMB (Specified Low-Income Medicare Beneficiary): covers your Part B premium only, for people with a bit more income than QMB allows.
- QI (Qualifying Individual): also covers only the Part B premium, for a higher income band still, with limited annual funding on a first-come, first-served basis.
Income and resource limits for these programs are set nationally and adjust each year; Texas uses the standard federal limits rather than its own separate figures. Apply through your state Medicaid office.
Extra Help: lower Part D costs
Extra Help, the Part D Low Income Subsidy, can eliminate your Part D deductible, cover your premium up to a regional benchmark amount, and cap your copays at roughly $5.10 for generic drugs and $12.65 for brand-name drugs in 2026. Apply through Social Security at ssa.gov, you can apply for Extra Help even if you are not sure you qualify for a Medicare Savings Program.
D-SNP plans: Medicare and Medicaid under one plan
A Dual-Eligible Special Needs Plan is a Medicare Advantage plan built specifically for people with both Medicare and Medicaid. It coordinates benefits from both programs under one plan with one set of rules, often with a $0 premium since Medicaid or the plan itself covers most or all remaining cost-sharing. D-SNP availability varies by county, check your own county guide for the current count, or see the C-SNP guide for the related chronic-condition version of a Special Needs Plan.
Common questions about Medicaid and dual eligibility
What does "dual eligible" mean?
It means you qualify for both Medicare and Medicaid at the same time. Medicaid can help cover costs Medicare does not, such as premiums, deductibles, and copays, depending on your specific income and program.
I live in Bexar County and heard Medicaid and Medicare are changing in 2027. What does that mean for me?
Texas HHSC has announced that, starting January 1, 2027, Bexar County dual-eligible members will need their Medicaid (STAR+PLUS) plan and their Medicare Dual-Eligible Special Needs Plan (D-SNP) to be run by the same company. Some members may need to pick a new D-SNP or a new STAR+PLUS plan to keep both aligned, watch for a notice from HHSC and call us if you want help understanding your options.
What is QMB and what does it cover?
Qualified Medicare Beneficiary (QMB) is a Medicare Savings Program for people with the lowest incomes among duals. It covers your Part A premium (if any), Part B premium, deductibles, coinsurance, and copays, so most Medicare cost-sharing is covered.
What are SLMB and QI?
Specified Low-Income Medicare Beneficiary (SLMB) and Qualifying Individual (QI) are Medicare Savings Programs for people with somewhat higher incomes than QMB allows. Both cover only your Part B premium, not deductibles or copays. QI has limited annual funding and is first-come, first-served each year.
What is Extra Help?
Extra Help is the Part D Low Income Subsidy. It can eliminate your Part D deductible, cover your premium up to a regional benchmark, and cap your drug copays at roughly $5.10 for generics and $12.65 for brand-name drugs in 2026. Apply through Social Security.
What is a D-SNP?
A Dual-Eligible Special Needs Plan is a type of Medicare Advantage plan built specifically for people who have both Medicare and Medicaid. It coordinates both programs’ benefits under one plan, often with a $0 premium since Medicaid or the plan covers most or all of your cost-sharing.
How do I apply for a Medicare Savings Program or Extra Help?
Apply for Medicare Savings Programs through your state Medicaid office, and for Extra Help through Social Security at ssa.gov or by calling 1-800-772-1213. You can also apply for both around the same time, a licensed agent or a benefits counselor can help you gather what you need.
Sources
- Texas Health and Human Services Commission
- Medicare.gov: Medicare Savings Programs
- Medicare.gov: Extra Help
Figures verified 2026-10-01.