Friday, November 25, 2022

How Do You Qualify For Medicare In Texas

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What Is The Texas Health Information Counseling And Advocacy Program

You CAN Qualify for Medicaid in Texas

If you are eligible for Medicare, the Texas’ Health Information, Counseling and Advocacy Program can help you enroll, find information and provide counseling about your options. This partnership between the Texas Health and Human Services system, Texas Legal Services Center and the Area Agencies on Aging trains and oversees certified benefits counselors across the state.

Helpful Resources For Texas Medicare Beneficiaries And Their Caregivers

Need help with your Medicare application in Texas, or have questions about Medicare eligibility in Texas? These resources provide free assistance and information.

  • The Health Information, Counseling, and Advocacy Program , with any questions related to Medicare coverage in Texas. Visit the website or call 1-800-252-9240.The Texas Department of Insurance has a resources page for Texas residents with Medicare coverage.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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Medicare Spending In Texas

In 2018, Original Medicares per-beneficiary spending in Texas averaged $11,627, which was 15 percent higher than the $10,096 national average. Texas had the second-highest average per-beneficiary costs in the country only Louisiana had higher average costs. Thats based on data that were standardized to eliminate regional differences in payment rates, but it did not include costs for Medicare Advantage.

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Medicare Statistical Trends In Texas

In 2018, approximately 3.9 million Texans received Medicare coverage. Take a look at these figures published by the Centers for Medicare & Medicaid Services:

  • 2,390,611 Texas beneficiaries enrolled in Medicare Part A and/or Part B
  • 1,552,275 Texas beneficiaries enrolled in a Medicare Advantage plan or other health plan
  • Of the 2,865,481 people who chose Medicare Part D coverage, more than 1.6 million beneficiaries enrolled in a stand-alone Medicare Prescription Drug Plan, while almost 1.2 people opted to get their Medicare prescription drug coverage from a Medicare Advantage plan that bundled medical and prescription drug coverage in their benefit offering.

As a Texan and Medicare beneficiary , perhaps you are wondering how much freedom of choice you have to match your Medicare coverage with your health-care needs today and in the future. The opportunities look bright in your home state. In 2018*

  • 177 Medicare Advantage plans are available statewide and offer a variety of benefit designs, premiums, and cost-sharing structures.
  • 100% of Texas Medicare beneficiaries have access to a Medicare Advantage plan.
  • 24 Medicare Prescription Drug Plans are available, and for those Medicare beneficiaries who had Part D prescription coverage in the past, 84% have access to a plan with a lower premium than they paid in 2017.
  • 32% of people with Medicare Part D receive Extra Help to help pay for their Part D coverage.

New To Medicare?

New To Medicare?

About Medicare In Texas

How to Apply to Medicaid

Beneficiaries in Texas can receive coverage through Original Medicare, Part A and Part B, and then add prescription drug coverage and/or a Medicare Supplement insurance policy for more comprehensive health insurance. Or they can join a private Medicare Advantage plan, also called Medicare Part C. These plans offer the at least the same amount of coverage as Medicare Part A and Part B , but may include other benefits, such as routine vision and dental, hearing, or prescription drug coverage.

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Medicare Eligibility At 65 And Older

The year you turn 65, you can apply for Medicare starting three months before your birth month until three months after. You generally have to meet three eligibility requirements to qualify for full Medicare benefits when you turn 65.

The chief requirement is that you must be a U.S. citizen or permanent legal resident who has lived at least five years in the United States.

In addition, you have to meet one of the following other requirements:

  • You or your spouse must have worked long enough to also be eligible for Social Security benefits or for railroad retirement benefits. This usually means youve worked for at least 10 years. You must also be eligible for Social Security benefits even if you are not yet receiving them.
  • You or your spouse is either a government employee or retiree who did not pay into Social Security but did pay Medicare payroll taxes while working.

Paying Medicare payroll taxes for 10 full years means you wont have to pay premiums for Medicare Part A, which covers hospital care.

You dont need the work credits to qualify for Medicare Part B, which covers doctor visits or outpatient services, or Medicare Part D, which covers prescription drugs. But everyone has to pay premiums for both.

You can still get Medicare if you never worked but it may be more expensive depending on your spouse or total work history.

Prepare for Medicare Open Enrollment

If I Give Away My House And All My Money

Not anymore. There is a 5-year look-back law now. Uncle Sam government will find your money and make you pay it back. You should consult an Elderlaw attorney specializing in Medicaid to understand the acceptable ways to “spend-down” assets to qualify for Medicaid as a low-income senior.

You can gift away some assets within limits to a beneficiary, but you should remember that these assets will no longer be in your control. Also remember that the leading type of elder abuse is financial, many times by a family member. Spousal poverty protection laws have been passed to allow the spouse of a senior who needs long-term nursing home care to maintain usually up to 50% of the couples assets.

To qualify for Medicaid in Texas, any interested individual must be an American Citizen, or an immigrant with legal and permanent residency status, and who is currently residing in the State of Texas.

Coverage can possibly begin from 3-months prior to the applications approval. Applications sometimes take longer than expected. You should ask about the usual approval timeframe when you submit your initial application for Medicaid coverage.

Follow these guidelines on how you qualify for Medicaid in Texas:

  • Chose the sub-program of the Texas Medicaid as applicable to your health needs. CHIP for Children Medicaid, STAR Medicaid Managed Care Program, STAR Plus Program and Womens Health Program are among the many sub-programs you can choose from.

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What If I Have Income From Work And Income That Is Not From Work

The two sources of income will be combined to arrive at whats deemed countable income. Not all of your work and non-work income counts as countable income though. Certain deductions are made.

First, take your total monthly non-work income and subtract $20. This is your countable non-work income total.

Non-Work Income – $20 = Countable Non-Work Income

Second, take your total monthly work income and subtract $65. Now divide that number by 2. That is your countable work income.

Work Income – $65 = Countable Work Income 2

Last, take the total you got for your countable non-work income and the total you got for your countable work income and add them together. This is the total COUNTABLE INCOME.

TOTALCountable Non-Work Income + Countable Work Income = Countable Income

You will qualify for SSI if the result is less than the monthly maximum SSI benefit .

For example, if the SSI benefit that applies to you is $749.50 , and your total countable income is $750, you qualify for a $1.00 benefit.

If the SSI benefit that applies to you is $750 , and your total countable income is $500.00, you qualify for a $250.00 benefit.

Overview Of Medicare In Texas

Medicare Supplement Plans Texas

Medicare is the United States federal health insurance program enacted in 1966 to cover hospital and medical expenses for beneficiaries. Over the years, Medicare has expanded its program to offer even broader coverage, often referred to as Medicare Part C and Medicare Part D coverage. In addition, Medicare coverage is delivered not only by the federal government, but also by private insurance companies that are contracted by Medicare to provide benefits to beneficiaries. With so many connecting parts and providers of coverage, choosing your Medicare coverage may seem a daunting exercise. To help you, weve pulled together some facts about the parts of Medicare and how they can work together in Texas to help you evaluate which Medicare coverage options are best for you.

Original Medicare is a federal program offered to individuals when they reach age 65, as well as certain people under 65 with disabilities or certain conditions, such as end-stage renal disease or Lou Gehrigs disease . Regardless of your health status or income level, you can get Original Medicare if you are a citizen or permanent, legal resident of the United States for at least five continuous years and meet the requirements for eligibility. The rules for Original Medicare in Texas are the same rules as those across the country. You can get personalized information about your eligibility and enrollment in Original Medicare from your local Social Security Office.

Original Medicare consists of two parts:

Read Also: What Is The Medicare Supplement Plan

How To Apply For Medicaid In Texas By Phone

While most people apply for Medicaid via the convenient online portal, there is a phone option for patients who either do not have access to the internet, or do not feel comfortable submitting such details through the web. To complete your Texas Medicaid application verbally, call 877-541-7905. You can receive TX Medicaid application assistance by phone Monday through Friday from 8 a.m. to 6 p.m.

Before you call in to apply for Medicaid by phone, it is important that you have all of the required information readily available. In the event you do not have all of the necessary details on hand, you can still submit your forms for Medicaid application, but expect a follow-up call to fill in any blanks.

After the representative has all the information he or she needs, you will be asked a few more questions to verify your identity. Once the Medicaid application process is complete, you will receive a phone call or a letter letting you know whether you qualify or not.

Discover all of the steps you must take when applying for Medicaid by .

Texas Medicaid Application And Qualifications

It is easy to confuse Medicaid with Medicare. The two programs are not without their similarities. One key difference is that Medicare is a federal program, whereas Medicaid is a state program with rules that vary depending on where you are. The other major difference is that Medicare is based largely on age and disability, while Medicaid is based largely on income.

Depending on your circumstances, you can be on both at the same time. Circumstances is the key word. Medicare tends to be long-term, if not permanent. Medicaid is often a shorter-term solution. There are other programs that are generally associated with Medicaid such as financial and grocery assistance. It is possible that if you have qualified for these other forms of assistance, Medicaid will be included.

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Where Can I Apply For Medicaid In Texas

Texass Medicaid program is overseen Texas Health and Human Services Commission . You can apply for Medicaid ABD benefits or an MSP using this website.

This page contains more information about applying for Medicaid.

Josh Schultz has a strong background in Medicare and the Affordable Care Act. He coordinated a Medicare ombudsman contract at the Medicare Rights Center in New York City, and represented clients in extensive Medicare claims and appeals. In addition to advocacy work, Josh helped implement federal and state health insurance exchanges at the technology firm hCentive. He has also held consulting roles, including at Sachs Policy Group, where he worked on Medicare and Medicaid related client projects.

Can I Be Enrolled In Medicare And Medicaid At The Same Time

TEXAS Medicaid Eligibility and Using Your Texas Benefits

Q: Can I be enrolled in Medicare and Medicaid at the same time?

A: In many cases, yes. Some Americans qualify for both Medicare and Medicaid, and when this happens, it usually means they dont have any out-of-pocket healthcare costs.

Beneficiaries with Medicare and Medicaid are known as dual eligibles and account for about 20 percent of Medicare beneficiaries . Dual eligibles are categorized based on whether they receive partial or full Medicaid benefits.

Full-benefit dual eligibles have comprehensive Medicaid coverage, while partial benefit dual eligibles receive help with Medicares premiums and cost sharing through a Medicare Savings Program .

The federal government oversees Medicare eligibility meaning it is the same in each state. But states set their own eligibility rules for Medicaid and the MSPs and income limits for these programs vary widely.

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Texas Medicaid Dental Coverage For Adults

Texas Medicaid Dental Coverage for Adults is provided by Dentaquest. It includes cleanings, fillings, crowns, and root canals and is available statewide. Adults and children can also get Texas Medicaid dental coverage through MCNA Dental. MCNA covers cleanings, exams, X-rays, fluoride, sealants, fillings, extractions, root canals, and dental emergencies.

How Does Ssi Decide My Benefit Amount

Eligibility for SSI depends on your income and resources.

Income is money that you earn, such as wages. Income also includes Social Security benefits, pensions, and food and shelter that you get without current employment. Your spouses income may be counted if your spouse does not get SSI. The more income you have, the less your SSI benefit will be.

Resources are things that you own and can turn into cash, and money that you already have. Property, stocks and bonds, and bank accounts are resources. Resources may be liquid or non-liquid.

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What Counts As Resources

To get SSI, your resources cannot be worth more than $2000 if single or $3000 for a couple. But you dont need to count everything you own.

You do not need to count:

  • The home that you live in and the land that it is on, regardless of size and value
  • Household goods and personal effects
  • Your car if used for transportation for you or a member of your household
  • Life insurance non-term policy with a face value of $1500 or less
  • Burial plots for you and your immediate family
  • Burial funds up to $1500 each for you and your spouse, less any excluded whole life insurance

Can I Select An Insurance Plan For My Medicare And Medicaid Benefits

Medicare Savings Program – Get Part B PAID

If you are dual eligible, you are can enroll in a dual eligible special needs plan that covers both Medicare and Medicaid benefits. These plans may also pay for expenses that Medicare and Medicaid dont over individually, including over-the-counter items, hearing aids, and vision or dental care.

Beneficiaries who are dual eligible can change between Original Medicare and Medicare Advantage or switch Part D plans at each quarter.

Read more about the Medicaid benefits available to Medicare enrollees.

Josh Schultz has a strong background in Medicare and the Affordable Care Act. He coordinated a Medicare ombudsman contract at the Medicare Rights Center in New York City, and represented clients in extensive Medicare claims and appeals. In addition to advocacy work, Josh helped implement health insurance exchanges at the technology firm hCentive. He also has held consulting roles, including at Sachs Policy Group, where he worked with insurer, hospital and technology clients.

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Medicare Eligibility In Texas

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More than 4 million Texans are enrolled in Medicare as of 2020,1 which is 14% of the states total population.2

But what does it take to qualify? Learn about your Medicare eligibility in Texas and the coverage options that are available to you.

And if youre ready to start comparing Medicare Advantage plans in Texas, you can do so with our innovative FitScore® technology right now! Get started reviewing your options.

Wic Program Benefits And Texas Snap

The WIC Program in Texas provides support to pregnant women and their newborn babies up until the childs fifth birthday. The program includes special breastfeeding assistance and nutritional classes . To be eligible, you must be considered at risk by a healthcare professional.

The WIC Program is similar to the SNAP program, which is the food stamp program for those in need. If you are eligible for SNAP, you can get your SNAP benefits installed right on your Lone Star Card, which you can then use like a credit card at stores that accept SNAP. SNAP is only for Texans with low income. It cannot be used to purchase tobacco, alcohol, or anything that you cant eat or drink. Most people can only receive SNAP benefits for three months every three years. If you work for at least 20 hours a week or are in job training, or if you are unable to work for any reason, you may be able to receive an extension.

These are the amounts of SNAP you can qualify for:

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