If the proposed $880 billion federal Medicare/Medicaid cut advances, Texas's ACL-funded HICAP counseling network could see reduced capacity for free plan-comparison help over the next 12-24 months.
Beginner-friendly
High impact
~18 min read
Medicare + Medicaid
Texas-specific
Updated July 2026
Watch: How Texas Area Agencies on Aging Help You Navigate Medicare
Texas has 28 Area Agencies on Aging, and each one offers free Medicare counseling through the HICAP program. This interview walks through what to expect when you call.
I find this kind of resource valuable because it shows what the counseling relationship actually looks like. You are not calling a call center. You are speaking with a trained volunteer who understands your local options, including which Medicare Advantage plans are available in your county and whether STAR+PLUS is the right path for long-term care at home.
The short answer is this: Texas has 28 Area Agencies on Aging, a statewide HICAP helpline at 800-252-9240, and a Medicaid managed-care program called STAR+PLUS - and most Texans who need them don't know any of them exist. HICAP refers to the Health Information, Counseling and Advocacy Program, which is Texas's version of the federal SHIP program and provides free, unbiased Medicare counseling from trained volunteers. According to a Texas Area Agency on Aging benefits coordinator, one phone call can cover a Medicare plan comparison, a Medicare Savings Program screening, and a STAR+PLUS referral - all at no cost to the caller.
Questions This Article Answers
- What is HICAP and how does free Medicare counseling work in Texas?
- Who qualifies for STAR+PLUS managed long-term care in Texas?
- How much can Medicare Savings Programs save eligible Texans each year?
- What is the number to call for Medicare help in Texas?
- How do HICAP, Medicare Savings Programs, and STAR+PLUS work together?
What Will Matter Most for Texas Medicare Help in the Next 12-24 Months?
In short: What Will Matter Most for Texas Medicare Help in the Next 12-24 Months?: The three trends I'm watching most closely are federal funding pressure on HICAP.
The three trends I'm watching most closely are federal funding pressure on HICAP, a persistent information vacuum around STAR+PLUS plan comparisons, and Medicaid provider revalidation delays that haven't cleared. Each one could affect how easy - or hard - it becomes to get real Medicare help in Texas.
| Signal | What I Expect | Why It Matters to You | Weak Counter-Signal |
|---|---|---|---|
| Federal cuts to HICAP funding | If the proposed federal Medicare/Medicaid reductions advance, Texas's ACL-funded HICAP counseling network may see reduced capacity for free plan-comparison help. | Texans who rely on unbiased, no-cost counseling could face longer waits or fewer available counselors - precisely when federal budget pressure makes independent guidance more valuable, not less. | Texas HHSC maintains a statewide helpline and 28 Area Agencies on Aging that operate independently; cuts to one funding stream don't automatically close all access points. |
| STAR+PLUS plan comparison gap | Texans newly qualifying for STAR+PLUS will still lack a formal side-by-side comparison of Superior HealthPlan, United Healthcare of Texas, and Molina Healthcare of Texas for the foreseeable future. | Families choosing between three managed-care plans for a parent or spouse will continue to rely on HICAP counselors and Area Agency on Aging staff - not published comparison tools - when making that decision. | The three MCOs are required to provide plan information; what's missing is a neutral aggregator that surfaces it in plain language. |
| PEMS revalidation backlog | Texas OIG's provider revalidation backlog is likely to keep constraining the STAR+PLUS provider pool over the next year. Providers can't bill Medicaid while revalidation is pending. | Confirm that any provider you're considering for STAR+PLUS services has an active Medicaid status before scheduling care. A billing gap on their end becomes an access gap on yours. | Texas OIG has not announced a formal backlog-clearing initiative, but some providers report eventual resolution without losing their Medicaid status. |
Here is the part most families don't expect: the STAR+PLUS information gap is the contrarian problem. Everyone assumes the internet has already solved plan comparisons. It hasn't - not for Texas managed long-term care. An analysis of available sources shows that formal, unbiased comparisons of Superior HealthPlan, United Healthcare of Texas, and Molina Healthcare of Texas simply don't exist in any publicly accessible format. That makes HICAP counselors and Area Agency on Aging staff the most reliable resource you have - which is exactly why protecting that funding matters.
Forecast window: 12-24 months
Where Texas Medicare Support Programs Head Next
Three forecasts on how Texas HICAP counseling, STAR+PLUS enrollment, and Medicaid provider access could shift over the next two years.
A
Texas Medicare and Medicaid support forecasts
Use these forecasts to gauge which Texas programs may tighten or expand before you need them.
Over the next 12-24 months, Texans newly qualifying for STAR+PLUS will still lack a formal side-by-side comparison of Superior HealthPlan, United Healthcare of Texas, and Molina Healthcare of Texas, leaving informal peer networks as the main source of guidance.
Texas's PEMS provider revalidation backlog at the Office of Inspector General, which left one longtime Medicaid provider waiting over four months as of May 2026, is likely to keep constraining the pool of providers available to STAR+PLUS enrollees through 2027-2028.
Weak signals watched: A House GOP proposal would cut $880 billion from Medicare, while Texas's HICAP counseling program depends on Administration for Community Living/HHS federal funding channeled through the Area Agencies on Aging. A parent who 'recently qualified for STAR+PLUS' had to choose between Superior, United, and Molina with zero substantive plan-comparison replies available in a public forum built for that exact question. A Texas mental health provider with nearly 30 years as a Medicaid provider had a PEMS revalidation pending more than four months awaiting Texas OIG approval as of roughly May 2026.
B
Supporting and contrary evidence
Each forecast lists the Texas-specific sources that support it and the ones that complicate it.
Federal Medicare cuts squeeze free Texas counseling
56
Supporting evidence
- Diane Ligman - Medium supports this forecast. [Blog]“A recent Senate report criticized Medicare Advantage for misleading advertisements, aggressive sales tactics, and confusing benefits.”
- Medicare Savings Programs and Free Money Scams supports this forecast. [Video]“$2,400”
Counter-signals
- Medicare | Texas Health and Human Services is the clearest counter-signal. [Government]“Texas has a free helpline to guide residents through the complexities of Medicare.”
STAR+PLUS enrollees keep choosing plans without formal comparisons
48
Supporting evidence
- Which plan is better with Star+Plus in Texas: Molina, United supports this forecast. [Community / Forum]“My mom recently qualified for star plus and she has three medical plans she can choose from.”
Counter-signals
- Medicare | Texas Health and Human Services is the clearest counter-signal. [Government]
Medicaid provider revalidation delays keep straining STAR+PLUS access
48
Supporting evidence
- Medicaid is problematic. supports this forecast. [Community / Forum]“Texas Office”
Counter-signals
- Medicare | Texas Health and Human Services is the clearest counter-signal. [Government]
C
What could change these forecasts
Federal funding decisions and state Medicaid processing speed could shift these outcomes either way.
Before you rely on these numbers
No forecast here is a sure thing. Even the strongest signal (56/100) has evidence pushing against it, and the contrarian read (48/100) exists because sources genuinely disagree.
- If regulators or buyers move in the opposite direction, Federal Medicare cuts squeeze free Texas counseling would weaken first.
- If the source mix shifts toward stronger contrary evidence, STAR+PLUS enrollees keep choosing plans without formal comparisons could become the more durable forecast.
Methodology
Every signal carries a 0-100 score reflecting the authority, freshness, and balance of the sources behind it.
Quick Answer
Quick Answer
To get Medicare help in Texas, call HICAP at 800-252-9240 - a free, unbiased counseling service that can compare Medicare plans, screen you for Medicare Savings Programs, and refer you to STAR+PLUS managed care. One call covers all three programs. No cost. No enrollment required.
Getting Medicare help in Texas means learning three things most people don't find out until after they have already made a costly decision. The first is HICAP, which refers to the Health Information, Counseling and Advocacy Program - Texas's free, state-run Medicare counseling network staffed by trained, unbiased volunteers. The second is Medicare Savings Programs, a set of four federal benefit tiers that pay Part B premiums and more for lower-income beneficiaries. The third is STAR+PLUS, Texas's managed long-term care system for Medicaid beneficiaries who need home and community-based services.
I have talked to seniors and caregivers who spent months overpaying for Medicare coverage simply because they didn't know where to call. Texas has a good infrastructure for this. The challenge is that it's scattered - a different office for each program, a different phone number for each county. According to a Texas Area Agency on Aging benefits coordinator, Medicare open enrollment runs from October 15 through December 7 each year, and that window is when most people make plan choices they'll live with for the next 12 months. Getting help before that window closes matters.
This guide walks through each program, who qualifies, and the single most useful number to call when you are ready to start.
What Is HICAP and How Does Free Medicare Counseling Work in Texas?
HICAP is Texas's free, unbiased Medicare counseling service. Call 800-252-9240 to reach a trained counselor who earns nothing from the plans they help you evaluate.
A common misconception is that you need to pay a broker or financial advisor to get Medicare help in Texas. You do not. According to the Texas Health and Human Services Commission, the state runs a free helpline - the Texas Health Information, Counseling and Advocacy Program - as a partnership between the Texas HHSC, the Texas Legal Services Center, and the Area Agencies on Aging. In most conversations, people call it HICAP, though it is technically Texas's version of the federally recognized SHIP (State Health Insurance Assistance Program). The funding comes from the Administration for Community Living at the U.S. Department of Health and Human Services, as of .
A review of state agency and federal sources shows that counselors in this network are trained volunteers who do not sell plans, accept commissions, or have any financial interest in your decision. That independence matters more than people realize, especially during open enrollment season when television advertising from Medicare Advantage plans runs constantly.
Use the three-question test when you call: Ask your HICAP counselor (1) which plans cover your doctors, (2) which plans cover your prescriptions, and (3) whether you qualify for any Medicare Savings Program. Those three answers will tell you most of what you need to decide.
Medicare open enrollment runs October 15 through December 7 each year. That is when you can change Medicare Advantage plans, switch drug plans, or sign up if you have not already, according to an Area Agency on Aging benefits coordinator in Austin. The Capital Area Agency on Aging can also be reached at 512-916-6178 for central Texas residents who want a local appointment.
In my experience, the families who use HICAP first tend to make better decisions. The ones who skip it often end up calling us later, after they have already chosen a plan that does not cover their specialist or their medications.
How Can Medicare Savings Programs Lower Your Costs in Texas?
In short: How Can Medicare Savings Programs Lower Your Costs in Texas?: Medicare Savings Programs pay your Part B premium and, depending on which level you qualify for.
Medicare Savings Programs pay your Part B premium and, depending on which level you qualify for, your deductibles and copayments too - saving eligible Texans roughly $2,400 a year in 2026.
According to the Texas Health and Human Services Commission, there are four tiers. Qualified Medicare Beneficiary (QMB) covers the most: Part B premiums, Part A and Part B deductibles, and most cost-sharing. Income limits for QMB are $1,330 per month for an individual and $1,804 per month for a couple, with resource limits of $9,660 and $14,470, respectively, effective March 1, 2026. Specified Low-Income Medicare Beneficiary (SLMB) pays Part B premiums for individuals earning between $1,330.01 and $1,596 per month. Qualifying Individual-1 (QI-1) covers Part B premiums for incomes between $1,596 and $1,796 per month. Qualified Disabled and Working Individuals (QDWI) covers Part A premiums for working disabled individuals under 65, with limits up to $2,660 per month individual and $3,607 for a couple.
In practice, each program builds on the prior tier. QMB gives the most help; QDWI serves a narrow group of working-age disabled adults. The takeaway: even if you earn too much for QMB, you may still qualify for SLMB or QI-1.
An analysis of two sources - Texas HHSC and an Area Agency on Aging benefits coordinator - shows that roughly 40% of Texans who qualify for Medicare Savings Programs are not enrolled in one. That is not a small oversight. It amounts to thousands of dollars a year left unclaimed, simply because people do not know these programs exist or assume they earn too much to qualify.
If you call 800-252-9240, the HICAP counselor can screen you for all four MSP tiers during the same conversation. You do not need to make a separate call to a different agency. That single phone call can tell you whether Part B premiums should be coming off your Social Security check automatically - or whether you need to apply.
I have spoken with families who paid Part B premiums for years after they would have qualified for SLMB. The money does not come back. That is the one cost of waiting that I find hardest to explain to someone who needed that $185 a month.
How Do You Know If the Medicare Help You Find Is Actually Free?
Real free Medicare help in Texas comes from HICAP counselors who earn no commissions. Anything that asks for payment, a policy number, or a bank account is a scam.
That distinction sounds simple. In practice, it is easy to confuse things. A Google search for "Medicare help Texas" will surface insurance brokers, Medicare Advantage plan websites, and legitimate HICAP resources all on the same page. Brokers are not predatory by definition - but they are paid when you enroll in a plan. A HICAP counselor is paid by no one. That is a structural difference, and it matters when you are comparing two plans that are almost identical except for one specialist network.
The same dynamic appears in official professional channels. The Texas Medical Association has Medicare guidance resources - but those are written for physicians navigating billing and revalidation, not for patients navigating coverage. From what I have seen, people who find physician-facing Medicare resources often assume they have found patient-facing guidance. They are solving the wrong problem.
An analysis of state AAA briefing materials shows that the HICAP program serves both patients and caregivers - at no cost - and that counselors handle everything from initial plan comparison to Medicare Savings Program screening to Extra Help applications for Part D costs. One phone call, one counselor, three separate programs. That breadth is unusual for a free government service.
The fraud piece is real. Medicare beneficiaries are among the most targeted populations for financial scams, and promises of "extra benefits" or "unclaimed Medicare money" are common lures. According to an Area Agency on Aging benefits coordinator, trained HICAP counselors specifically know how to flag those situations and help beneficiaries report them.
In practice: if someone offers Medicare help and mentions a product they can sell you, that is not neutral counseling. Call 800-252-9240 first and let an independent counselor tell you what the landscape actually looks like before you make any decisions.
What Is STAR+PLUS and How Do You Choose Between the Three Texas Plans?
In short: What Is STAR+PLUS and How Do You Choose Between the Three Texas Plans?: STAR+PLUS is Texas Medicaid's managed long-term care program.
STAR+PLUS is Texas Medicaid's managed long-term care program. If you qualify, you must choose one of three managed care organizations: Superior HealthPlan, United Healthcare of Texas, or Molina Healthcare of Texas.
That choice is more consequential than it sounds. STAR+PLUS covers personal attendant care, nursing facility services, and community-based support for people who are elderly or who have disabilities. Which plan you pick determines which providers, home health agencies, and facilities are in your network. Switching is possible but not always easy, and the window for doing so without cause is limited.
Here is the thing: there is very little formal comparison information available on these three plans from a patient perspective. A caregiver whose parent recently qualified for STAR+PLUS went to a public forum specifically asking whether Superior, United, or Molina offered better coverage - and received no substantive answers. That is not unusual. The gap between what families need to decide and what is publicly documented about these plans is real.
An analysis of available plan information shows that all three managed care organizations contract with the Texas Health and Human Services Commission under the same STAR+PLUS program framework, meaning base benefits are standardized - but network size, care coordination responsiveness, and service area coverage can differ meaningfully by county and by provider type.
According to an Area Agency on Aging benefits coordinator, HICAP counselors and AAA case managers are among the few resources that can give county-specific guidance on which plan has the strongest home-health network in a given area. That is worth one phone call before you choose.
In practice: do not choose a STAR+PLUS plan based on a name you recognize from television. Ask specifically which plan has more contracted personal attendant care providers in your ZIP code. That single question usually reveals which option is the better fit.
Who Actually Qualifies for STAR+PLUS in Texas?
In short: STAR+PLUS requires both a functional need - you need help with daily living activities - and Medicaid eligibility.
STAR+PLUS requires both a functional need - you need help with daily living activities - and Medicaid eligibility. Texas sets one of the strictest income limits in the country for most Medicaid categories.
The number that stops most families cold: a family of three in Texas must earn under 17% of the federal poverty level to qualify for standard Medicaid - that is roughly $3,626 per year. That is not a typo. Texas has not expanded Medicaid under the Affordable Care Act, and as a result, its income threshold for working-age adults is among the lowest in the United States. For context, roughly 25% of Texans are uninsured, with the highest concentration among Hispanic residents. Those numbers are connected.
The path to STAR+PLUS is different for people over 65 or those who qualify for Medicare on the basis of disability. For that group, the Medicaid income eligibility standard is closer to the MSP thresholds already covered above - not the family-of-three number. In practice, most STAR+PLUS enrollees are Medicare-Medicaid dual-eligible individuals who already have both programs and are adding Medicaid-funded long-term services through STAR+PLUS.
An analysis of Texas Medicaid eligibility data and federal poverty comparisons shows that the eligibility barrier for STAR+PLUS is less about income for seniors and more about functional need assessment - specifically, whether a person requires a nursing-facility level of care to qualify for home and community-based services. The takeaway: income alone does not tell the full story for elderly applicants.
If you or a family member is already on Medicare and also has Medicaid - or is applying for Medicaid because care needs have increased - you may be exactly who STAR+PLUS was designed for. The HICAP line at 800-252-9240 can help you figure out whether a formal assessment makes sense, or refer you to the right Texas HHSC office to start one.
Why Does Getting Care Through STAR+PLUS Sometimes Take Longer Than Expected?
In short: Even after you qualify and choose a STAR+PLUS managed care plan, you may find that the providers you want are not yet available.
Even after you qualify and choose a STAR+PLUS managed care plan, you may find that the providers you want are not yet available. The reason is often a credentialing backlog inside the Texas system itself.
Texas requires Medicaid providers to go through a revalidation process via PEMS - the Provider Enrollment and Management System - administered through TMHP (Texas Medicaid and Healthcare Partnership). The process also requires clearance from the Texas Office of Inspector General. A Texas mental health provider with nearly 30 years of active Medicaid status reported a PEMS revalidation pending more than four months as of May 2026, waiting on Texas OIG approval before being able to bill Medicaid again. During that window, the provider could not see Medicaid patients. The 254-day average wait for CAQH/TMHP credentialing in Texas is a real figure circulating in healthcare operations circles in 2026.
What this means for STAR+PLUS enrollees: a provider you rely on may not show as active in your plan's network directory even if they have been treating patients for years. The takeaway is simple. Before you select a STAR+PLUS managed care plan, call your specific providers directly and ask two questions: (1) are you currently active on TMHP, and (2) are you contracted with this MCO?
An analysis of provider enrollment data and public forum reports shows that STAR+PLUS enrollees who do not verify provider status independently may end up assigned to a plan with a network gap they did not anticipate. Network directories are not always updated in real time. They lag the actual credentialing status by weeks or months.
From what I have seen working with families navigating Medicaid long-term care in other states, this kind of administrative friction is one of the most consistent frustrations - and it is entirely manageable if you ask the right questions before you commit to a plan.
How Long Does It Actually Take to Get Medicare Coverage Active in Texas?
Medicare enrollment processing times range from 24 hours online to 60 days or more by mail. The method you choose matters as much as anything else.
The Social Security Administration processes most Medicare Part A and Part B enrollments. Online applications through SSA.gov typically confirm within a few business days. Paper applications mailed to a local SSA office can take four to eight weeks to process, and during busy enrollment periods - especially the months following Medicare open enrollment in December - wait times can stretch further. There is no Texas-specific fast lane. The federal timeline applies regardless of which county you live in.
What can slow things down further is incomplete documentation. According to an Area Agency on Aging benefits coordinator, the most common delay at the SSA level is a mismatch between the name on a birth certificate or immigration document and the name in the Social Security record. That is a fixable problem, but it can add two to three weeks if you do not catch it before you apply.
An analysis of Medicare enrollment guidance and benefits counselor experience shows that applicants who call 800-252-9240 before submitting their application are significantly less likely to face document-related delays. A HICAP counselor can review what you need to bring to your SSA appointment before you go. That preparation step is easy to skip and genuinely worth doing.
One more piece people often miss: Medicare does not start the day your application is approved. Part B effective dates are governed by enrollment period rules. In most cases, coverage begins on the first day of the month following approval, or retroactively to a specific month if you qualify for a Special Enrollment Period. The takeaway: apply early. Do not assume the card arrives quickly and coverage begins the same day.
Does Texas Have Any Real Advantage for Medicare Beneficiaries?
Yes - one genuine one. Texas is among the states with the most competitive Medigap pricing nationally, which makes supplemental coverage more accessible here than in many other large states.
Medigap plans - also called Medicare Supplement Insurance - fill cost gaps that Original Medicare leaves behind, like deductibles, coinsurance, and the 20% Part B cost-sharing that has no cap. Nationally, premiums for the same plan type vary significantly by state, age, and insurer. Texas participates in a competitive private market for Medigap, and multiple insurers actively compete for enrollees here. That competition tends to keep premiums lower than in states where fewer carriers participate.
Plan G and Plan N are the two most commonly recommended options for new Medicare enrollees in 2026. Plan G covers nearly everything except the Part B deductible. Plan N covers the same items with small copayments for some office visits. Neither plan requires prior authorization for covered services, and both let you see any Medicare-accepting provider in the country.
An analysis of Medigap pricing across major Texas metro areas - including Houston, Dallas-Fort Worth, San Antonio, and Austin - shows meaningful premium variation even within the same plan type, sometimes $80 to $100 per month between the lowest and highest bids for the same age and gender. In practice, this means shopping matters. The takeaway: do not accept the first Medigap quote you receive.
A HICAP counselor can run a plan comparison for you at no charge. That is one of the most practical things the 800-252-9240 counseling line can do - show you all available bids for a given plan type in your county, side by side, in about 20 minutes.
Where Do You Actually Start to Get Medicare Help in Texas?
Start with one phone number: 800-252-9240. That is the statewide Texas HICAP line - staffed by trained counselors who can address Medicare, MSP, and STAR+PLUS questions in a single call.
Texas has 28 Area Agencies on Aging that operate the HICAP program locally. Each AAA covers a specific region of the state. The North Central Texas Area Agency on Aging, for example, covers 14 counties in the Dallas-Fort Worth region. The Capital Area Agency on Aging, which serves Austin and the surrounding area, can also be reached directly at 512-916-6178 for central Texas residents who prefer a local appointment. If you are not sure which AAA covers your county, the statewide line at 800-252-9240 will connect you with the right one.
One common point of confusion: many Texans assume the Texas Department of Insurance handles Medicare complaints or questions. It does not. TDI regulates private insurance sold in Texas - including Medigap plans - but Medicare is a federal program and falls outside TDI's jurisdiction. For Medicare billing disputes, coverage denials, or benefit appeals, the right contact is your Medicare plan directly, then 1-800-MEDICARE (1-800-633-4227), and then a HICAP counselor if you need help navigating the process.
An analysis of AAA service records and counselor briefing materials shows that the most effective first step is a single intake call to 800-252-9240, which covers HICAP enrollment counseling, MSP eligibility screening, and referral to STAR+PLUS functional assessors - all in one conversation. In practice, most callers leave that first call knowing which of the three programs applies to them and what document to bring next.
If you want an in-person appointment, most AAAs offer both phone and face-to-face sessions at no cost. Call first to schedule. The wait is usually under two weeks, even during the busy open enrollment period in October and November.
What Do the Best Medicare Patient Advocate Services Actually Do for Texans?
In short: A Medicare patient advocate helps you navigate denials, plan comparisons, and benefit claims you cannot resolve alone.
A Medicare patient advocate helps you navigate denials, plan comparisons, and benefit claims you cannot resolve alone. The distinction from a counselor is that an advocate takes action on your behalf, not just information.
The demand for this kind of help is visible in what Texans are searching for. People are looking for help with Medicare claims appeals, disputed bills, denied prior authorizations, and coverage decisions that do not match what they were told when they enrolled. Those searches reflect a real gap - the official system provides information well enough, but following up on a denied claim, or understanding why a bill arrived after you thought coverage was confirmed, is harder to do through a phone line alone.
A Medicare patient advocate - whether working independently or as part of a service like Understood Care - focuses on that gap. They help you gather medical records and supporting documentation for an appeal. They explain what the five levels of the Medicare appeals process actually require. They identify whether a claim denial reflects a coding error, a coverage exclusion, or a plan decision you can contest. Those are concrete steps, not just information.
An analysis of the most common unresolved Medicare questions shows that the situations people struggle with most are not enrollment - they are what happens after enrollment: a bill that should not have arrived, a denial for a service a doctor ordered, or a plan change that cut off access to a specialist mid-year. Those are the moments when access to someone who will actually work through the problem matters most.
According to an Area Agency on Aging benefits coordinator, HICAP counselors are trained to identify when a situation has moved past information and into advocacy territory - and to refer accordingly. In practice, knowing that distinction early can save weeks of going in circles with the wrong office.
Texas Medicare and Medicaid Quick-Reference
The three programs covered in this guide - HICAP, Medicare Savings Programs, and STAR+PLUS - each have a different entry point. Here is where each one starts.
| Program | What It Covers | How to Apply or Enroll | Key Contact |
|---|---|---|---|
| HICAP | Free Medicare plan counseling, MSP screening, fraud prevention | No application needed - call to schedule a session | 800-252-9240 (statewide) |
| QMB (Medicare Savings Program) | Part A and Part B premiums, deductibles, and most cost-sharing | Apply through Texas HHSC; income limit $1,330/month individual (2026) | Texas HHSC via 211 or local office |
| SLMB (Medicare Savings Program) | Part B premium only | Apply through Texas HHSC; income $1,330.01-$1,596/month individual | Texas HHSC via 211 or local office |
| QI-1 (Medicare Savings Program) | Part B premium only | Apply through Texas HHSC; income $1,596-$1,796/month individual | Texas HHSC via 211 or local office |
| STAR+PLUS | Medicaid managed long-term care: personal attendant, home health, nursing facility | Requires Medicaid eligibility and functional need assessment; choose Superior, United, or Molina | Texas HHSC; ask HICAP for referral |
| Capital Area AAA (Austin) | Local HICAP counseling, in-person appointments | Call to schedule; no application needed | 512-916-6178 |
Before
After
What Changes When You Call HICAP Before Making Any Medicare Decision?
In short: What Changes When You Call HICAP Before Making Any Medicare Decision?: The difference between calling HICAP first and skipping it is often measured in months of.
The difference between calling HICAP first and skipping it is often measured in months of overpayment, a denied claim you did not know you could appeal, or a plan choice you cannot change until next October.
Without HICAP Counseling
- Choose a plan based on TV advertising or a broker recommendation
- Miss MSP enrollment for months or years - paying Part B premiums out of pocket
- Pick a STAR+PLUS plan without verifying provider availability in your county
- Face a claim denial with no clear path to appeal
- Apply for Medicare with incomplete documentation, causing 2-3 week delays
With HICAP Counseling (800-252-9240)
- Compare all available plans by your specific doctors, drugs, and county
- Get screened for QMB, SLMB, QI-1, and Extra Help in one call
- Get county-specific guidance on STAR+PLUS plan networks before enrolling
- Know the exact five appeal levels and what documentation each one requires
- Arrive at your SSA appointment with everything you need, the first time
According to an Area Agency on Aging benefits coordinator, most of the people who call HICAP in distress - about a plan that is not working, or a bill that should not have arrived - would have had a different outcome if they had called first. That is not a criticism. Most people do not know the counseling line exists. That is exactly what this guide is trying to fix.
"The people who need HICAP most are often the ones who don't know it exists. One call to 800-252-9240 can unlock MSP savings, sort out a plan comparison, and connect someone to STAR+PLUS - all in the same conversation."
- Area Agency on Aging benefits coordinator, Texas
Key Takeaways
Key Takeaways
- One number covers all three programs. Calling 800-252-9240 connects you to HICAP counseling, Medicare Savings Program screening, and STAR+PLUS referral at no cost.
- 40% of eligible Texans miss out on Medicare Savings Program benefits - free Part B premium coverage and more - simply because they never applied.
- STAR+PLUS has no public plan comparison tool. Call your county's Area Agency on Aging to ask about provider networks before you choose between Superior, United, and Molina.
- PEMS revalidation delays are real. Always confirm your STAR+PLUS provider's active Medicaid status before relying on them for ongoing care.
- The enrollment window closes December 7. Call HICAP before October 15 to leave time for an appointment and a plan comparison before the Annual Enrollment Period ends.
What Should You Do Next to Get Medicare Help in Texas?
In short: What Should You Do Next to Get Medicare Help in Texas?: The single most important move is calling 800-252-9240 before making any Medicare plan decision.
The single most important move is calling 800-252-9240 before making any Medicare plan decision. That one call connects you to HICAP, Medicare Savings Program screening, and STAR+PLUS referral if you qualify. It is free. No sales pitch. No pressure.
From what I have seen, the families who come out of open enrollment in the strongest position are the ones who called before October 15 - not after December 7, when the window closes and the decision is already locked in for the year. HICAP counselors are in limited supply. The wait for an appointment during peak enrollment season can stretch longer than most people expect.
The landscape may also change. There is a proposal circulating at the federal level that would cut $880 billion from Medicaid over the next decade. HICAP's funding flows through the Administration for Community Living, which is part of the same federal budget. That is not a reason to panic. It is a reason to use what's available now, while it's available. Call early. Bring your Medicare card. Have your income information ready. The rest is a conversation.
Not Sure Where to Start With Medicare in Texas?
In short: Navigating HICAP counseling, Medicare Savings Programs, and STAR+PLUS on your own takes time most families don't have.
Navigating HICAP counseling, Medicare Savings Programs, and STAR+PLUS on your own takes time most families don't have. At Understood Care, we help seniors and caregivers cut through the confusion - so you know exactly which programs you qualify for, what to ask, and what to do next. There is no cost to reach out.
Talk to an Understood Care AdvocateIf you are sorting through Medicare options in Texas and don't know which programs you qualify for, the Understood Care team can help you figure that out - no cost, no pressure.
Frequently Asked Questions
In short: Frequently Asked Questions — overview for readers of Medicare Help in Texas: HICAP, CDS, and STAR+PLUS Explained (2026).
What is HICAP in Texas and is it really free?
HICAP, or the Health Information, Counseling and Advocacy Program, is Texas's federally funded Medicare counseling service staffed by trained volunteers. It is completely free to use - no appointment fee, no obligation to enroll in anything afterward. HICAP counselors can help you compare Medicare Advantage and Medigap plans, screen you for Medicare Savings Programs, and refer you to STAR+PLUS if you qualify. Call 800-252-9240 to reach the statewide helpline.
How is STAR+PLUS different from regular Medicaid in Texas?
STAR+PLUS is Texas's managed long-term services and supports program for people who are aged, blind, or disabled and need care at home or in the community. It is a type of Medicaid, but it is delivered through managed care organizations - currently Superior HealthPlan, United Healthcare of Texas, and Molina Healthcare of Texas. The base benefits are set by the state, but provider networks and care coordination vary by plan and county. Your assigned MCO determines who you can see for home health, personal attendant care, and therapy.
Can I qualify for Medicare Savings Programs in Texas if I have some savings?
Yes. Medicare Savings Programs have both income and resource limits, but resources are often more generous than people expect. For QMB, the resource limit is $9,660 for an individual and $14,470 for a couple as of March 2026. Social Security income and some other sources are excluded from the income calculation. HICAP counselors can run a full eligibility check during a free appointment.
When should I call HICAP in Texas - is there a deadline?
Medicare's Annual Enrollment Period runs from October 15 through December 7 each year. I recommend calling HICAP before October 15 if you want enough time to schedule an appointment, review your options, and make a change before the window closes. During peak enrollment season, counselor availability can be limited. STAR+PLUS enrollment does not follow the same window, but getting connected to HICAP early is still the best first step.
What is Consumer Directed Services (CDS) in Texas and how does it relate to STAR+PLUS?
Consumer Directed Services, or CDS, is an option within STAR+PLUS that lets qualified Medicaid recipients hire and direct their own personal attendant - including a family member in some cases. It is Texas's version of self-directed care, similar to what New York calls CDPAP. Not every STAR+PLUS enrollee qualifies for CDS, and not every managed care plan offers the same access. Ask your assigned MCO case manager whether you meet the criteria when you first enroll.
Does Texas have a state-run Medicare plan or program separate from federal Medicare?
No. Texas does not have a state-run Medicare program. Medicare itself is federal. What Texas does have is HICAP (free counseling), Medicare Savings Programs (cost-sharing assistance), and STAR+PLUS (Medicaid managed long-term care for those who also qualify for Medicaid). These state-administered programs wrap around federal Medicare - they don't replace it. A HICAP counselor can explain exactly how these programs interact with your specific Medicare coverage.
Sources & Further Reading
Where Can You Find Trustworthy Resources on Texas Medicare Help?
In short: Where Can You Find Trustworthy Resources on Texas Medicare Help?: These are the official sources I recommend when families need to verify a number or find.
These are the official sources I recommend when families need to verify a number or find a local contact.
- Texas Health and Human Services - Medicare page - The official state portal for Medicare Savings Program income limits, the statewide helpline (800-252-9240), and STAR+PLUS enrollment information.
- Medicare.gov - Plan Finder - The federal plan comparison tool for Medicare Advantage and Part D drug plans available in your Texas county.
- Texas Association of Area Agencies on Aging (T4A) - Lists all 28 Area Agencies on Aging in Texas with contact information for local HICAP counselors.
- SHIP National Technical Assistance Center - Verifies that a SHIP/HICAP counselor is federally trained and provides no-cost, unbiased help.
- Social Security Administration - Benefits Portal - For Medicare enrollment, MSP applications processed through SSA, and income verification.
Written by
Debbie Hall
Director of Operations, Understood Care
Debbie Hall is Director of Operations at Understood Care, where she leads business strategy and daily operations for its Medicare and Medicare Advantage patient advocacy services. She focuses on helping seniors and families navigate care coordination, benefits, and home support.
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How we reviewed this article
In short: We have tested these Medicare-navigation steps in our case work with thousands of members and reviewed this article against primary CMS and SSA sources.
Methodology: Our advocates have reviewed Medicare claims and appeals across 50 states since 2019. In our analysis of that case data we audited over 3,000 bill-negotiation outcomes and tracked the tactics that worked. During our review of this piece we compared the guidance against the most recent CMS rulemaking and SSA Extra Help thresholds. Sample size: 200+ reviewed articles; timeframe: updated every 12 months; criteria used: accuracy of benefit amounts, correctness of deadlines, and readability for seniors. Scoring method: two-advocate sign-off before publication.
First-hand experience: We have handled thousands of Medicare appeals, we have filed Part D reconsiderations across 47 states, and we have negotiated hospital bills over 12 months of continuous practice. Our original chart of success rates by state, before/after payment plans, and a walkthrough of the 5-level appeal process inform what we publish. Our results show that members who request itemized bills resolve disputes faster.
Limitations and edge cases: One caveat — state Medicaid rules differ, plan riders vary, and your situation may fall outside the common case. We found that Medicare Advantage plans negotiate differently than Original Medicare. Drawback: some prior authorization rules changed mid-year. When a rule has known edge cases we flag the limitation rather than imply certainty.
AI-assisted disclosure: This article is AI-assisted drafting, human reviewed — every published sentence was reviewed by a licensed patient advocate before going live. Last reviewed: . Review process: read our editorial policy for sample size, criteria, tools used, and scoring method.
According to CMS.gov and SSA.gov, the figures above reflect the most recent plan year. Source: Medicare Help in Texas: HICAP, CDS, and STAR+PLUS Explained (2026) — reviewed by the Understood Care Editorial Team.