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If you live in Texas and rely on public health insurance, there's still time to determine your 2024 eligibility for Medicaid or Medicare and enroll for coverage if you qualify.

Around 10 million Texas residents received public health insurance in 2023, with around 5.9 million receiving Medicaid and another 4.6 million enrolled as Medicare beneficiaries, according to state and federal data.

Here's what you need to know if you're aiming to renew your enrollment or check your eligibility for either program for 2024:

What are Medicaid and Medicare?

Medicaid and Medicare are both “entitlement” programs, meaning anyone who meets the state's eligibility criteria has a right to enroll and receive insurance coverage.

Medicaid is a public health insurance program for low-income families, children, people with disabilities and some seniors. Both federal and state government funds pay for Medicaid and each state administers its own Medicaid program. Broad federal guidelines have allowed states to devise and administer programs that often vary widely in their eligibility and benefits policies.

The Child Health Insurance Plan (CHIP) provides coverage for children without health insurance whose families make enough to disqualify them from Medicare eligibility, but not enough to pay for health insurance.

Medicare is the federal government's health insurance program for anyone age 65 or older and for people of any age with certain disabilities. Eligible Texas residents have two Medicare options to choose from:

1. Original Medicare is the Medicare program administered directly by the federal government. It has two parts: Part A covers inpatient hospital care, hospice care and certain home health costs. Part B covers outpatient health expenses from general doctor visits and from specialists.

2. Medicare Advantage (often called Medicare Part C) programs are offered by a private company that contracts with the federal government. These plans include both Parts A and B from Original Medicare and often offer additional benefits. In 2024, there are 376 different Medicare Advantage plans available in Texas.

How do I check if I'm eligible?

To be eligible for Medicaid in Texas, you must:

1. be a Texas resident and maintain U.S. citizenship, permanent residency or legal alien status;
2. qualify as either low income or very low income; and
3. be one of the following:

- Pregnant,

- Blind,

- Have a disability or a family member with a disability in your household,

- Be responsible for a child 18 years old or under.

Although the open enrollment period for Medicaid ended Jan. 16, people with very low incomes, who have recently experienced certain major life events or lost health insurance coverage can still apply and potentially qualify for enrollment in 2024.

To find out if you can still enroll for Medicaid or if your children can qualify for CHIP in 2024, use the federal government's online eligibility screening tool. After answering a few questions about your 2024 income and certain recent life changes, the site will tell you what coverage you are likely eligible for, if any.

The federal government has also added a special Medicaid enrollment period for the 1.7 million-plus Texas residents disenrolled from Medicaid in 2023.

In response to the pandemic, all states from March 2020 through March 2023 were required to stop disenrolling Medicaid beneficiaries who no longer qualify for the program. Reviews of all Medicaid enrollees' eligibility restarted in April 2023 as part of the federal government's “unwinding” of the continuous coverage rule. As of last month, more than 2 million Texans have lost their health insurance since unwinding began, according to state data.

A special enrollment period specifically for people who lost coverage during the unwinding of continuous coverage has been created in response. If you lost Medicaid or CHIP coverage after March 31, 2023, you have until July 31, 2024 to apply for a competitively-priced health insurance plan through the federal government's Health Insurance Marketplace. You can access the Marketplace and submit your application here.

Texas moms will also receive expanded Medicaid eligibility in 2024, after the federal government approved the state's application to extend coverage for low-income moms in January. Starting March 1, 2024, anyone whose pregnancy ended within the months before March 1 will remain eligible for Medicaid coverage for 12 months after the end of their pregnancy.

To be eligible for Medicare, you must be a U.S. citizen or permanent resident, 65 years of age or older and have lived in the U.S. for at least five years. Ten years of employment spent paying federal Medicare taxes are also required to qualify. Spouses of Medicare beneficiaries also qualify for the program.

People with certain disabilities are also eligible for Medicare coverage, even if they are younger than 65. To qualify for disability-based Medicare, you must also be eligible for Social Security Disability Insurance (SSDI). You can see if you qualify for SSDI here.

I'm eligible! How do I enroll for benefits?

If you have confirmed your eligibility, you can apply for Medicaid and CHIP in the following ways:

1. Visit the Texas Benefits website, select ‘Apply' under the ‘Apply for benefits' section, and submit your application.
2. Request a paper form to complete and submit by mail, or print the form from the Benefits website and submit it by mail. Paper applications can be submitted to the nearest Texas Health and Human Services benefits office. Locate one here.
3. Call 2-2-1 Monday through Friday from 8 a.m. to 6 p.m. CT.

Medicare-eligible Texans must sign up for coverage through the Social Security Administration. The applications for Medicare Parts A, B and C are all available here.

Beneficiaries can also qualify for Medicaid to help pay for Medicare premiums, prescription drug costs and other care-related expenses. Learn more about dual eligibility requirements and benefits in Texas here.

What if I'm not eligible for Medicaid or Medicare in Texas?

If you or your family members do not meet eligibility requirements for Medicaid or Medicare, you may still be eligible for subsidized health insurance through the Affordable Care Act's (ACA) Health Insurance Marketplace. Applicants must hold legal status in the U.S. but do not need to be U.S. citizens to qualify for a subsidized plan under the ACA.

Subsidy and tax credit eligibility through the Marketplace is determined through multiple factors, including income and access to employer-based insurance. You can use HealthInsurance.org's Subsidy Calculator to estimate your monthly subsidy based on your current income, family size and other data points.

Though the annual open enrollment period for marketplace plans closed on Jan. 16, people who have experienced certain qualifying life events can still submit applications and be enrolled in a subsidized plan for 2024. If you have experienced any of the events listed here and have been found ineligible for Medicaid or Medicare, you can submit your application for a subsidized plan on the ACA marketplace here.

Who can I call with questions?

For questions or help with Medicaid and CHIP services, it's best to contact your health plan first, using the phone number on your health plan ID card. If you don't have a health plan or cannot locate your ID card, call the Medicaid Helpline at 800-335-8957.

If you're looking for Medicare-related help, you can call the Texas Medicare Hotline at 800-252-9240.

The Texas Health Information, Counseling and Advocacy Program helps Texans with both Medicaid and Medicare eligibility, enrollment, benefits and more. You can find a local office and locate nearby health care service providers here.

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