Medicare Savings Programs: How to Get Help Paying Medicare Costs

Medicare provides essential health coverage for over 67 million Americans, but the premiums, deductibles, and coinsurance can create a serious financial burden — especially for people living on fixed incomes. The standard Part B premium alone is $202.90 per month in 2026, and that does not include the costs you face when you actually use your coverage.

If you are struggling with Medicare costs, there is help available. Medicare Savings Programs (MSPs) are state-run programs that pay part or all of your Medicare expenses depending on your income and resources. Millions of people qualify but never apply — often because they simply do not know these programs exist.

This guide explains all four Medicare Savings Programs, the 2026 income and asset limits for each, what they cover, how to apply, and how they connect to Extra Help with prescription drug costs. We also clarify the important differences between MSPs and full Medicaid coverage.

What Are Medicare Savings Programs?

Medicare Savings Programs are federally mandated, state-administered Medicaid programs that help people with limited income and resources pay for their Medicare costs. They are part of the Medicaid program but serve a specific, narrow purpose: covering the premiums, deductibles, coinsurance, and copayments associated with Medicare Part A and Part B.

There are four distinct MSP levels, each with different income thresholds and benefit levels. The most generous program — QMB — covers nearly all Medicare cost-sharing, while the other three primarily help with premium payments. All four programs share one powerful benefit: automatic enrollment in Extra Help (the Low-Income Subsidy) for Part D prescription drug costs.

You apply for MSPs through your state Medicaid office, not through Medicare itself. There is no limited enrollment window — you can apply at any time during the year. And unlike many government programs, the application process is relatively straightforward.

The Four Medicare Savings Programs Explained

1. Qualified Medicare Beneficiary (QMB) Program

QMB is the most comprehensive Medicare Savings Program and provides the greatest financial relief. If you qualify, the state pays for all of the following:

• Part A premiums (if you have to pay them)
• Part B premiums ($202.90 per month in 2026)
• Part A deductible ($1,736 per benefit period)
• Part B deductible ($283 per year)
• All Medicare coinsurance and copayments

QMB essentially eliminates your out-of-pocket costs for Medicare-covered services. Providers who accept Medicare are legally prohibited from billing QMB beneficiaries for deductibles, coinsurance, or copayments. If a provider tries to bill you for these amounts, they are violating federal law.

2026 QMB income limit: Up to 100% of the federal poverty level — $1,275 per month ($15,300 per year) for an individual, or $1,724 per month ($20,688 per year) for a married couple.

2. Specified Low-Income Medicare Beneficiary (SLMB) Program

SLMB is designed for people whose income is slightly above the QMB threshold but still limited. The program pays your Part B premium only — it does not cover deductibles, coinsurance, or copayments. In 2026, this means the state pays $202.90 per month on your behalf, saving you $2,434.80 per year.

While SLMB does not cover cost-sharing at the point of care, it still provides significant relief. The Part B premium is the single largest recurring Medicare expense for most beneficiaries, and having it paid by the state frees up over $200 per month for other necessities.

2026 SLMB income limit: Between 100% and 120% of the federal poverty level — $1,275 to $1,530 per month ($15,300 to $18,360 per year) for an individual, or $1,724 to $2,069 per month ($20,688 to $24,828 per year) for a married couple.

3. Qualifying Individual (QI) Program

The QI program is similar to SLMB — it pays your Part B premium — but it covers people with slightly higher income. QI has one important difference from the other MSPs: it is funded through a limited annual block grant from Congress, which means funding could theoretically run out. In practice, Congress has renewed QI funding every year since the program began, and beneficiaries who apply early in the year are prioritized.

Another key distinction: QI requires annual reapplication. Unlike QMB and SLMB, which continue as long as you remain eligible, QI enrollment must be renewed each year. You cannot receive QI benefits and full Medicaid at the same time — if you qualify for full Medicaid, you would receive that coverage instead.

2026 QI income limit: Between 120% and 135% of the federal poverty level — $1,530 to $1,721 per month ($18,360 to $20,652 per year) for an individual, or $2,069 to $2,327 per month ($24,828 to $27,924 per year) for a married couple.

4. Qualified Disabled and Working Individuals (QDWI) Program

QDWI is the most specialized of the four programs. It applies only to people under 65 who have a disability, were previously entitled to Medicare Part A based on disability, and lost their premium-free Part A coverage because they returned to work and their earnings exceeded the substantial gainful activity limit. QDWI pays only the Part A premium — not the Part B premium, deductibles, or cost-sharing.

This program serves a small but important population: disabled individuals who want to continue working but would otherwise face a Part A premium of up to $565 per month in 2026 because their work disqualified them from premium-free coverage.

2026 QDWI income limit: Up to 200% of the federal poverty level — $2,550 per month ($30,600 per year) for an individual, or $3,448 per month ($41,376 per year) for a married couple.

2026 Income and Asset Limits at a Glance

Here is a summary of the income thresholds for all four programs in 2026, based on the federal poverty level guidelines. These are the federal minimum thresholds — many states set their limits higher, so you may qualify even if your income slightly exceeds these amounts.

• QMB: Income up to 100% FPL — $1,275/month individual, $1,724/month couple
• SLMB: Income 100%–120% FPL — $1,275 to $1,530/month individual, $1,724 to $2,069/month couple
• QI: Income 120%–135% FPL — $1,530 to $1,721/month individual, $2,069 to $2,327/month couple
• QDWI: Income up to 200% FPL — $2,550/month individual, $3,448/month couple

Asset limits: Following the Consolidated Appropriations Act of 2023, the federal government eliminated the asset test for QMB, SLMB, and QI programs effective January 1, 2024. This means your savings, investments, and other countable resources are no longer considered when determining eligibility for these three programs. However, QDWI still has an asset limit — $4,000 for individuals and $6,000 for couples in most states. Some states may still apply asset tests that are more generous than the old federal standard. Always check with your state Medicaid office for the most current rules.

What Each Program Pays For

Understanding exactly what each Medicare Savings Program covers is critical when evaluating your options. Here is a breakdown of the benefits by program level.

QMB covers: Part A premiums, Part B premiums, Part A deductible, Part B deductible, all Medicare coinsurance, and all Medicare copayments. This is the only MSP that covers cost-sharing at the point of care. A QMB beneficiary should pay nothing out of pocket for any service covered by Original Medicare.

SLMB covers: Part B premiums only. You remain responsible for deductibles, coinsurance, and copayments. In 2026, SLMB saves you $2,434.80 per year in Part B premium costs.

QI covers: Part B premiums only — identical to SLMB in terms of benefits. The difference is purely in the income threshold and the requirement to reapply annually.

QDWI covers: Part A premiums only. This program does not pay Part B premiums, deductibles, coinsurance, or copayments. It is specifically for disabled workers who lost premium-free Part A when they returned to work.

Automatic Enrollment in Extra Help (Low-Income Subsidy)

One of the most valuable benefits of enrolling in any Medicare Savings Program is automatic qualification for Extra Help, also called the Low-Income Subsidy (LIS). Extra Help is a federal program administered by Social Security that reduces your Part D prescription drug costs. If you are enrolled in QMB, SLMB, QI, or QDWI, you do not need to apply separately for Extra Help — you are automatically enrolled.

Extra Help pays for part or all of your Part D plan premium, eliminates or reduces your Part D deductible, and lowers your copayments for prescription drugs to a few dollars per prescription. In 2026, full Extra Help means you pay no more than $4.50 for generics and $11.20 for brand-name drugs. Without Extra Help, you could face hundreds or thousands of dollars in annual drug costs even with the new $2,100 Part D out-of-pocket cap.

People who receive Extra Help also get special enrollment periods that allow them to switch Part D plans once per quarter during the first three quarters of the year. This flexibility is not available to standard Part D enrollees, who are generally locked into their plan choice for the calendar year.

How to Apply for Medicare Savings Programs

Medicare Savings Programs are administered by state Medicaid agencies, so the application process varies by state. However, the general steps are the same everywhere.

1. Contact your state Medicaid office. You can find your state's Medicaid agency by visiting Medicaid.gov or calling 1-800-MEDICARE (1-800-633-4227). Many states allow you to apply online, by mail, by phone, or in person.
2. Complete the application. You will need to provide information about your income (Social Security benefits, pensions, wages, investment income), resources (bank accounts, stocks, bonds — though asset tests have been eliminated for QMB, SLMB, and QI), and your Medicare enrollment status.
3. Provide documentation. Common documents include your Medicare card, Social Security benefit letter, recent bank statements, proof of any pension or retirement income, and a government-issued ID.
4. Wait for a determination. Most states process MSP applications within 45 days. If approved, benefits typically begin the month after your approval date. Some states backdate benefits to the month of application.

If you need help with the application, your State Health Insurance Assistance Program (SHIP) provides free, unbiased counseling. SHIP counselors can help you determine which program you may qualify for and assist with the paperwork. Call 1-877-839-2675 to find your local SHIP office.

Medicare Savings Programs vs. Medicaid: Key Differences

One of the most common points of confusion is the relationship between Medicare Savings Programs and Medicaid. While MSPs are technically part of the Medicaid program, they are not the same as full Medicaid coverage. Here are the key differences.

Medicaid is a comprehensive health insurance program for people with very low income. It covers a wide range of services including doctor visits, hospital stays, long-term care, nursing home care, home health services, and more. Eligibility rules and benefits vary significantly by state. If you qualify for both Medicare and full Medicaid, you are considered a "dual-eligible" beneficiary and receive the most extensive coverage available.

Medicare Savings Programs are narrower in scope. They help pay your Medicare premiums and, in the case of QMB, your Medicare cost-sharing amounts. They do not provide additional health coverage beyond what Medicare already covers. You can be enrolled in an MSP without having full Medicaid. The income limits for MSPs are higher than for full Medicaid in most states, which means many people who do not qualify for Medicaid may still qualify for an MSP.

The practical impact: if you qualify for full Medicaid, you already receive benefits that exceed what MSPs provide. If your income is too high for full Medicaid but still limited, an MSP can still save you thousands of dollars per year in Medicare premiums and cost-sharing. The two programs are not mutually exclusive, but MSPs serve a broader population with higher income limits.

Who Should Apply for a Medicare Savings Program?

You should consider applying for a Medicare Savings Program if you are enrolled in Medicare (or eligible for Medicare) and fall into any of these categories:

• Your monthly income is at or below $1,721 for an individual or $2,327 for a couple (QI threshold)
• You are having difficulty paying your monthly Part B premium of $202.90
• You are avoiding medical care because of Medicare deductibles and coinsurance
• You are a disabled worker under 65 who lost premium-free Part A after returning to work
• You want to qualify for Extra Help with Part D prescription drug costs

Even if you are unsure whether you qualify, it is worth applying. The application is free, and many states have income thresholds that exceed the federal minimums listed above. Some states also count income differently — for example, excluding certain types of income or applying income disregards that effectively raise the qualifying threshold.

Special Enrollment Rights for MSP Beneficiaries

Enrolling in a Medicare Savings Program gives you more than financial assistance — it also unlocks special enrollment rights that provide greater flexibility with your Medicare coverage choices.

MSP enrollees who also have Medicaid or Extra Help qualify for a Special Enrollment Period that allows them to switch Medicare Advantage plans or switch from Medicare Advantage back to Original Medicare once per quarter during the first nine months of the year (January through September). Standard Medicare beneficiaries can only make plan changes during the Annual Election Period (October 15 through December 7) or the Medicare Advantage Open Enrollment Period (January 1 through March 31).

This flexibility is especially valuable if you enroll in a Medicare Advantage plan that turns out to be a poor fit — perhaps your doctor leaves the network or the plan's drug formulary changes. Instead of being locked in until the next enrollment period, you can switch to a plan that better meets your needs.

Common Mistakes to Avoid

When it comes to Medicare Savings Programs, several common mistakes cause eligible beneficiaries to miss out on benefits they deserve.

• Assuming you do not qualify. Many people underestimate the income thresholds. The QI program covers individuals earning up to $20,652 per year. With state-specific disregards and higher limits, even more people may qualify. Always apply and let the state determine your eligibility.
• Confusing MSPs with full Medicaid. You do not need to qualify for full Medicaid to get an MSP. The income limits for MSPs are significantly higher, and the programs are specifically designed for Medicare beneficiaries who need help with premiums and cost-sharing.
• Not reporting QMB status to providers. If you have QMB, make sure every healthcare provider knows. Providers cannot legally bill you for Medicare cost-sharing, but they may not know you have QMB unless you tell them. Bring your Medicaid card or QMB documentation to every appointment.
• Forgetting to reapply for QI. Unlike the other MSPs, the QI program requires annual reapplication. If you miss the reapplication deadline, you will lose your Part B premium assistance until you reapply and are approved again.
• Not applying for Extra Help separately if you lose MSP status. If your income increases and you lose your MSP, you also lose automatic Extra Help. However, you may still qualify for Extra Help independently through Social Security if your income and resources remain below the Extra Help thresholds. File a separate application at ssa.gov to avoid a gap in prescription drug assistance.

The Bottom Line

Medicare Savings Programs are among the most underutilized benefits in the Medicare system. An estimated 2 to 3 million people who qualify for these programs have never applied. If you are enrolled in Medicare and your income is limited, an MSP could save you thousands of dollars per year in premiums alone — and QMB could eliminate your cost-sharing entirely.

The removal of asset tests for QMB, SLMB, and QI in 2024 expanded eligibility to millions more beneficiaries. If you were previously denied because of savings or retirement accounts, it is worth reapplying under the new rules. The application is free, there is no enrollment period, and the potential savings are substantial.

Contact your state Medicaid office to apply, or call your local SHIP at 1-877-839-2675 for free, unbiased help. Do not leave money on the table — these programs exist specifically to make Medicare affordable, and the only way to find out if you qualify is to apply.