Orlando Harmon
Medicare is a federal health insurance program for people aged 65 and over. Those under 65 may also be eligible if they have a disability, End-Stage Renal Disease (ESRD), or ALS (Lou Gehrig's Disease). Medicare beneficiaries on a low income may qualify for additional support through a Medicare Savings Program (MSP). MSPs are run by individual states and help cover the costs of Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) premiums, deductibles, coinsurance, and copayments. To qualify for an MSP, applicants must meet income and asset requirements, which vary by state. Some states have higher income limits than the federal baseline, and certain types of income or resources may not be considered when determining eligibility.
| Characteristics | Values |
|---|---|
| Medicare Savings Programs | Help pay for Part B premiums (must have Part A and Part B to qualify) |
| Income limits are slightly higher in Alaska and Hawaii | |
| You may qualify even if your income or resources are higher than the federal limits listed | |
| Your state determines which program(s) you qualify for | |
| You must apply every year to stay in the QI Program | |
| Qualified Medicare Beneficiary (QMB) program | Covers Parts A and B premiums, deductibles, coinsurance, and copayments |
| Specified Low-Income Medicare Beneficiary (SLMB) program | Covers Part B premiums |
| Qualifying Individual (QI) program | Covers Part B premiums; only available for people who don't qualify for any other Medicaid coverage or benefits |
| Qualified Disabled & Working Individual (QDWI) program | Covers Part A premiums |
| Supplemental Security Income | A program through Social Security for certain people with lower incomes |
| Insure Kids Now | A health insurance program for children under 19 |
| Medicaid | A joint federal and state program that helps cover medical costs for some people with limited income and resources |
| Extra Help/Part D Low-Income Subsidy (LIS) | A federal program that helps pay for some to most of the costs of Medicare Part D prescription drug coverage |
| State Pharmaceutical Assistance Programs (SPAPs) | Offered in some states to help eligible individuals pay for prescriptions; most require enrollment in a Medicare Part D plan and application for Extra Help |
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What You'll Learn
Medicare Savings Programs
The Qualified Medicare Beneficiary (QMB) program is for people with income less than 100% of the Federal Poverty Level (FPL) and resources under $9,660 if single, and $14,470 if married. QMB covers Medicare premiums (Part A, if applicable, and Part B), deductibles, copayments, and/or coinsurance.
The Specified Low-Income Medicare Beneficiary (SLMB) program is for people with income over the SLMB limit, which is typically higher than the QMB limit. SLMB covers Part B premiums, but those enrolled are still responsible for their Medicare deductibles and co-insurance.
The Qualified Individual-1 (QI-1) program is for people who don't qualify for any other Medicaid coverage or benefits. Those enrolled in QI-1 can visit doctors who accept Medicare, but this program does not provide Health First Colorado benefits.
The Qualified Disabled and Working Individuals (QDWI) program has the lowest income limits, with a limit of $4,000 for one person and $6,000 for a married couple.
It is important to note that income limits are slightly higher in Alaska and Hawaii, and some states do not count certain types or amounts of income or resources when determining eligibility. Additionally, you may need to reapply annually to maintain your enrollment in the program.
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Qualified Medicare Beneficiary (QMB) program
The Qualified Medicare Beneficiary (QMB) program is one of four Medicare Savings Programs (MSPs) sponsored by Medicaid. The program covers Medicare Part A and Part B premiums, deductibles, copayments, and coinsurance for people with limited income and assets.
In 2023, over 8 million individuals (more than 1 out of 8 Medicare beneficiaries) were in the QMB group. The QMB program is a great way to save money on doctor visits, hospital stays, and medical procedures. This program is one of the three MSPs that cover the entire Medicare Part B premium ($185 a month for most beneficiaries in 2025). This alone translates to an annual saving of $2,220. Since this premium is normally deducted from your Social Security check, having QMB means more money in your check every month.
To be enrolled in the QMB program, you must qualify for or be enrolled in Medicare Part A at a minimum. You must also meet strict income and asset limits. Most U.S. states use the general guidelines based on the Federal Poverty Guidelines (FPG), but some may set higher income limits or waive the asset guidelines altogether. These limits change each year.
You can apply for Medicare Savings Programs through your state. When you apply, your state determines which program(s) you qualify for. Even if you don’t think you qualify, you should still apply. You may qualify in some states for these programs even if your income or resources are higher than the federal limits listed. Contact your state to find out.
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Part D Low-Income Subsidy (LIS)
Medicare's Part D Low-Income Subsidy (LIS), also known as "Extra Help", is a program that assists low-income individuals in covering the costs of their prescription medications. This program is particularly beneficial for those who have limited income and resources and need help with their prescription drug expenses.
To be eligible for the LIS/Extra Help program, individuals must meet certain income requirements. Specifically, those with incomes up to 150% of the Federal Poverty Level (FPL) are eligible for assistance. Additionally, individuals who are enrolled in both Medicare and Medicaid, receive Supplemental Security Income (SSI), or qualify for a Medicare Savings Program will be automatically enrolled in the LIS/Extra Help program. It is important to note that income limits for these programs are slightly higher in Alaska and Hawaii compared to other states.
The application process for the LIS/Extra Help program can be completed through the Social Security Administration (SSA). Individuals can apply online or via a paper application obtained from their local SSA office. Once an application is submitted, a decision regarding eligibility is typically received within three weeks. Moreover, individuals can apply for Extra Help at any time before or after enrolling in Part D.
The LIS/Extra Help program provides significant financial support for prescription drug costs, including Part D premiums, deductibles, and copayments. The estimated average annual value of this assistance is $5,900 per person. Additionally, those enrolled in the program will pay no more than $12.15 in 2025 for each drug covered by their Medicare drug plan.
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State Pharmaceutical Assistance Programs (SPAPs)
Many states offer State Pharmaceutical Assistance Programs (SPAPs) to help residents pay for prescription drugs. Each program works differently, and eligibility criteria may vary. SPAPs may work in conjunction with Medicare Part D, covering premiums, deductibles, and copays. In some cases, you may be required to sign up for Medicare Part D to qualify for assistance from a SPAP.
To find out if your state offers an SPAP, visit www.medicare.gov. This website will also provide information on eligibility criteria and how to enrol. Alternatively, you can contact your state directly to enquire about SPAPs and other Medicare Savings Programs.
Medicare Savings Programs are offered by individual states to help pay for Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) premiums. These programs may also cover Medicare Part A and Part B deductibles, coinsurance, and copayments. Eligibility for these programs is typically based on income, with limits that may vary by state and increase annually. Some states do not consider certain types or amounts of income or resources when determining eligibility.
In addition to SPAPs and Medicare Savings Programs, there are other avenues for obtaining financial assistance with medical costs. Supplemental Security Income is a program offered by Social Security for certain individuals with lower incomes. Medicaid is a joint federal and state program that assists individuals with limited income and resources in covering medical expenses. The U.S. territories also have programs to help individuals with limited income and resources pay for Medicare costs.
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Medicaid
Medicare is the federal health insurance program for people aged 65 and over. If you are under 65, you may still be eligible if you have a disability, End-Stage Renal Disease (ESRD), or ALS (Lou Gehrig's Disease).
There are several Medicare Savings Programs (MSPs) that can help with the costs of Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) premiums, deductibles, coinsurance, and copayments. These programs are typically income-based, with limits that go up each year. The Qualified Medicare Beneficiary (QMB) program, for example, covers Parts A and B premiums, deductibles, coinsurance, and copayments. Similarly, the Specified Low-Income Medicare Beneficiary (SLMB) program covers Part B premiums. The Qualifying Individual (QI) program is another option for those who do not qualify for any other type of Medicaid coverage or benefits.
If you require assistance with prescription drug costs, the Extra Help program, also known as the Part D Low-Income Subsidy (LIS), may be able to help. This federal program assists with the cost of prescription drugs covered by Medicare Part D, including deductibles and copays. State Pharmaceutical Assistance Programs (SPAPs) are also available in some states to help eligible individuals with prescription costs.
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Frequently asked questions
The Medicare Savings Program is a program run by individual states that helps pay for Part A (Hospital Insurance) and Part B (Medical Insurance) premiums. The program might also pay for deductibles, coinsurance, and copayments.
Qualification requirements vary by state. In general, you must have income and resources below a certain limit, which changes annually. Some states do not count certain types or amounts of income or resources when determining eligibility.
The QMB program is a federal program that covers Parts A and B premiums, deductibles, coinsurance, and copayments.
The QI program is for people who do not qualify for any other Medicaid coverage or benefits. It covers Part B premiums.
The Extra Help program assists people with limited income and resources with the costs of Medicare Part D prescription drug coverage.
