If you need help paying for Medicare-related costs, you could be eligible for a Medicare Savings Program (MSP).
Eligibility is based primarily on your income, assets and current Medicare coverage.
There are four primary MSP plans, each with slightly different types and levels of coverage and each with different requirements to assist you with paying Medicare costs.
Learn more about MSPs, and then reach out to Medicare Plan Finder if you have questions or need help with your application.
Qualifying for Medicare Savings Programs (MSPs)
To qualify for these assistance programs, you must meet your state’s limited income, resources, and assets restrictions.
Most states use the federal poverty level (FPL) as a guideline. Because income limits are based on the FPL, they can change annually. New limits are released early in the year and take effect on January 1.
If it appears that your income and assets are above the stated MSP guidelines, you should still apply.
You might still qualify for an MSP because some income and assets may not be counted when your eligibility is determined. Specifically, in all states, that includes:
The first $20 of your monthly income
The first $65 of your monthly wages
Half of your monthly wages (after the $65 is deducted)
Food stamps (Supplemental Nutrition Assistance Program (SNAP) support)
Alaska, Connecticut, the District of Columbia (DC), Hawaii, and Maine have higher income limits and residents may be able to qualify with slightly higher income and resource limits in these jurisdictions.
What Counts as a Resource or Asset?
Medicare clearly defines what counts as a resource or an asset for purposes of qualifying for an MSP.
Resources such as stocks, bonds or money in checking or savings accounts are included.
Your home, one car, furniture, personal and household items, life insurance with a cash value of less than $1,500, a burial plot, and up to $1,500 set aside for burial expenses are not included.
Alabama, Arizona, Connecticut, Delaware, DC, Mississippi, New York, and Vermont do not apply asset limits.
Because income limits and restrictions determine eligibility and vary from state to state, you should call your local Medicaid office or State Health Insurance Programs (SHIP) to find out if you qualify.
Qualified Medicare Beneficiary (QMB)
The QMB Program helps to pay for Medicare Part A and Part B premiums, deductibles, coinsurance, and co-payments.
You will not receive reimbursement for any payments you made before your QMB effective date. You will not receive a bill from Medicare after your QMB effective date.
If you receive Social Security benefits, your Part B premium will be covered by QMB and will no longer be deducted from your Social Security check.
Requirements in 2019 were:
Gross monthly income limits are 100% of the Federal Poverty Level plus $20 but may vary depending on your state.
- Individual monthly income of $1,061 or less (most states)
- Married monthly income of $1,430 or less (most states)
- Individual resources of $7,730 or less
- Married resources of $11,600 or less
To make sure your provider knows you’re in the QMB Program, be sure to show your Medicare or Medicaid card and your QMB card every time you get care.
Medicare providers are not allowed to bill you for services covered by Medicare. If you are billed in error, contact your provider and plan about the charges to see if they can rectify the situation for you.
If you qualify for the QMB Program, you automatically qualify for Low-Income Subsidy (Extra Help) assistance to pay for prescription drug coverage.
QI Program (Qualifying Individual Program)
The QI Program is a state program that helps people pay Part B premiums if they have Part A and meet income and asset restrictions.
If you receive Social Security benefits, your Part B premium will be covered by QI and will no longer be deducted from your Social Security check.
Also, when you start receiving QI Program aid, you may be reimbursed for your Part B premiums for up to three months before your QI Program effective date.
QI assistance is awarded on a first-come, first-serve basis. Priority is given to people who got QI benefits the previous year. You must also reapply every year. In addition, QI benefits are not awarded to those who qualify for Medicaid.
Requirements in 2019 were:
Gross monthly income limits are 135% of the Federal Poverty Level plus $20.
- Individual income of $1,426 or less (most states)
- Married couple income of $1,923 or less (most states)
- Single resources of $7,730 or less
- Married resources of $11,600 or less
Income limits for QI benefits are slightly higher in Alaska and Hawaii.
If you qualify for the QI Program, you automatically qualify for Low-Income Subsidy (Extra Help) assistance to pay for prescription drug coverage.
Specified Low-Income Medicare Beneficiary (SLMB) Program
The SLMB Program is administered by individual states and helps pay Medicare Part B premiums for people who have Medicare Part A and meet income and asset limitations.
You may receive reimbursement for up to three months of Part B premium payments from before your SLMB effective date.
If you receive Social Security benefits, your Part B premium will be covered by SLMB and will no longer be deducted from your Social Security check.
Requirements in 2019 were:
Gross monthly income limits are 120% of the Federal Poverty Level plus $20.
- Single income of $1,269 or less
- Married income of $1,711 or less
- Single resources of $7,730 or less
- Married resources of $11,600 or less
Income limits for SLMB benefits are slightly higher in Alaska and Hawaii.
If you qualify for the SLMB Program, you automatically qualify for Low-Income Subsidy (Extra Help) assistance to pay for prescription drug coverage.
Qualified Disabled and Working Individuals (QDWI) Program
The QDWI Program helps pay your Medicare Part A premiums.
You may be eligible for QDWI benefits if:
- You’re a working disabled person under 65
- You lost your premium-free Part A when you went back to work
- You aren’t getting medical assistance from your state (mainly Medicaid)
- You meet the income and resource limits required by your state
Requirements in 2019 were:
- Individual monthly income of $4,249 or less
- Married couple monthly income of $5,722 or less
- Individual resources of $4,000 or less
- Married couple resources of $6,000 or less
Qualifying for Low-Income Subsidies (Extra Help)
If you qualify for QMB, SLMB, or QI, you will also automatically qualify for Low-Income Subsidies (LIS). The LIS Program is more commonly referred to as “Extra Help.”
If you are already enrolled in Medicaid, Supplemental Security Income (SSI), or a Medicare Savings Program (MSP), you automatically qualify for Extra Help even if you don’t meet Extra Help’s eligibility requirements.
If you don’t get any of these benefits, you can apply for Extra Help through the Social Security Administration either online or with a printed application.
Extra Help provides assistance for prescription drug plan costs like Part D premiums up to a state-specific benchmark amount, as well as deductibles, coinsurance, and co-payments.
Extra Help also eliminates any Part D late enrollment penalty you might otherwise have incurred if you held off signing up for Part D.
You can qualify for full or partial Extra Help depending on your income level and assets. If you are denied Extra Help assistance, you have the right to appeal the decision.
If you use Extra Help, you need to use pharmacies in your network and use prescriptions in your plan’s formulary.
Medicare Savings Programs Application Process
When you apply for MSPs, you will apply for all of the MSP programs listed above at the same time.
You will apply through your state Medicaid program. You can view your state’s MSP website here. Each state’s application process is different because MSPs are tied direction to state-funded Medicaid.
Most states will actually allow you to apply for Medicaid, MSPs, and other health care and financial programs all at the same time.
When you apply for health insurance assistance, you may need legal documentation such as your Social Security Administration card, your Medicare card, your birth certificate (or passport/green card), and proof of your address and income.
If you have qualifying assets and resources, you may need proof for those as well (bank statements, life insurance policies, stocks, etc.).
The Medicare Savings Program application is different in every state because the programs are tied directly to Medicaid, which is state-funded.
Most states will allow you to apply for Medicaid, MSPs, and other health care and financial programs all at the same time.
After you file a Medicare Savings Program application, you should receive a “Notice of Action” within 45 days. This notice will tell you whether or not you have been approved.
If your application is approved, you will be automatically enrolled in the program that most aligns with your qualifications. Your benefits will begin on the month indicated on your Notice of Action (this is usually the following month).
If you are denied, you can request a hearing.
If you don’t receive a reply within 45 days, contact your state Medicaid office to check on the status of your application.
