Medicare Savings Programs and Extra Help: How to Get Help Paying for Medicare
Medicare is not free. Premiums, deductibles, copays, and Coinsurance, the costs we break down in our guide on Medicare out-of-pocket expenses, copays, and coinsurance, can add up to thousands of dollars a year. For people on fixed incomes, that adds up to a real burden.
What many people do not know is that help is available. Several programs exist specifically to reduce or eliminate Medicare costs for people with limited income and resources. Between them, these programs helped nearly 14 million Medicare beneficiaries in a recent year.
If you or someone you know is struggling with Medicare costs, this guide explains the main programs available, who qualifies, what they cover, and how to apply.
Overview: Two Types of Programs
There are two major categories of Medicare cost-reduction assistance:
Medicare Savings Programs (MSPs): State-administered programs that help with Medicare Part A and Medicare Part B costs (premiums, deductibles, coinsurance).
Extra Help (Low Income Subsidy): A federal program that helps with Medicare Part D prescription drug costs.
These programs are separate, have different qualification criteria, and are administered by different agencies. That said, many people qualify for both.
Medicare Savings Programs (MSPs)
Medicare Savings Programs are jointly funded by the federal government and states. They are administered by your state’s Medicaid agency.
There are four types of MSPs, each covering different costs and available to people at different income levels.
1. Qualified Medicare Beneficiary (QMB)
Who it helps: People with the lowest incomes
Income limit (2026 estimate): Up to 100% of the Federal Poverty Level (FPL), roughly $1,250/month for an individual, $1,688/month for a couple
Resource limits: Vary by state; generally $9,090 for an individual, $13,630 for a couple (some resources are excluded)
What QMB covers:
- Medicare Part A Premium (if applicable)
- Medicare Part B premium
- Part A and Part B deductibles
- Part A and Part B coinsurance and copays
QMB is the most comprehensive MSP. If you qualify, you should not be billed for Medicare cost-sharing on covered services. Providers are prohibited by law from billing QMB beneficiaries for Medicare deductibles, coinsurance, or copays.
If a provider is billing you for these costs and you are on QMB, you have the right to dispute the bill.
2. Specified Low-Income Medicare Beneficiary (SLMB)
Who it helps: People with slightly higher incomes than QMB
Income limit (2026 estimate): 100%–120% of FPL, roughly $1,250–$1,504/month for an individual
What SLMB covers:
- Medicare Part B premium only
If you qualify for SLMB, your state pays your Part B premium. This saves you the standard Part B premium amount ($185/month in 2026), potentially over $2,200 per year.
3. Qualifying Individual (QI)
Who it helps: People with incomes slightly above SLMB
Income limit (2026 estimate): 120%–135% of FPL, roughly $1,504–$1,693/month for an individual
What QI covers:
- Medicare Part B premium only
QI is similar to SLMB but available to a slightly higher income bracket. Note that QI is funded by Congress each year and has limited slots: first-come, first-served enrollment applies.
4. Qualified Disabled and Working Individuals (QDWI)
Who it helps: Disabled individuals who lost premium-free Part A coverage because they returned to work
What QDWI covers:
- Medicare Part A premium only
This is a narrower program for a specific situation. If you have a disability, returned to work, and now must pay for Part A, QDWI can help.
Summary: MSP Comparison
| Program | Income Range (Individual) | What It Pays |
|---|---|---|
| QMB | Up to 100% FPL | Part A + Part B premiums, deductibles, and coinsurance |
| SLMB | 100%–120% FPL | Part B premium only |
| QI | 120%–135% FPL | Part B premium only |
| QDWI | Up to 200% FPL (disabled only) | Part A premium only |
Note: Income and resource limits change annually. The figures above are estimates. Check with your state Medicaid agency for current limits.
Extra Help (Low Income Subsidy) for Part D
Extra Help, also called the Low Income Subsidy (LIS), is a federal program run by the Social Security Administration (SSA) that helps pay for Medicare Part D prescription drug costs.
What Extra Help Covers
If you qualify for Extra Help, you receive assistance with:
- Part D plan premium (reduced or eliminated)
- Annual drug Deductible (reduced or eliminated)
- Drug copays (significantly reduced)
Who Qualifies for Extra Help?
For 2026, you may qualify for Extra Help if:
- Your income is at or below 150% of the Federal Poverty Level: roughly $1,875/month for an individual or $2,534/month for a couple
- Your resources (savings, investments, real estate other than your home) are below limits: generally $17,220 for an individual, $34,360 for a couple
Automatic qualification: If you already receive full Medicaid, Supplemental Security Income (SSI), or a Medicare Savings Program (QMB, SLMB, or QI), you are automatically enrolled in Extra Help.
How Much Does Extra Help Save?
Extra Help beneficiaries pay significantly reduced amounts for prescriptions:
- Full Extra Help (lowest income): $0 Part D premium (if plan premium is at or below the benchmark), $0 deductible, and very low copays (around $1–$4 for generics, $3–$10 for brand-name drugs in 2026)
- Partial Extra Help (slightly higher income): Reduced premium, reduced deductible, and reduced copays
Given that prescription drug costs are one of the largest healthcare expenses for many retirees, Extra Help can save hundreds or even thousands of dollars per year.
How to Apply for These Programs
Applying for Medicare Savings Programs
MSPs are administered by your state Medicaid agency. To apply:
Contact your state Medicaid office. You can find your state’s contact information at Medicaid.gov or by calling 1-800-MEDICARE (1-800-633-4227).
Apply online through your state’s Medicaid portal in most states.
Apply in person at your local Department of Social Services or Medicaid office.
Get help from a SHIP counselor. Your State Health Insurance Assistance Program (SHIP) provides free, unbiased assistance and can help you complete applications.
Applying for Extra Help
To apply for Extra Help:
- Apply online at SSA.gov/extrahelp
- Call Social Security at 1-800-772-1213
- Visit your local Social Security office
- Ask a SHIP counselor to help with the application
You can apply for Extra Help at any time during the year. It is not tied to an enrollment period.
Applying for Both at the Same Time
If you apply for an MSP through your state Medicaid agency, your state may automatically forward your information to Social Security for an Extra Help determination. Ask your state agency about this.
Common Questions About MSPs and Extra Help
I think I might qualify, but I’m not sure. Should I apply anyway?
Yes. Many people who are unsure whether they qualify find out they do when they actually apply. There is no Penalty for applying and being denied. SHIP counselors can do a quick informal assessment to give you a sense of whether you are likely to qualify before you begin the formal process.
Do these programs look at assets like my home or car?
Many assets are excluded from resource limits, including your primary home, one car, burial funds up to certain limits, and household goods. The resource test is less restrictive than many people assume. Your home does not count against you.
If I qualify for QMB, do I still need a Medigap plan?
QMB provides very comprehensive protection. For many QMB beneficiaries, the combination of Medicare plus QMB coverage may be sufficient without adding a Medigap plan. However, every situation is different, and a licensed advisor can help you evaluate whether additional coverage makes sense.
Can I have both Extra Help and a Medigap plan?
Yes. Extra Help covers Part D drug costs; Medigap covers Part A and Part B cost-sharing. They address different gaps and can both apply.
What if my income or resources change?
MSPs require annual renewal. If your income or resources change significantly, notify your state Medicaid agency. If you lose eligibility, you may need to find other coverage for Part B premiums.
You May Qualify and Not Know It
One of the most consistent findings in Medicare policy research is that millions of people who qualify for these programs are not enrolled. Barriers include lack of awareness, concerns about stigma, and the perceived complexity of applying.
If you have limited income and are on Medicare, there is no downside to checking your eligibility. These programs exist specifically to help you.
A SHIP counselor in your state can screen you for eligibility at no cost, help you apply, and follow up if needed. To find your local SHIP, visit shiphelp.org or call 1-800-MEDICARE.
Bottom Line
Medicare Savings Programs and Extra Help exist to make Medicare affordable for people with limited income and resources. Between them, they can cover Part B premiums, deductibles, coinsurance, and prescription drug costs, potentially saving thousands of dollars per year.
These programs sit at the opposite end of the income spectrum from IRMAA, the income-related surcharge that raises Medicare costs for higher-income beneficiaries. Whether your income is low or high, it pays to understand how it affects what you owe Medicare.
If you are unsure whether you qualify, the answer is to apply or get a free assessment from a SHIP counselor. Many people discover they qualify for programs they did not know existed.
REMEDIGAP’s licensed advisors can also help you understand your coverage options and identify programs that may reduce your costs. Reach out for a free consultation.
This article is for educational purposes. Program income limits, resource limits, and coverage details change annually and vary by state. Confirm current information with your state Medicaid agency or at Medicare.gov.
💡 Your next step: If you don’t qualify for savings programs, compare whether a Medicare Supplement plan is worth the premium for your specific situation.
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Written by Michael Quinn
Licensed Broker, REMEDIGAP Founder
Fact Checked by Joann Quinn
Chief Compliance Officer
As a licensed insurance broker, REMEDIGAP upholds the principles of integrity in our editorial standards and ensures transparency in how we receive compensation from our insurance partners.