If Medicare premiums, medical bills, or prescription drug costs are stretching your budget, you may qualify for programs that help pay some of these expenses. You don’t necessarily have to be completely without savings to qualify. Eligibility depends on the program, your income and resources, and the rules in your state.
This article explains three options worth exploring: Medicare Savings Programs, Extra Help with prescription drug costs, and Medicaid for people who qualify for both Medicare and Medicaid.
You don’t have to wait for Medicare’s Annual Enrollment Period to apply for these financial assistance programs. Applications are generally accepted throughout the year.
1. Medicare Savings Programs (MSPs)
Medicare Savings Programs are state-administered programs that help eligible people pay certain Medicare expenses. Depending on the program, assistance may include your monthly Part B premium, your Part A premium if you owe one, and Medicare deductibles, copayments, and coinsurance.
There are four programs, each with its own eligibility requirements and benefits.
| Program | What it generally helps pay |
| Qualified Medicare Beneficiary (QMB) | Part A premium, if applicable; Part B premium; and Medicare deductibles, copayments, and coinsurance for covered services |
| Specified Low-Income Medicare Beneficiary (SLMB) | Part B premium |
| Qualifying Individual (QI) | Part B premium, subject to eligibility requirements and available program funding |
| Qualified Disabled and Working Individuals (QDWI) | Part A premium for certain people with disabilities who return to work and lose premium-free Part A |
What about income and savings limits?
Each program has different income limits, and some also have resource limits. Federal guidelines provide a starting point, but states may have more generous eligibility rules or disregard certain income and assets.
Limits change over time, so check the current figures with your state Medicaid office or on the official Medicare Savings Programs website.
Don’t assume you earn too much or have too much in savings without checking. Some resources may not count toward eligibility, and the rules vary by state.
You cannot simply choose whichever Medicare Savings Program you prefer. Your state determines which program you qualify for based on your circumstances.
An important protection for QMB beneficiaries
The Qualified Medicare Beneficiary (QMB) program offers particularly valuable protection. If you qualify, the program pays your Part B premium and, if you owe one, your Part A premium. Medicare providers also cannot bill you for Medicare-covered deductibles, coinsurance, or copayments.
This protection applies even if your provider does not participate in Medicaid.
What should you do if you receive a bill?
- Show your provider proof of your QMB status, such as your Medicare and Medicaid cards or other documentation.
- Explain that federal rules prohibit billing QMB beneficiaries for Medicare-covered deductibles, coinsurance, and copayments.
- If the problem continues, call Medicare at 1-800-MEDICARE (1-800-633-4227).
- If a debt collector is pursuing an improper QMB bill, you can submit a complaint to the Consumer Financial Protection Bureau or call 1-855-411-2372.
If you have already paid a bill that you should not have been charged, ask your provider to make a refund.
One important distinction: QMB does not itself pay your outpatient prescription drug costs. However, people enrolled in QMB automatically qualify for Extra Help, which reduces Medicare Part D prescription drug expenses.
- Extra Help: Assistance with Prescription Drug Costs
Extra Help is a federal program administered through the Social Security Administration. It helps people with limited income and resources pay Medicare Part D prescription drug costs.
Depending on your circumstances and plan, Extra Help can reduce or eliminate your Part D plan premium and deductible and lower what you pay for covered prescriptions.
Who qualifies?
Eligibility depends on your income and resources. The limits change, so check the official Social Security Administration Extra Help website for the figures that apply to the year you are reading this article.
You generally receive Extra Help automatically if you:
- Have full-benefit Medicaid.
- Receive Supplemental Security Income (SSI).
- Receive state assistance paying your Medicare Part B premium through a Medicare Savings Program.
If you qualify automatically, you generally do not need to submit a separate Extra Help application.
If none of these circumstances apply to you, you can apply directly through Social Security, online, by phone, or in person.
Don’t rule yourself out based on a quick estimate of your income or savings. Certain income and resources are excluded when eligibility is calculated. For example, your primary home and one vehicle generally are not counted as resources under Extra Help rules. Other exclusions may apply.
The rules for Extra Help are not identical to those for Medicare Savings Programs, so check each program separately.
Even if you think your income is slightly above the published limit, it may be worth asking Social Security or a free SHIP counselor whether you qualify.
- Dual Eligibility: Medicare and Medicaid
Some people qualify for both Medicare and Medicaid. They are often called dual eligible beneficiaries.
Medicare generally pays first for services covered by both programs, and Medicaid may help with remaining Medicare costs, depending on the person’s eligibility category and state rules. Medicaid may also cover certain services that Medicare does not.
For people with limited incomes and resources, this assistance can make a substantial difference in monthly expenses.
Can dual eligibility help you change Medicare plans?
It may. People who qualify for Medicaid or Extra Help generally have additional opportunities to change their Medicare prescription drug coverage during the year.
Certain people with full Medicaid benefits also have additional opportunities to enroll in eligible integrated Medicare Advantage plans that coordinate Medicare and Medicaid benefits.
However, these enrollment opportunities have specific rules. Dual eligibility does not give everyone unrestricted permission to switch any Medicare Advantage or Part D plan at any time.
Before changing plans, check with Medicare or your State Health Insurance Assistance Program (SHIP) to understand which enrollment options apply to you and whether a proposed plan covers your doctors, hospitals, and medications. Never cancel existing coverage until you have been accepted into a new coverage plan.
If your income or resources are limited, contact your state Medicaid office even if you have already investigated other assistance programs. You may qualify for help you haven’t previously received.
- Where to Apply
You don’t have to navigate these programs alone. Here are the best places to start.
- Medicare Savings Programs: Apply through your state Medicaid office. Application procedures and eligibility rules vary by state. Start with the official Medicare Savings Programs page.
- Extra Help: Apply through the Social Security Administration.
- Free, unbiased Medicare counseling: Contact your State Health Insurance Assistance Program (SHIP). SHIP counselors can help you understand eligibility, compare coverage options, and work through applications.
If you are unsure which program to ask about, a SHIP counselor or your state Medicaid office can help you identify the most appropriate starting point.
Don’t Assume You Have to Pay Everything Yourself
If you were turned down for assistance in the past, consider checking again. Your income, resources, household circumstances, or state eligibility rules may have changed.
These programs can reduce expenses month after month, potentially freeing up money for food, housing, utilities, and other essentials.
The bottom line: Don’t assume you must manage every Medicare expense on your own. A phone call or application could uncover assistance that makes healthcare more affordable.
Continue the series:
[Medicare Basic] · [Part A and Part B] · [Part D] · [Medigap] · [Medigap Plans: G, N, K, and L] · [Medicare Advantage Plans] · [Appeals]