Medicare Savings Programs: Get Help Paying Medicare Costs

Millions of Americans with Medicare struggle to afford premiums, deductibles, and cost-sharing — yet many don’t realize that government programs exist specifically to help cover these costs. Medicare Savings Programs (MSPs) are state-administered programs that pay some or all of your Medicare out-of-pocket costs if your income and assets are limited.

If you have Medicare and a modest income, you could save hundreds or thousands of dollars per year through an MSP. This guide explains exactly what each program covers, who qualifies under the 2026 limits, and how to apply at no cost.

What Are Medicare Savings Programs?

Medicare Savings Programs are state Medicaid programs designed to help people with Medicare who have limited income and resources. Unlike Medicaid itself (which provides full health coverage), MSPs specifically help pay for Medicare’s cost-sharing — premiums, deductibles, and coinsurance.

There are four levels of MSPs, each covering different costs and serving different income levels. States administer these programs, so the application process varies by state — but the eligibility income and resource guidelines are set federally and are similar across states. Many states are actually more generous than the federal floor, and a growing number have dropped the asset test entirely (more on that below).

The Four Medicare Savings Programs

1. Qualified Medicare Beneficiary (QMB) Program

The QMB program is the most comprehensive MSP. It covers:

Your Medicare Part A premium (if you pay one)
Your Medicare Part B premium ($202.90/month in 2026)
Medicare deductibles — the $283 Part B deductible and the $1,736-per-benefit-period Part A hospital deductible in 2026
Medicare coinsurance and copays

QMB is the strongest protection available: if you’re enrolled in QMB, healthcare providers who accept Medicare cannot bill you for Medicare cost-sharing at all — it’s illegal for them to do so under federal law, and if they try, you have the right to refuse payment. (See the billing-protection section below for what to do if you’re billed in error.)

2026 QMB Income Limits (federal floor, monthly):

Individual: $1,350/month (about $16,200/year)
Couple: $1,824/month (about $21,888/year)

2026 Resource limits (excluding your home, one car, and household goods):

Individual: $9,950
Couple: $14,910

Exact figures are updated annually and many states raise them, so always verify with your state Medicaid office. Note that the income limits already build in a standard $20 monthly “general income disregard,” which is why the actual cutoffs sit slightly above the published Federal Poverty Level.

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

The SLMB program covers your Medicare Part B premium ($202.90/month in 2026) but not other cost-sharing like deductibles and copays.

2026 SLMB Income Limits (federal floor, monthly):

Individual: $1,616/month (about $19,392/year)
Couple: $2,184/month (about $26,208/year)

Resource limits are the same as QMB ($9,950 individual / $14,910 couple).

If your income is between the QMB and SLMB limits, SLMB can save you $2,434.80 per year just on the Part B premium (12 × $202.90).

3. Qualifying Individual (QI) Program

The QI program also covers the Medicare Part B premium only, at roughly the same benefit level as SLMB. The difference is funding: QI is paid from a capped annual block grant and is given out on a first-come, first-served basis each year. If a state’s funding runs out before you apply, you may have to wait until the following year — and you cannot have QI at the same time as full Medicaid.

2026 QI Income Limits (federal floor, monthly):

Individual: $1,816/month (about $21,792/year)
Couple: $2,455/month (about $29,460/year)

Resource limits are the same as QMB and SLMB ($9,950 / $14,910).

Apply early in the calendar year to maximize your chance of receiving QI benefits.

4. Qualified Disabled and Working Individuals (QDWI) Program

The QDWI program is a niche but valuable benefit for people under 65 who:

Have a disability
Have returned to work
Lost premium-free Medicare Part A because their earnings exceeded the threshold

QDWI pays the Part A premium only (which can run over $500/month for someone who has to buy in). Because these are working people, the income test is more generous and applies large earned-income disregards.

2026 QDWI Income Limits (federal floor, monthly, including the $20 general and $65 earned-income disregards):

Individual: $5,405/month
Couple: $7,299/month

2026 QDWI Resource limits:

Individual: $4,000
Couple: $6,000

If you’re working with a disability and got a bill for Part A, this is the program to ask about — it’s one of the least-known benefits in all of Medicare. See our guide to Social Security disability benefits for how disability, work, and Medicare interact.

A Real Dollar Example: What QMB Saves in 2026

Consider Dorothy, a 72-year-old widow with $1,300/month in Social Security and $6,000 in a savings account. She qualifies for QMB. Here’s what the program eliminates for her in 2026:

Cost	Without QMB	With QMB
Part B premium (12 × $202.90)	$2,434.80	$0
Part B annual deductible	$283	$0
20% coinsurance on, say, $8,000 of outpatient care	$1,600	$0
One 4-day hospital stay (Part A deductible)	$1,736	$0
Approximate annual total	~$6,050	$0

On top of that, QMB makes Dorothy automatically eligible for Extra Help, wiping out most of her Part D drug costs too. For someone living on roughly $15,600 a year, that’s the difference between affording care and skipping it. This is why MSPs are among the highest-value benefits a low-income beneficiary can claim — and why leaving one unclaimed is so costly.

QMB Billing Protection: You Cannot Be Balance-Billed

One of QMB’s most important — and most frequently violated — protections is the federal balance-billing prohibition. Providers who accept Medicare are barred from billing QMB enrollees for deductibles, coinsurance, or copays for Medicare-covered services. This applies whether the provider is in or out of your plan’s network, and whether you have Original Medicare or a Medicare Advantage plan.

Improper billing is unfortunately common, often because a provider’s billing system doesn’t flag the patient’s QMB status. If you’re a QMB enrollee and receive a bill for Medicare cost-sharing:

Tell the provider you’re in the QMB program and ask them to stop billing you and refund any amount you’ve already paid.
Show proof of QMB status — your Medicaid card, an MSN (Medicare Summary Notice) showing QMB, or your award letter.
If it continues, call 1-800-MEDICARE to file a complaint. Medicare can contact the provider directly.

You are never required to pay these charges, even while a billing dispute is being sorted out.

How MSP Income Is Counted (and What Doesn’t Count)

A frequent reason people wrongly assume they don’t qualify is that they compare their gross income to the limits. MSPs use countable income, which is often lower. Key rules:

A flat $20/month is disregarded from almost any income (the general income disregard).
An additional $65 plus half of the remainder is disregarded from earned (wage) income — significant for people still working part-time.
Supplemental Nutrition Assistance Program (SNAP/food stamps), housing assistance, home energy assistance, and most income-tax refunds do not count.

Because of these disregards, someone whose paycheck or pension looks slightly over the limit may still qualify once countable income is calculated. When in doubt, apply — the state does the math.

The Resource Rules: What Counts and What Doesn’t

“Resources” in the MSP context refers to assets you own. Not everything counts:

Excluded from resources (not counted):

Your primary home (no matter its value)
One car
Household furniture and personal effects
Life insurance policies with a face value of $1,500 or less
Up to $1,500 in burial funds per person
Certain prepaid burial expenses

Counted as resources:

Bank accounts (checking and savings)
Certificates of deposit (CDs)
Stocks, bonds, and mutual funds
Any real estate you own besides your primary home

Many people who believe they don’t qualify are surprised to find that their resources — once excluded items are removed — fall within the program limits. The exclusion of your home is significant: even a homeowner with a substantial property value may qualify if their liquid assets are modest.

A major 2026 change: under federal rules that took effect in 2024 and were reinforced in 2026, states must now generally accept your self-attestation about resources rather than demanding bank statements for every account, streamlining a step that used to discourage applicants. And a growing list of states — including Alabama, Arizona, Connecticut, Delaware, Louisiana, Maine, Mississippi, New York, Oregon, Vermont, and the District of Columbia, among others — have eliminated the asset test entirely, basing eligibility on income alone. Check your state’s current rules; the federal figures above are only a floor.

How MSPs Interact With Extra Help (Part D LIS)

If you qualify for any Medicare Savings Program (QMB, SLMB, or QI), you are automatically enrolled in Extra Help — the federal Low-Income Subsidy (LIS) that slashes Part D prescription drug costs. You don’t file a separate application; the link is automatic.

A pivotal change took effect in 2024: the partial Extra Help tier was eliminated, so everyone who qualifies now receives the full subsidy (the income ceiling for full Extra Help rose to 150% of the Federal Poverty Level — roughly $23,475/year for an individual and $31,725 for a couple in 2026). Full Extra Help in 2026 provides:

$0 Part D deductible
Reduced or $0 plan premiums (if you choose a “benchmark” plan)
Capped copays: no more than $5.10 for generics and $12.65 for brand-name drugs — and as low as $1.60 generic / $4.90 brand for those also on Medicaid or with income below the poverty line
$0 copays once you hit the catastrophic threshold ($2,100 in out-of-pocket drug spending in 2026)
No Part D late-enrollment penalty, even if you signed up late

Stacking these benefits is what makes MSPs so valuable. Qualifying for QMB, for example, can eliminate your Part B premium, your Medicare deductibles, your cost-sharing, and most of your drug costs at once — easily $5,000–$7,000 a year in combined savings for someone with ongoing prescriptions. For more on how the drug benefit itself works, see our guides to Medicare Part D and the Part B vs. Part D drug split.

MSP vs. Full Medicaid: Dual Eligibility

MSPs are sometimes confused with full Medicaid. They’re related but distinct:

An MSP alone pays Medicare’s cost-sharing but does not add benefits beyond Medicare.
Full Medicaid (for those with lower income/assets) adds benefits Medicare doesn’t cover — most importantly long-term custodial care in a nursing home, plus dental, vision, and transportation in many states.

People who have both Medicare and full Medicaid are called “dual eligibles.” If you’re dual-eligible, you may be able to enroll in a Dual-Eligible Special Needs Plan (D-SNP) — a type of Medicare Advantage plan built for this population that coordinates both programs and often adds extra benefits at $0 premium. See our comparison of Medicare Advantage vs. Original Medicare for how those plans work. If long-term care is your concern, our guides to Medicaid planning for long-term care and long-term care insurance go deeper.

How to Apply

Applying is free. You can apply through:

Your state Medicaid office: Every state has a Medicaid agency that processes MSP applications. Search “Medicare Savings Program [your state]” or visit Medicaid.gov for state-specific contact information.
Your local Social Security Administration (SSA) office: SSA can accept MSP applications and forward them to your state Medicaid agency. (You can also use SSA’s online Extra Help application, which the SSA shares with your state to start an MSP determination.)
Medicare.gov/talk-to-someone: Medicare’s website can direct you to local help, including State Health Insurance Assistance Programs (SHIP) that offer free, unbiased help with MSP applications.
Your local SHIP counselor: SHIP counselors provide free one-on-one assistance with Medicare enrollment, plan selection, and benefit programs — including MSP applications. Find your local SHIP at medicare.gov/about-us/find-local-help.

When you apply, have ready:

Proof of income (Social Security statements, pension statements, recent tax returns)
Bank and investment account statements
Information about any other assets

What Happens After You Apply

Processing times vary by state but typically take 30–60 days. If approved:

For QMB, SLMB, or QI: Your state notifies Medicare, and your Part B premium is no longer deducted from your Social Security check (or you stop being billed for it). You should see the change within 1–3 months, and your Extra Help drug benefit usually starts the following month.
Retroactive coverage: SLMB and QI benefits can often be paid retroactively for up to three months before the application month if you qualified then — meaning a possible refund for recent Part B premiums. (QMB generally starts the month after approval, not retroactively.) Ask your state Medicaid office about its specific rules.
Renewal: MSPs are not permanent — most states require you to renew annually (a “redetermination”). Your state will send you a renewal notice. Respond to it: failing to renew means your benefits lapse even if you still qualify.

Are You Leaving Money on the Table?

Studies suggest millions of Medicare beneficiaries who qualify for MSPs are not enrolled. The programs are underutilized for several reasons:

Many people don’t know the programs exist
Some believe they earn “too much” without checking the actual limits or the income disregards
Some assume owning a home disqualifies them (it doesn’t)
The application process can seem daunting

If your monthly income is below roughly $1,800 (individual) or $2,500 (couple), it’s worth checking. Even if you don’t qualify for the full QMB program, the SLMB or QI programs could save you over $2,400 per year on Part B premiums alone — and unlock Extra Help on top.

IRMAA: The Higher-Income Surcharge (the Opposite of an MSP)

While MSPs help lower-income beneficiaries, the opposite mechanism applies to higher earners. The Income-Related Monthly Adjustment Amount (IRMAA) adds a surcharge to both Part B and Part D premiums for beneficiaries whose income exceeds certain thresholds.

In 2026, the Part B IRMAA surcharge ranges from $81.20 to $487.00 per month above the standard $202.90 premium, depending on income (based on your 2024 tax return). If your income has recently dropped because of a life-changing event — retirement, divorce, or the death of a spouse — you can appeal the surcharge using Form SSA-44. Our dedicated guide to IRMAA surcharges walks through every bracket and the appeal process.

Frequently Asked Questions

Can I have a Medicare Advantage plan and still get an MSP? Yes. MSPs and Extra Help work with both Original Medicare and Medicare Advantage. With QMB, your plan’s copays for Medicare-covered services are also covered, and you can’t be balance-billed. Many MSP enrollees are steered toward D-SNPs that coordinate the two programs.

Does an MSP affect my Social Security check? Positively. If you currently have the Part B premium deducted from Social Security, an MSP that covers Part B stops that deduction — so your monthly check goes up by $202.90 (2026).

What if I’m just over the income limit? Apply anyway. The published limits are a federal floor; many states set higher limits or have no asset test, and income disregards ($20 general, plus earned-income rules) frequently bring countable income under the cap. Only the state can make the final determination.

Is an MSP the same as Medicaid? No. An MSP pays your Medicare costs; full Medicaid adds coverage Medicare lacks (notably long-term custodial care). Some people qualify for both — see the dual-eligibility section above.

Will an MSP put a lien on my house or be recovered from my estate? MSP benefits (payment of premiums and cost-sharing) are generally not subject to Medicaid estate recovery. Estate recovery applies to long-term-care Medicaid, not to MSP-only assistance.

Key Takeaways

Medicare Savings Programs pay Part B premiums, deductibles, and cost-sharing for eligible lower-income Medicare beneficiaries — worth $2,400 to $7,000+ a year
QMB is the most comprehensive: it covers Part A and B premiums, deductibles, and all cost-sharing, and bars providers from billing you
2026 federal income floors (monthly): QMB $1,350/$1,824, SLMB $1,616/$2,184, QI $1,816/$2,455; uniform resource limit $9,950/$14,910 — and many states are more generous or have no asset test
Eligibility uses countable income after the $20 general (and earned-income) disregards, and your home is never counted
Qualifying for any MSP (QMB, SLMB, QI) automatically enrolls you in full Part D Extra Help — now a single full-subsidy tier since 2024
Application is free through your state Medicaid office, local SSA office, or a SHIP counselor
An estimated 1–2 million eligible beneficiaries are not enrolled — if your income is modest, check whether you qualify

For help comparing your Medicare coverage options more broadly, see our guides on Medicare Advantage vs. Original Medicare, Medigap plans compared, what Part B covers, and total healthcare costs in retirement. To make sure you enroll on time and avoid penalties, see our Medicare enrollment periods guide.

Sources

All sources are official government or nonprofit consumer resources, verified July 2026. Medicare and Social Security rules and dollar amounts change annually — confirm current figures at the links above before making decisions.