Key Takeaways

  • Several core benefits programs can help low-income Medicare beneficiaries afford their health care, food, and prescriptions.

  • Programs like LIS/Extra Help, the Medicare Savings Programs (MSPs), and Medicaid can also help pay for the costs of Medicare.

  • Explore our handy "cheat sheet" to learn the basics of how these benefits programs' eligibility and funding work in our cheat sheet.

Medicare is a federal health insurance program for older Americans. But it's not free, and out-of-pocket costs for Medicare premiums, co-payments, co-insurance, and prescriptions can add up. Fortunately, there are programs available that can help Medicare beneficiaries afford their healthcare and prescriptions as well as other basic living costs.

This core benefits "cheat sheet" helps explain the way benefits for low-income Medicare beneficiaries are administered, and how basic eligibility is determined.

Learn which agencies (federal or state) fund the benefit and set eligibility criteria, and how the programs are delivered. Since some states set their own guidelines for programs, benefits counselors are encouraged to contact their state agency for specific guidance.

Benefits programs covered 

Click on one of the bullets below to be dropped down to the area showing more information about how these specific benefits are administered:

Core Benefits Cheat Sheet Printout (2024)

You can also find cheat sheet available to print that gets updated annually following the release of the Federal Poverty Guidelines (FPL).

Extra Help/Medicare Part D Low-Income Subsidy (LIS)

Federal

State

Sets Eligibility Criteria

Yes

Income Limits:

Up to 150% FPL

($1,883/mo for individuals and $2,555/mo for married couples)1 + $20 monthly income disregard per household

Resource/Asset Limits:
Up to $17,010 for singles
Up to $33,950 for married couples2

No

Caveat: People enrolled in Medicare Savings Programs are automatically deemed eligible for LIS; because states have the flexibility to establish more liberal (than federal) standards for MSPs, people in those states may be deemed for LIS based on those standards

Makes Eligibility Determinations

Yes

No

Caveat: The Medicare Modernization Act requires state Medicaid agencies to accept applications and determine eligibility for LIS, but there has been no federal enforcement

Delivers the Benefit

Yes, through subsidies paid to Part D plans

No, but some states supplement LIS via State Pharmaceutical Assistance Program (SPAP) coverage of premiums or cost-sharing

Funds the Benefit

Yes

No

How to Apply: Applicants must apply directly through Social Security—either online at www.ssa.gov, at their local office, or by calling 800-772-1213.

Medicare Savings Programs (MSPs):
Qualified Medicare Beneficiary (QMB),
Specified Low-Income Medicare Beneficiary (SLMB), & Qualified Individual (QI)

Federal

State

Sets Eligibility Criteria

Yes

Income Limits:3

QMB: 100% FPL ($1,255/mo forsingle people, $1,703/mo for married couples) + $20 monthly income disregard per household

SLMB: 120% FPL ($1,506/mo forsingle people, $2,044/mo for married couples) + $20 monthly income disregard

QI: 135% FPL ($1,694/mo for single people, $2,300 for married couples) +$20 monthly income disregard

Resource/Asset Limits:4

$9,430 for single people
$14,130 for married couples

Yes, states can be “less restrictive” than federal criteria.

Makes Eligibility Determinations

No

Yes

Delivers the Benefit

Yes, pays Medicare premiums and pays increased SSA benefits accordingly

Yes, pays Medicare copay & coinsurance amounts on behalf of QMBs to health care providers (unless the applicable Medicaid payment rate is less than corresponding Medicare payment rate)

Funds the Benefit

Yes, through the FMAP (Federal Medical Assistance Percentages) for QMB & SLMB, fully for QI

Yes, through state share for QMB & SLMB, nothing for QI

How to Apply: Applicants must apply through their local Medicaid office.

Low Income Home Energy Assistance Program (LIHEAP)

Federal

State

Sets Eligibility Criteria

Yes, via block grants to states

Eligible households must have income between 110% and 150% FPL, or that does not exceed 60% of the state median income

Yes, can set specific criteria and priorities within federal parameters

11 states have set an asset test5 for FY24

Makes Eligibility Determinations

No

Yes, generally through local/county agencies (e.g., Community Action Agencies)

Delivers the Benefit

No

Yes, often through vouchers to private heating/cooling suppliers

Funds the Benefit

Yes

Yes, federal funding incentives to states that raise local funding

How to Apply: LIHEAP applications are accepted through county/local level low-income energy offices (typically Community Action Agencies), usually for short window application periods each season.

Medicaid

Federal

State

Sets Eligibility Criteria

Yes, broad minimum criteria

Yes, details must comply with federal law and regulations

Makes Eligibility Determinations

No

Yes

Delivers the Benefit

No

Yes, through reimbursing health care providers

Funds the Benefit

Yes, through a federal match called FMAP (Federal Medical Assistance Percentages) ranging from 50% up to 74%

Yes, subject to FMAP

How to Apply: Applicants must apply through their local Medicaid office.

Supplemental Nutrition Assistance Program, or SNAP (formerly known as Food Stamps)

Federal

State

Sets Eligibility Criteria

Yes

Income Limits:6

Gross monthly income of 130% FPL ($1,580 for

single people, $2,137 for married couples)

Net monthly income of 100% FPL ($1,215 for

single people, $1,644 for married couples)

A number of deductions are available for applicants to subtract excess expenses from their income

Resource Limits:

$2,750 for the household, or if one person is over age 60 or disabled,
$4,250, unless states have adopted more liberal options

No, but states have an option of setting more liberal income and asset limits, or eliminating asset tests altogether

Makes Eligibility Determinations

No

Yes, requires interview and documentary verification of eligibility

Delivers the Benefit

No

Yes, through electronic benefits transfer (EBT) cards

Funds the Benefit

Yes

No

How to Apply: SNAP applications are submitted to the local SNAP office; most states

offer online applications for SNAP, often combined with other programs administered by the same state agency (e.g., Medicaid, TANF).

Supplemental Security Income (SSI)

Federal

State

Sets Eligibility Criteria

Yes

No, except for state supplements

Makes Eligibility Determinations

Yes, through SSA

No, except for state supplements

Delivers the Benefit

Yes

Some states allow SSA to deliver their state supplements; others deliver the state supplements separately

Funds the Benefit

Yes, except for state supplements

No, except for state supplements

How to apply: Applicants must apply directly through Social Security by calling 1-800- 772-1213 or visiting their local Social Security office. The application/appointment process can be started online at ssa.gov.

Find Out More

2024 Federal Poverty Guidelines

Extra Help/LIS:

LIHEAP:

Medicaid/Medicare Savings Programs:

SNAP:

SSI:

This resource was supported in part by grant 90MINC0002-03-00 from the U.S. Administration for Community Living (ACL), Department of Health and Human Services. Points of view or opinions do not necessarily represent official ACL policy.

Sources

1. Monthly income limits are rounded to the nearest dollar. The limits in Alaska for singles/couples are $2,351/$3,193 (+ $20) and in Hawaii, $2,164/$2,938 (+ $20). See our Part D LIS Eligibility Chart for more information, found on the internet at https://ncoa.org/article/part-d-low-income-subsidy-extra-help-eligibility-and-coverage-chart

2. Asset limits include $1,500/person burial allowance. If beneficiaries notify SSA that they expect to use some of their resources for burial expenses, the 2024 resource limits are $17,220 ($34,360 if married) for the full LIS benefit. For more information go to this resource found on the internet at https://www.cms.gov/files/document/lis-memo.pdf

3. Rounded to the nearest whole dollar. In Alaska, eligibility for QI is up to $2,116/$2,873 (+ $20) and in Hawaii, eligibility for QI is $1,947/$2,644 (+ $20). These figures are based on 2024 Federal poverty guidelines.

4. A burial allowance of up to $1,500 is not counted as part of the resource limit in this chart. States have varying ways of counting this allowance; learn more in this NCOA fact sheet - found on the internet at https://www.ncoa.org/article/differences-in-treatment-of-the-burial-disregard

5. See LIHEAP Heating Assistance Eligibility: Asset Test for more information on each state’s limits, found on the internet at https://liheapch.acf.hhs.gov/tables/assets.htm

6. Income eligibility for SNAP takes places on a federal fiscal year calendar, with FY24 figures using 2024 poverty guidelines through Sept. 30, 2024. Income limits are higher in Alaska and Hawaii. Learn more from the USDA at this resource found on the internet at https://www.fns.usda.gov/snap/eligibility#What%20are%20the%20SNAP%20income%20limits.  Most households must meet both a gross & net income test, but households with elderly (age 60+) and disabled persons need only meet the net income test.