Medicare provides essential health coverage. But many beneficiaries still face challenges paying for premiums, deductibles, copayments, and prescription drugs. Fortunately, several Medicare cost assistance programs exist to help people with limited income reduce these expenses and improve access to needed medical care.

This toolkit highlights four key programs that can provide significant financial relief: Medicare Savings Programs, Extra Help, State Pharmaceutical Assistance Programs, and Medicaid.

How can I help more people get Medicare cost assistance?

Medicare Savings Programs, Extra Help, State Pharmaceutical Assistance Programs, and Medicaid provide critical financial support for Medicare beneficiaries with limited income. Together, these programs help reduce premiums, deductibles, copayments, and prescription drug costs while offering important enrollment protections.

Understanding and using these resources can improve health care access and provide greater financial stability for those who qualify.

Medicare cost assistance toolkit resources

What are Medicare Savings Programs?

Medicare Savings Programs (MSPs) are state‑administered programs that help people with limited income pay Medicare costs, most commonly the Part B premium. In addition to premium assistance, MSPs offer important enrollment protections.

Key benefits of MSPs

• Payment of the Medicare Part B premium
• Enrollment in Medicare Part B outside usual enrollment periods
• Elimination of any Part B late enrollment penalty
• Automatic enrollment into the Extra Help program for prescription drugs

Common types of Medicare Savings Programs

• Qualified Medicare Beneficiary (QMB)
  • Pays Medicare Part A and Part B premiums
  • Covers Medicare deductibles, coinsurance, and copayments
  • Providers are prohibited by federal law from billing individuals enrolled in QMB

• Specified Low‑Income Medicare Beneficiary (SLMB)
  • Pays Medicare Part B premiums only
• Qualifying Individual (QI)
  • Pays Medicare Part B premiums
  • Limited funding; enrollment may be capped each year
• Qualified Disabled Working Individual (QDWI)
  • Pays Medicare Part A premiums
  • Must be disabled, under 65 years of age, and have returned to work and lost your premium-free Part A coverage

What is Extra Help (Part D Low‑Income Subsidy)?

Extra Help, also called the Part D Low‑Income Subsidy (LIS), is a federal program that reduces the cost of Medicare prescription drug coverage.

Extra Help benefits

• Pays the Part D premium up to a state‑specific benchmark
• Reduces prescription drug copayments
• Eliminates the Part D late enrollment penalty
• Provides a monthly Special Enrollment Period (SEP) to enroll in or change a stand‑alone Part D plan

Extra Help can substantially lower prescription drug costs throughout the year.

What are State Pharmaceutical Assistance Programs (SPAPs)?

Many states offer State Pharmaceutical Assistance Programs (SPAPs) that help residents pay for prescription drugs. These programs vary by state and may coordinate with Medicare Part D.

SPAPs May Help With:

• Part D premiums
• Deductibles
• Copayments

Some states have qualified SPAPs, which provide beneficiaries with a Special Enrollment Period (SEP). This SEP allows individuals to enroll in or make changes to their Medicare Part D or Medicare Advantage coverage outside standard enrollment periods.

Medicaid and Medicare

For individuals eligible for both Medicare and Medicaid (often referred to as dually eligible), Medicaid can help cover costs that Medicare does not fully pay.

How Medicaid works with Medicare

• Secondary insurance: Medicaid may pay Medicare coinsurance and copayments.
• Premium assistance: Individuals eligible for both programs are automatically enrolled in a Medicare Savings Program.
• Prescription drug assistance: Dually eligible beneficiaries are automatically enrolled in Extra Help.
• Care coordination: Some states require enrollment in Medicaid Managed Care (MMC) plans, which may offer options to coordinate care through specialized Medicare Advantage plans.

This coordination can reduce costs and simplify care for beneficiaries with complex needs.

This resource was supported by the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $13,504,196.00 with 100 percent funding by ACL/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by ACL/HHS or the U.S. Government.