Qualifying for the Medicare Savings Programs or Extra Help
3 min read
Are you wondering how to get help with Part A & B costs? While Medicare may cover many essential healthcare services for older adults, it isn’t free. If you’re unable to afford Medicare, there are benefits such as Medicare Savings Programs (MSPs) that can help.
What are Medicare Savings Programs?
These are Medicaid-administered benefits that help cover Medicare premiums and out-of-pocket costs, such as deductibles and coinsurance. Who qualifies for Medicare Savings Programs? MSPs are available for Medicare beneficiaries with limited incomes and resources who do not qualify to be fully enrolled in Medicaid. Participants must meet certain income and resource levels and have Medicare Part A to qualify. If requirements are met, Medicare and state Medicaid programs work together to provide assistance through Medicare Savings Programs.
There are four different Medicare Savings Programs. Each has a unique income and resource eligibility limit. Even if a person is not eligible for Medicaid, they may qualify for one of these programs to help cover Medicare costs.
What is the income limit for Medicare Savings Programs?
It depends. The four programs are listed below, along with what each one pays for and the income and resource level limits that must be met to qualify. If you want to know, “Do I qualify for Medicare Savings Programs?”, this chart can provide an answer*.
| Qualified Medicare Beneficiary (QMB) | Specified Low-Income Medicare Beneficiary (SLMB) | Qualified Individual (QI) | Qualified Disabled and Working Individual (QDWI) | |
|---|---|---|---|---|
| What it covers | Medicare premiums (Part A, if applicable, and Part B), deductibles, copayments, and/or coinsurance | Medicare Part B premium | Medicare Part B premium | Medicare Part A premiums (for people with Medicare who are under age 65, disabled, and no longer qualify for free Medicare Part A only because they returned to work) |
| You may qualify if your monthly income is less than: |
$1,235 if single $1,663 if married |
$1,478 if single $1,992 if married |
$1,660 if single $2,239 if married |
$4,945 if single $6,659 if married |
| You can own up to this amount of resources and still qualify: |
$9,090 if single $13,630 if married |
$9,090 if single $13,630 if married |
$9,090 if single $13,630 if married |
$4,000 if single $6,000 if married |
*Some states may have even higher income or resource limits for these programs—or they may eliminate resource limits entirely.
Get help with Part D Prescription Drug Costs
Does Medicare pay for prescriptions? Yes—Medicare Part D is available to help cover the cost of prescription drugs. This benefit is offered through private, Medicare-approved plans. Most people enrolled in a Part D plan have out-of-pocket expenses. However, if you qualify, you can get help paying for Medicare drug costs with a program called Extra Help (also called Part D low-income subsidy or LIS).
What is Extra Help from Medicare?
Extra Help is a federal program that helps people with limited income and resources pay for their Part D premiums and drug costs. What exactly does Extra Help with Medicare cover? Most people who qualify will pay:
- No premiums
- No deductibles, and
- No more than $4.15 for each generic/$10.35 for each brand-name drug their plan covers in 2023.
The amount of Extra Help provided depends on income and resources. If you qualify for Extra Help, it is possible to join a Medicare Part D plan at any time and not have to pay a penalty, even if enrollment is late.
Plus, people who receive Extra Help can change Part D plans at any time – as often as once per month. Learn about switching plans.
Qualifying for Extra Help with Medicare Costs
You may be wondering, “Am I qualified for Medicare Extra Help?” There are different levels of Extra Help available, depending on income and assets. People with a lower income and fewer assets get more help with their Medicare drug plan costs.
If you have Medicare and have limited income and resources, you may be able to get Extra Help paying for your prescription drug costs if:
- Your annual income is less than $22,110 if single or $29,820 if married. If you live in Alaska or Hawaii, you may still get help even if your income is higher than these limits.
- You have assets of less than $16,660 if single or $33,240 if married.
You may not qualify for Extra Help if your income or assets are over these limits. Remember that you can apply for help even if you are slightly over the qualifying limit.
If you think you qualify for Extra Help, get a BenefitsCheckUp and learn about all of your options. It is free and confidential.
