Medicare Savings Programs: An Overview of Help Paying Your Medicare Premiums

Medicare can be a big help with health costs, but the monthly premiums, deductibles, and copays can still add up. For people with limited income and resources, Medicare Savings Programs (MSPs) may help pay some or all of those costs.

This guide explains, in plain language, how Medicare Savings Programs typically work, who may qualify, what to expect when applying, and how to move forward through official government channels. HowToGetAssistance.org is an informational site only; it is not a government office and cannot take applications or check your status.

What Are Medicare Savings Programs?

Medicare Savings Programs are state-run programs that use Medicaid funds to help certain people with Medicare pay for:

• Medicare Part A premiums (hospital insurance) in some cases
• Medicare Part B premiums (doctor and outpatient care)
• Sometimes Medicare deductibles, coinsurance, and copayments

These programs are also called “Medicare Premium Assistance Programs” in some states. They are overseen by each state’s Medicaid agency (or equivalent health benefits office), but they are connected to your federal Medicare benefits.

If you qualify, your state pays Medicare costs directly to Medicare. This can lower your monthly bills and protect more of your Social Security check.

The Four Main Types of Medicare Savings Programs

Most states offer four main types of Medicare Savings Programs. Names and some details may vary slightly by state, but the structure is similar.

1. Qualified Medicare Beneficiary (QMB)

QMB is usually the most comprehensive Medicare Savings Program.

It can help pay:

• Part A premiums (if you owe them)
• Part B premiums
• Medicare deductibles
• Medicare coinsurance and copayments

People with QMB coverage often pay little or nothing out of pocket for Medicare-covered services, as long as the provider accepts Medicare and follows QMB rules.

2. Specified Low-Income Medicare Beneficiary (SLMB)

SLMB is more limited than QMB.

It usually helps pay only the Part B premium, not deductibles or copays.

3. Qualifying Individual (QI)

QI is similar to SLMB:

• Helps pay only the Part B premium
• Has slightly higher income limits than SLMB in many states
• Is often funded on a year-to-year basis, so you typically must reapply each year

States generally approve QI applications on a first-come, first-served basis, as long as funding is available.

4. Qualified Disabled and Working Individual (QDWI)

QDWI is for certain people who:

• Are under 65, have a disability, and
• Returned to work and lost their free Part A benefits because of that work

QDWI may help pay your Part A premium so you can keep Part A coverage while working.

Quick Comparison: The Four Medicare Savings Programs

Below is a simplified comparison. Exact rules and names can vary by state, and income/resource limits change over time. For current rules, contact your state Medicaid office or benefits agency.

Who Typically Qualifies for a Medicare Savings Program?

Eligibility rules are set at the state level but must follow federal guidelines. In most states, you generally need to:

• Have or be eligible for Medicare Part A
• Have limited income (monthly income must fall below the program’s limit)
• Have limited resources (such as savings and investments, under a certain threshold)
• Live in the state where you are applying
• Be a U.S. citizen or qualified non-citizen according to state and federal rules

Income Limits

Each Medicare Savings Program has its own income limit, and these amounts:

• Are usually based on monthly income
• Often differ for individuals vs. married couples
• May change each year

Income may include:

• Social Security benefits
• Pensions
• Wages from work
• Some types of other income

Some states exclude or disregard certain income types or amounts. Because of this, it can be worth applying even if you think your income is slightly too high.

Resource (Asset) Limits

States also look at resources, sometimes called “assets,” such as:

• Money in checking and savings accounts
• Stocks, bonds, mutual funds
• Some extra property besides your main home

Typically not counted as resources:

• Your primary home
• One vehicle (in many cases)
• Basic personal belongings

The exact rules vary by state, and resource limits can change. Your state Medicaid or health benefits office can explain what they count as resources.

What Can Medicare Savings Programs Pay For?

Depending on which program you qualify for, an MSP can help with:

• Medicare Part A premium: For people who do not get Part A “premium-free”
• Medicare Part B premium: The monthly charge taken from your Social Security check or paid directly
• Deductibles: The amount you pay before Medicare starts covering certain services
• Coinsurance and copayments: Your share of the cost for services, under QMB

One important side effect:
If you qualify for any Medicare Savings Program, you usually also get Extra Help (Low-Income Subsidy) for Medicare Part D, which can lower prescription drug costs. This is handled through Social Security or the Medicare program, not through HowToGetAssistance.org.

Why Medicare Savings Programs Matter

For many people, these programs can:

• Increase monthly take-home income by covering the Part B premium that would otherwise be deducted from Social Security
• Lower or eliminate out-of-pocket costs for doctor visits and hospital care (especially under QMB)
• Help prevent coverage loss if you cannot afford premiums
• Provide more predictable health care costs on a limited budget

How to Check If You Might Qualify

While exact limits change, you might consider checking your eligibility if:

• You have Medicare Part A and/or Part B, and
• Your monthly income is modest, and
• Your savings and investments are limited

Because states have different rules, a direct conversation with an official is often the most accurate.

You can:

• Call your state Medicaid office or state health benefits agency
• Contact your local State Health Insurance Assistance Program (SHIP) for free counseling
• Call Medicare’s official helpline and ask for help identifying the correct state office
• Call Social Security if you’re uncertain about your Medicare status or premiums

When you call, you can ask:
“I’d like to ask about Medicare Savings Programs in this state and see if I might qualify.”

What Documents to Gather Before You Apply

While requirements vary by state, it is common to be asked for:

Proof of identity and status

• Photo ID (driver’s license, state ID, or similar)
• Social Security number
• Proof of citizenship or immigration status (such as a birth certificate, passport, or immigration documents), if needed

Proof of Medicare

• Medicare card (showing Part A and/or Part B)
• Any Medicare Advantage or Part D plan information (if applicable)

Proof of income

• Recent Social Security benefit statement
• Pension or retirement statements
• Pay stubs if you or your spouse work
• Statements for other regular income, such as annuities

Proof of resources (assets)

• Recent bank statements (checking, savings, credit union)
• Statements for stocks, bonds, mutual funds, or retirement accounts (if counted in your state)
• Information about other property (if you own more than one)

Proof of residence

• Recent utility bill, lease, or other official mail with your name and address

Having these documents ready before you contact your state Medicaid or health agency can help prevent delays.

How and Where to Apply for a Medicare Savings Program

You cannot apply for Medicare Savings Programs through HowToGetAssistance.org. To apply, you must use official government channels, typically:

• Your state’s Medicaid office
• A county human services or social services department
• An official online benefits portal for your state
• In some areas, designated community agencies that process applications on behalf of the state

Because each state runs its own process, the steps can differ.

Common Ways to Apply

1. Online Application

   • Many states have a state benefits website or portal where you can:
     • Create an account
     • Fill out a Medicare Savings Program or Medicaid application
     • Upload documents or mail them in later
   • To find the correct portal, search for your state name plus terms like “Medicaid application” or “state benefits portal” or call your local Medicaid office for the website address.

2. Paper Application by Mail or In Person

   • You can often:
     • Request an application from your state Medicaid office or county social services office
     • Pick up a form at a local office
     • Mail in the completed application with copies of your documents
   • Some offices also allow drop-off at a reception desk.

3. Phone Application or Phone Assistance

   • Some states let you start an application by phone, then mail or upload documents.
   • If they do not take full applications by phone, staff can usually:
     • Explain requirements
     • Send you forms
     • Tell you where to submit them

If you are unsure which office to contact, you can:

• Call the Medicare helpline and ask for your state Medicaid agency’s phone number
• Call 211 in many areas and ask for help reaching your state Medicaid office or aging and disability resource center

What Happens After You Apply

Once your state agency receives your application and documents, there are usually several steps:

1. Initial Review

   • Staff confirm your application is complete and that they have enough information to start.
   • If something is missing, they may send you a request for additional information with a deadline.

2. Eligibility Determination

   • The agency reviews your income, resources, Medicare status, and residency.
   • They decide which, if any, Medicare Savings Program you qualify for (QMB, SLMB, QI, or QDWI).

3. Decision Notice

   • You typically receive a written notice by mail:
     • Approval notice: Explains which program you qualify for, when coverage starts, and what it will pay.
     • Denial notice: Explains why you were denied and how to appeal if you disagree.

4. Premium Adjustments

   • If you are approved:
     • Your Part B premium (and possibly Part A) may be paid by your state.
     • For people on Social Security, this often means a higher Social Security payment, because the premium is no longer deducted.
   • For QMB:
     • Providers should be notified that you have QMB status, which affects what they can bill you.

5. Extra Help Enrollment

   • If you qualify for any MSP, you generally are automatically enrolled in Extra Help for Part D prescription coverage, if you are not already in it.
   • You should receive a separate notice about prescription assistance.

Common Reasons for Delays or Denials

Applications can be delayed or denied for many reasons. Some common issues include:

• Missing documents: Income or bank statements not provided or outdated
• Incomplete application: Sections left blank or signatures missing
• Income or resources above the state limit: Based on the state’s calculations
• Not having Medicare Part A: Some programs require Part A entitlement
• Residency questions: Address or living situation not clearly documented
• Not responding to requests on time: Failing to provide additional information by the deadline

If you receive a denial letter and do not understand it, you can:

• Call the state agency that issued the decision and ask for an explanation
• Contact your local SHIP program for free help understanding your options

How Appeals and Reviews Usually Work

If you believe you were denied by mistake, or if the decision does not match your situation:

1. Read the Notice Carefully

   • The letter usually explains the reason for denial and your appeal rights.
   • Look for deadlines—there is often a limited time window to appeal.

2. File an Appeal

   • Instructions vary by state, but you may:
     • Fill out an appeal form, or
     • Write a letter requesting an appeal, or
     • Call a specified appeals or fair hearing number
   • Follow the instructions in your notice and keep copies of everything.

3. Gather Supporting Information

   • Update any income or resource documents
   • Correct any errors (for example, if income was counted twice)
   • Provide any missing information the agency listed in its notice

4. Hearing or Review

   • Some states offer a phone or in-person hearing where you can explain your case.
   • You can often have a representative, such as a family member, legal aid advocate, or SHIP counselor.

If your situation changes later (for example, your income decreases), you can usually reapply, even if a past application was denied.

Staying Enrolled: Renewals and Changes

Medicare Savings Programs are not always permanent approvals. Most states require:

• Annual renewal (redetermination) of eligibility
• Reporting of major changes in income, resources, or living situation

You may receive a renewal form or a notice asking you to:

• Confirm your current income and resources
• Submit updated documents
• Sign and return forms by a specific deadline

Failing to complete renewal steps on time can lead to loss of MSP coverage, which can cause your Medicare premiums to start being deducted again or your out-of-pocket costs to increase.

If you receive a renewal notice:

• Respond as soon as possible
• Call the number on the notice if you have questions or need more time

If You Do Not Qualify for a Medicare Savings Program

If you are told you do not qualify, you still may have options to reduce health costs:

• Extra Help (Low-Income Subsidy) for Part D

  • You can apply directly through Social Security for help with prescription drug costs, even if you do not get an MSP.

• Medicaid (Full or Partial Coverage)

  • Some people with limited income and resources may qualify for full Medicaid in addition to Medicare, which can help with other medical services.
  • Contact your state Medicaid office to ask about eligibility.

• State Pharmaceutical Assistance Programs (SPAP)

  • Some states run separate programs that help with drug costs for people with Medicare.

• Local Assistance Programs

  • Organizations such as Aging and Disability Resource Centers, Area Agencies on Aging, or community health clinics may offer guidance or financial assistance programs.

• Nonprofit and Charitable Programs

  • Some disease-specific organizations and health charities may offer help with copays or medications.

Local resources like 211, your Area Agency on Aging, or your SHIP program can help you explore what else may be available.

Protecting Yourself From Scams

Because Medicare involves personal information and financial benefits, there is a risk of scams. To stay safe:

• Only apply through official channels

  • Use your state’s Medicaid or benefits agency, Social Security, or Medicare’s official helpline.
  • Be cautious of websites or callers that claim you can “get approved instantly” for a fee.

• Do not pay anyone just to submit an MSP application

  • Legitimate application help from SHIP, Area Agencies on Aging, or state offices is typically free.

• Protect your personal information

  • Do not give out your Social Security number, Medicare number, or bank information to unknown callers.
  • If you are unsure whether a call is official, hang up and call the agency back using a published number you look up yourself.

• Verify websites and phone numbers

  • Look for clear identification of state or federal agencies.
  • When in doubt, call Medicare, Social Security, or your state Medicaid office directly and ask how to reach the correct program.

Key Takeaways and Next Steps

• Medicare Savings Programs (QMB, SLMB, QI, and QDWI) help people with limited income and resources pay Medicare premiums and sometimes other costs.
• Eligibility is based on income, resources, and Medicare status, and is determined by your state Medicaid or health benefits agency.
• You typically need to provide proof of identity, Medicare, income, resources, and residency.
• Applications must go through official state or federal channels—not through HowToGetAssistance.org.
• If you are approved, you may see lower or eliminated Medicare premiums and could automatically qualify for Extra Help with prescription drugs.
• If denied, you have appeal rights, and you can explore other assistance programs.

To move forward, contact:

• Your state Medicaid office or health benefits agency to ask about applying for a Medicare Savings Program
• Your local State Health Insurance Assistance Program (SHIP) for free one-on-one help
• Medicare or Social Security if you need help confirming your current Medicare enrollment and premiums

Bringing your documents and questions to these official offices can help you get clear, personalized guidance on whether a Medicare Savings Program can lower your Medicare costs.