Medicare Savings Programs: How They Work and Who Can Get Help
If Medicare premiums and copays are stretching your budget, a Medicare Savings Program (MSP) may be able to pay some or all of those costs for you. These programs are run by state Medicaid offices and are designed specifically for people with lower incomes who have Medicare.
What is a Medicare Savings Program?
A Medicare Savings Program is a state-run benefit that helps eligible Medicare beneficiaries pay for:
- Part A premiums (hospital coverage), in some cases
- Part B premiums (doctor visits, outpatient care)
- Sometimes deductibles, coinsurance, and copayments
You must already have, or be eligible for, Medicare Part A to qualify for any MSP. If you qualify, the state pays Medicare directly on your behalf, and your Social Security check may go up because your Part B premium is no longer being taken out.
There are four main types of MSPs:
- Qualified Medicare Beneficiary (QMB) – The most comprehensive help; can cover Part A (if you owe it), Part B premiums, and Medicare deductibles, coinsurance, and copays.
- Specified Low-Income Medicare Beneficiary (SLMB) – Helps pay Part B premiums only.
- Qualifying Individual (QI) – Also helps with Part B premiums only, but funded differently and approved on a first-come, first-served basis each year.
- Qualified Disabled and Working Individual (QDWI) – Helps certain disabled individuals who returned to work pay for their Part A premium.
Who Qualifies for a Medicare Savings Program?
Eligibility is set by federal rules but applied by each state, so income and asset limits vary slightly by state and can change yearly. In general, you must:
- Be enrolled in, or eligible for, Medicare Part A
- Have monthly income below your state’s MSP limits
- Have countable resources (savings, investments) under your state’s limits
States look at:
- Income: Social Security, pensions, wages, some retirement income
- Resources: Bank accounts, stocks, bonds; some items are not counted, such as your primary home, one car, basic personal belongings, and certain burial funds
If your income is slightly over the limit, do not assume you’re ineligible. Some states use more flexible rules or disregard certain income, and the limits differ for individuals and couples.
How to Apply for a Medicare Savings Program
You apply through your state Medicaid office, not through Medicare:
- Contact your state Medicaid program and ask for a Medicare Savings Program application.
- Gather proof of identity, residency, Medicare card, income, and resources.
- Submit the application and respond to any follow-up requests.
If you’re approved:
- Your state will start paying the covered Medicare costs going forward.
- In some cases, you may get retroactive help for recent months’ premiums.
- You’re usually automatically enrolled in Extra Help for prescription drug costs if you qualify for an MSP.
Understanding and applying for a Medicare Savings Program can significantly reduce your out-of-pocket costs and make it easier to afford the care you need. If you think your income and resources might fit, it’s worth applying—many people who qualify never use this help simply because they don’t realize they’re eligible.