Understanding Medicare Assistance Programs
There are several assistance programs available to help those on a limited fixed income with their medical and/or prescription drug costs through Social Security or your State welfare office. Please take the time and read about the programs below to see if you may qualify for any assistance program or the extra benefits and services often combined with various Medicare Advantage plans.
Medicare Assistance Programs
- Medicaid
- Medicare Savings Programs
- Qualified Medicare Beneficiary (QMB)
- Specified Low-Income Medicare Beneficiary (SLMB)
- Qualified Individual (QI)
- Extra Help/Low Income Subsidy (LIS)
- Extra Benefits & Services
What is Medicaid?
Medicaid is a state and federal program that provides health coverage if you have a limited fixed income.
Medicaid provides health coverage to people with low-income and asset levels who meet certain eligibility requirements. Medicaid is a joint federal and state program that helps with medical costs for some people with limited income and resources. Medicaid also offers benefits not normally covered by Medicare, like nursing home care and personal care services.
What does Medicaid cover?
Medicaid pays for “medically necessary” health care such as:
- Physician visits
- X-ray and laboratory tests
- Hospital and nursing-home care
- Home healthcare
- Prosthetic and orthopedic devices
- Hearing aids
- Medical equipment
- Ambulance services
- Certain prescription drugs excluded as a Medicare Part D benefit
Medicaid will only cover these costs and services if you use providers that accept Medicaid. If you have both Medicare and Medicaid, Medicare is the primary payer (meaning Medicare will pay first for Medicare-covered benefits) and Medicaid is the secondary payer. If you qualify for Medicaid, it will also cover your Medicare Part A and B deductibles and co-payments, and pay your monthly Medicare Part B premium.
Medicare Savings Program
Medicare Savings Programs are federally funded program administered by each state. These programs are for people with limited income and resources and help pay some or all of the Medicare premiums, deductibles, co-payments and coinsurance.
There are three major Medicare Savings Programs:
- Qualified Medicare Beneficiary (QMB)
- Specified Low-Income Medicare Beneficiary (SLMB)
- Qualifying Individual (QI)
Below are general requirements for the MSP:
- Reside in a state or the District of Columbia,
- Are age 65 or older,
- Receive Social Security Disability benefits, or
- People with certain disabilities or permanent kidney failure (even if under age 65)
- Meet standard income and resource requirements.
Medicare Savings Program (2026)
Medicare offers several Medicare Savings Programs (MSPs) that assist people with low income and assets:
Qualified Medicare Beneficiary (QMB)
- Pays Part A Premium, Part B Premium, Part A & B Deductibles, Part A & B Coinsurance
- Monthly Income**: (at or below 100% FPL/+ $20 income disregard per household)
- Most States: $1,350 if single, $1,824 if married
- Alaska: $1,683 if single, $2,275 if married
- Hawaii: $1,550 if single, $2,095 if married
- Resources^: $9,950 if single, $14,910 if married
Specified Low-Income Medicare Beneficiary (SLMB)
- Pays Part B Premium
- Monthly Income**: (between 100-120% FPL/+ $20 disregard)
- Most States: $1,616 if single, $2,184 if married
- Alaska: $2,015 if single, $2,725 if married
- Hawaii: $1,856 if single, $2,509 if married
- Resources^: $9,950 if single, $14,910 if married
Qualified Individual (QI)
- Pays Part B Premium
- Monthly Income**: (between 121-135% FPL/+ $20 disregard)
- Most States: $1,816 if single, $2,455 if married
- Alaska: $2,265 if single, $3,064 if married
- Hawaii: $2,086 if single, $2,821 if married
- Resources^: $9,950 if single, $14,910 if married
^ Monthly income includes +$20 income disregard, except in those states that have higher income disregards or no disregard. Income is rounded to the nearest dollar.
Notes * States can apply more liberal income and resource eligibility criteria. Check with your state Medicaid agency.** Income limits, as per CMS guidance, are rounded up to the next dollar. States may disregard other income aside from the standard $20 general exclusion.^ Resources do not include $1,500 per person burial allowance. States vary on how they count this resource.
Some States use different naming conventions for their programs from the standard nomenclature:
- Alaska: QI is called SLMB Plus
- Connecticut: QI is called ALMB
- District of Columbia: QMB is the sole program, with expanded eligibility
- Maine: Groups SLMB and QI together
- Maryland: QI is called SLMB II
- Nebraska: Federal QMB is replaced with full Medicaid. SLMB and QI are referred to as QMB
- New Hampshire: QI is called SLMB-135
- New York: Eliminated SLMB in 2023
- North Carolina: QMB, SLMB, and QI are called MQB, MQB-B, and MBQ-E respectively
- Oregon: SLMB and QI are called SMB and SMF respectively
- Wisconsin: QI is called SLMB Plus
In addition to some states eliminating the asset test, several states have exercised the following options:
- California: Asset limit reinstated as of January 1, 2026.
- Connecticut: Income limits increased to 211%/231%/246% FPL, with no standard disregard.
- District of Columbia: Increased income limits for QMB to 300% FPL. All applications are for QMB and do not include $20 income disregard.
- Illinois: Increased income disregard to $25 per household.
- Indiana: Increased income limits to 150%/170%/185% FPL.
- Maine: Income limits increased to 150%/170%/185% FPL (no disregard). Assets counted only include liquid assetsand include an $8,000 exclusion for singles, $12,000 for couples.
- Mississippi: Increased income disregard to $50.
- Nebraska: QMB program replaced with full Medicaid.
- South Carolina: QMB program provides full Medicaid.
Extra Help Eligibility?
You may qualify for the Extra Help available under Medicare Part D if:
- Your assets are less than $18,090 (single individual) or $36,100 (married couple living together)
- Your annual income is less than $24,180 (single individual) or $32,700 (married couple living together).
- Your annual income is higher than the eligibility limit, but you support other family members who also live in the same household; or you live in Hawaii or Alaska.
Assets that count toward eligibility include:
- Cash and bank accounts, including checking, savings, and certificates of deposit
- Real estate outside of your primary residence
- Stocks and bonds, including U.S. savings bonds
- Mutual funds and IRAs
Extra Help Income/Asset Levels?
Additional Benefits Available
There are programs available to help those on Medicare get extra benefits and services, like:
- Over the Counter Health Products
- Comprehensive Dental Coverage
- Routine Foot Care
- Fitness Membership
- Hearing Exam and Hearing Aid Coverage
- Transportation for Medical Appointments
- Chiropractic & Acupuncture
- Vision Exams and Eyewear
Next Steps
- Find out what assistance programs you qualify for.
- Get a drug plan comparison to see if you can save money on your prescriptions.
- Determine what extra benefits you need.
- Let our Simple Senior Benefits advisors help you through the process to make sure you get all the benefits and services you deserve.
Let one of our Advisors assist you today!
Our advisors help you through the process to make sure you get all the benefits and services you deserve.