Medicare Savings Programs and Extra Help: Who Qualifies

1Could you qualify? The federal limits

There are three Savings Programs most people choose among, and income decides which one fits. These are the federal monthly limits for 2026 in the 48 contiguous states and D.C., with a standard $20 disregard already built in:

Swipe sideways to see the whole table.

Countable resources must be no more than $9,950 for one person or $14,910 for a couple. Treat these as floors, not ceilings. States may count income and resources more generously, several have dropped the resource test altogether, and limits are higher in Alaska and Hawaii. Anyone within reach of these amounts should apply rather than rule themselves out.

A fourth program, Qualified Disabled and Working Individuals, pays the Part A premium for people under 65 who lost premium-free Part A because they returned to work.

2What counts as income, and what does not

Income is counted before deductions. Your Social Security counts at its gross amount, before the Part B premium comes out, so use the figure on your award letter, not the deposit in your bank. Pensions, annuities, interest and dividends count too.

Earnings from work are treated more gently. After the first $65 a month, only half counts, so someone still working part time can have total income well above the table and still qualify. Some states disregard even more.

On the resource side, the home you live in, one car, household goods and burial funds up to a limit do not count. A retiree who owns a modest house outright and has a few thousand dollars in the bank is often well within the limits.

3A ten-minute check at the kitchen table

You do not need an advisor to get a first answer. Gather your Social Security award letter, any pension statements and your most recent bank statements, then:

1. Write down your monthly Social Security before the Medicare premium is taken out, from the award letter.
2. Add any pension, annuity, interest or other regular income. If you work, add only half of what you earn above $65 a month.
3. Compare the total with the table. Because the $20 disregard is already built into the limits, you do not subtract it yourself.
4. Add up savings, investments and any property other than your home and one car, and compare that with $9,950, or $14,910 for a couple.
5. If you are under, or within a few hundred dollars, apply. Your state may count more generously than the federal rules.

4What each program really does

QMB is the broadest. Besides premiums, it pays the deductibles, coinsurance and copays Medicare leaves to you, and doctors and hospitals may not bill a QMB enrollee for Medicare-covered services. Coverage generally starts the month after the state approves you.

SLMB and QI pay the Part B premium only, but they can reach back up to three months before the month you applied. QI is funded each year and handed out first come, first served, so you must reapply annually, and you cannot have QI if you qualify for full Medicaid.

Couples closer to the top can still qualify. A couple with $2,300 a month in combined income and $12,000 in savings is under the QI limit and the resource limit, so each can have the Part B premium paid for the year, as long as the state still has QI funds when they apply.

5Extra Help with prescriptions

Extra Help, also called the Part D Low-Income Subsidy, is run by Social Security rather than the state. It pays the monthly premium for a Part D plan up to a benchmark amount in your state, removes the plan's deductible, and limits what you pay at the pharmacy: in 2026 no covered drug costs more than $12.65, and generics cost less. It also removes any Part D late enrollment penalty. Since 2024 everyone who qualifies gets the full subsidy.

To qualify on your own application, income must be below 150 percent of the federal poverty line and resources below $16,590 for one person or $33,100 for a couple in 2026, amounts that include $1,500 each for burial expenses. You qualify automatically, without applying, if you have a Medicare Savings Program, full Medicaid or SSI. For people who take several medications, the savings can run to thousands of dollars a year; see Medicare Part D for how drug coverage works.

6The worries that keep people from applying

"Isn't this Medicaid?"

The Savings Programs are run by state Medicaid agencies, and the application goes there, which is enough to keep many retirees away. But a Savings Program is not full Medicaid coverage. You keep Original Medicare or your Medicare Advantage plan, with the same doctors; the program only pays premiums and, for QMB, cost-sharing. Our guide to Medicare and Medicaid explains how the two programs differ and fit together.

"Will the state take my house?"

Since 2010, federal law has exempted Medicare Savings Program benefits from Medicaid estate recovery, so premiums and cost-sharing paid under these programs are not claimed back from your estate. A state may still seek to recover the cost of other Medicaid services, such as long-term care, which is a separate question if you also receive full Medicaid.

7Situations that change the answer

You do not have premium-free Part A

QMB can pay the Part A premium for someone who did not work long enough to get Part A free. In most states you can sign up for Part A through the state at any time once you qualify for QMB, rather than waiting for Medicare's general enrollment period.

You paid a late enrollment penalty

Any Part B late enrollment penalty stops while the state pays your premium. If you have been paying a penalty for years, that alone can make the application worthwhile; see Medicare sign-up deadlines.

You also receive SSI or SNAP

People on SSI usually qualify for full Medicaid, which covers the same costs and more. Many households that qualify for a Savings Program also qualify for SNAP, a separate application.

8Applying

Apply for a Savings Program through your state Medicaid agency, and for Extra Help through Social Security, online or by phone. An Extra Help application also sends your information to the state to start a Savings Program application, unless you ask Social Security not to. Have your Social Security and Medicare numbers, recent bank statements, and information on pensions and other income.

Once you are enrolled, the state pays the Part B premium directly and the deduction disappears from your Social Security payment. It can take a few months for the deduction to stop, and premiums taken in the meantime are usually refunded. Mark the renewal date: missing the annual renewal is how many people find the deduction back in their check.

If the state turns you down, read how it counted your income and savings. A pension counted twice, or a bank balance that included a refund you had already spent, is worth pointing out, and the notice explains how to ask for a fair hearing; see appealing a benefit decision.

10Who decides

Your state Medicaid agency decides Savings Program eligibility using its own counting rules, which may be more generous than the federal figures here, and Social Security decides Extra Help. Our calculator estimates the Part B premium; it does not screen for either program.