Lowering your costs
Medicare Savings Programs and Extra Help: Who Qualifies
6 min read
Many people on Medicare pay more than they have to simply because nobody told them help exists. Two separate programs, Medicare Savings Programs and Extra Help, can cut your monthly premium and your pharmacy costs. Both are based on income and resources, and both are worth checking even if you think you earn too much.
What Medicare Savings Programs do
Medicare Savings Programs are run by your state Medicaid agency and they pay some or all of your Medicare costs. There are several levels, and the one you qualify for depends on your monthly income and countable resources.
- QMB pays your Part B premium and generally your deductibles, coinsurance, and copays
- SLMB pays your Part B premium only
- QI pays your Part B premium and is granted on a first come, first served basis each year
- QDWI helps certain working people with disabilities pay the Part A premium
What Extra Help does
Extra Help, also called the Low Income Subsidy, applies to Part D prescription coverage. It lowers or eliminates the plan premium and deductible and caps what you pay at the pharmacy. If you qualify for a Medicare Savings Program or for full Medicaid, you are automatically enrolled in Extra Help without a separate application.
Income and resources: what actually counts
The limits change every year, so treat any number you read online as a starting point rather than a verdict. What matters more is knowing what the state does and does not count.
- The home you live in and one vehicle are generally not counted as resources
- Some states, including Florida, disregard certain income and have their own rules
- Burial funds set aside up to a limit are usually excluded
- Applying costs nothing, and a denial one year does not prevent you from applying again
How to apply
Apply for Extra Help through the Social Security Administration, online or by phone. Apply for a Medicare Savings Program through your state Medicaid office: the Florida Department of Children and Families or Ohio Job and Family Services. You can apply for both at the same time, and the Social Security application can be forwarded to your state automatically.
What changes after you qualify
Qualifying opens doors beyond the savings themselves. People with Extra Help get a Special Enrollment Period that lets them change Part D or Medicare Advantage plans outside of Annual Enrollment, and may be eligible for Dual Special Needs Plans built for people with both Medicare and Medicaid.
FAQ
Common questions
Do Medicare Savings Programs and Extra Help mean I am on Medicaid?
Not necessarily. Medicare Savings Programs are administered by Medicaid but they pay Medicare costs; they are not the same as full Medicaid health coverage. Many people qualify for a savings program without qualifying for full Medicaid.
I was denied a few years ago. Should I try again?
Yes. Income and resource limits are adjusted each year and your own situation may have changed. Reapplying is free and a previous denial has no effect on a new application.
Will Extra Help lower what I pay at the pharmacy?
Yes. Depending on your level, Extra Help reduces or removes your Part D premium and deductible and limits your copay per prescription. The exact amounts are set each year by Medicare.
Can you help me figure out whether I qualify?
We can walk you through the questions on the phone and point you to the right application for your state. We do not process the application for you, but we make sure you know where it goes and what to expect.
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Have questions about your own situation?
Talk with a licensed Seniors Primero agent by phone. The conversation is free, there is no obligation, and we explain everything in plain language.
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.