At a glance

  • Four state-run Medicare Savings Programs (QMB, SLMB, QI, and QDWI) can pay some or all of your Medicare premiums.
  • A separate federal program, Extra Help, lowers prescription drug costs under Part D.
  • Millions of people who qualify never apply, often because they've simply never heard of these programs.
  • Free, unbiased Medicare counseling is available in every state through SHIP.
  • Annual Open Enrollment runs October 15 to December 7 each year.

What Medicare is: the 60-second version

Medicare is federal health insurance, mainly for people 65 and older and for some younger people with disabilities. It comes in four parts:

  • Part A covers hospital stays. Most people pay no premium for it, thanks to their work history.
  • Part B covers doctor visits and outpatient care. Nearly everyone pays a monthly premium for Part B, usually deducted from Social Security checks.
  • Part C (Medicare Advantage) is the option to get your Medicare through a private plan, often bundling extras like dental or vision.
  • Part D covers prescription drugs through private plans, with its own premium.

Those premiums, deductibles, and copays add up, and that's where two under-used lifelines come in: Medicare Savings Programs, which help pay premiums and sometimes other costs, and Extra Help, which cuts prescription costs. Both exist specifically for people on modest incomes, and both go unclaimed by millions who qualify.

Who qualifies

The four Medicare Savings Programs (MSPs) are run by your state Medicaid office, and each has its own income level. From lowest income limit to highest:

  • QMB (Qualified Medicare Beneficiary): the most generous. It pays your Part A and Part B premiums, and providers are not allowed to bill you for Medicare deductibles, coinsurance, or copays.
  • SLMB (Specified Low-Income Medicare Beneficiary): pays your Part B premium.
  • QI (Qualifying Individual): also pays your Part B premium, at a slightly higher income level. It's first-come, first-served each year, so apply early.
  • QDWI (Qualified Disabled and Working Individual): pays the Part A premium for certain disabled people under 65 who returned to work.

The income and asset limits change every year and differ in some states; a few have dropped asset limits entirely. Rather than quote numbers that will go stale, we'll say this: if your income is modest and mostly from Social Security, it costs nothing to apply and the answer may surprise you. Check the current limits at Medicare.gov or ask your SHIP counselor (below).

Extra Help (also called the Low-Income Subsidy, or LIS) is separate. It's run by Social Security and lowers Part D drug plan premiums, deductibles, and copays. Qualifying for an MSP or Medicaid generally enrolls you in Extra Help automatically.

Worth knowing: Every state has a State Health Insurance Assistance Program (SHIP) offering free, one-on-one Medicare counseling from trained, unbiased counselors rather than salespeople. They can check whether you qualify for an MSP or Extra Help and even help you fill out the forms. It's one of the best free services most people have never used.

What you could get

The value here is real money every month. If an MSP pays your Part B premium, that premium stops coming out of your Social Security check, so your monthly check goes up by that amount. QMB goes further by wiping out Medicare deductibles and copays at the doctor's office. Extra Help, by Social Security's own estimate, is worth thousands of dollars per year in reduced drug costs for many enrollees. Current premium and savings figures are published at the official links below.

It also helps to know the main enrollment windows:

  • Initial Enrollment Period: the 7 months around your 65th birthday (3 months before your birthday month, that month, and 3 months after). Missing it can mean a late penalty on Part B that lasts for life.
  • Annual Open Enrollment: October 15 to December 7. You can switch between Original Medicare and Medicare Advantage or change drug plans, with changes taking effect January 1.
  • MSPs and Extra Help have no season, so you can apply for those any day of the year.

How to apply

  1. For a Medicare Savings Program: apply through your state Medicaid office. You can find your state's contacts through Medicare.gov, or call 1-800-MEDICARE. You'll typically need proof of income (like your Social Security award letter) and bank statements.
  2. For Extra Help: apply free at the Social Security website linked below, by calling Social Security, or at a local office. The application is short.
  3. Not sure where you fit? Contact your local SHIP first. A counselor will screen you for all of these programs at once, free of charge.
  4. If you're denied, you can appeal. You can also reapply later if your income changes or the limits rise, which they do most years.

Official sources & applications

Watch out for

Medicare will not call you to sell you a plan. Full stop. Government employees don't cold-call to offer "new Medicare cards," "plan upgrades," or refunds, and they never ask for your Medicare number, Social Security number, or bank details over an unexpected call. If someone does, hang up. When you need Medicare, you call them at 1-800-MEDICARE, not the other way around.

Guard your Medicare number like a credit card. Scammers use stolen numbers to bill Medicare for equipment and tests you never received. Review the Medicare Summary Notices you get in the mail and report charges you don't recognize.

Be careful with aggressive plan marketing, especially during Open Enrollment. TV ads and telemarketers pushing "$0 premium" plans are selling something, and the plan that pays the highest commission is not necessarily the one that covers your doctors and prescriptions. Before switching plans, run your actual medications and doctors through the official Medicare.gov plan finder or sit down with a SHIP counselor (the free, no-commission option).