Medicare Savings Programs (MSPs) are state-run programs that help people with limited income pay for Medicare costs like premiums, deductibles, and copayments. To qualify, you generally need to have Medicare, meet your state’s income limits (which vary by program level), and in most states, fall below a resource cap. There are four separate programs, each covering different costs and using different income thresholds, so you may qualify for one even if you don’t qualify for another.
The Four Programs and What They Cover
Each Medicare Savings Program targets a different slice of Medicare costs. The most generous is the Qualified Medicare Beneficiary (QMB) program, which covers Part A premiums (if you don’t get premium-free Part A), Part B premiums, and Part B deductibles, coinsurance, and copayments. If you qualify for QMB, doctors and hospitals cannot bill you for cost-sharing on Medicare-covered services.
The Specified Low-Income Medicare Beneficiary (SLMB) program covers only your Part B premium. The Qualifying Individual (QI) program also covers only the Part B premium. Both require you to already have Part A and Part B. The difference between SLMB and QI is the income threshold: QI allows slightly higher income than SLMB, making it an option for people who earn a bit too much for SLMB but still need help with their monthly premium.
The fourth program, Qualified Disabled and Working Individuals (QDWI), is narrower. It pays only your Part A premium and applies to a specific situation: you’re under 65, you have a disability, and you lost your free Part A coverage because you returned to work. To qualify for QDWI, you must still have the disabling condition, you must sign up for premium Part A, and you cannot already be eligible for Medicaid.
Income Limits for Each Program
Income limits are set as a percentage of the federal poverty level (FPL) and update each year. For 2025, the approximate monthly income ceilings are:
- QMB: 100% of the federal poverty level, roughly $1,255 per month for an individual or $1,704 for a married couple.
- SLMB: 120% of FPL, roughly $1,506 per month for an individual or $2,045 for a couple.
- QI: 135% of FPL, roughly $1,694 per month for an individual or $2,300 for a couple.
- QDWI: 200% of FPL, roughly $2,510 per month for an individual or $3,408 for a couple.
These figures can shift slightly depending on your state, because some states use higher thresholds. Alaska and Hawaii have higher poverty guidelines, so their limits are also higher.
How Your Income Is Counted
States use the same general rules as the Supplemental Security Income (SSI) program when calculating your countable income. That means not every dollar you receive counts toward the limit. Standard exclusions typically include the first $20 per month of most income and the first $65 per month of earned income. After that $65 exclusion, only half of your remaining earned income is counted. So if you work part-time and earn $500 a month, your countable earned income would be well below $500.
Social Security benefits, pensions, and investment income all count as unearned income, but after applying the $20 general exclusion your effective limit is a bit higher than the posted number. The bottom line: even if your gross income looks like it’s right at or slightly above the threshold, you may still qualify once exclusions are applied.
Resource and Asset Limits
Most states also look at your countable resources, sometimes called assets. The federal baseline for the QDWI program is $4,000 for an individual and $6,000 for a couple. For QMB, SLMB, and QI, the resource limits are generally higher, typically around $9,430 for an individual and $14,130 for a couple, though these figures are adjusted annually.
Countable resources include bank accounts, stocks, bonds, and cash. Your primary home does not count. One vehicle is typically excluded. Life insurance policies with a face value under $1,500 and burial funds up to $1,500 are also usually excluded.
Here’s an important detail: a growing number of states have eliminated the asset test entirely for MSP eligibility. States like Alabama, Arizona, California, Colorado, Connecticut, Delaware, Louisiana, Maine, Maryland, Massachusetts, Minnesota, Mississippi, New York, Oregon, and Vermont (among others) no longer count resources when determining whether you qualify. If you live in one of these states, your savings and investments won’t disqualify you, and only your income matters. Check with your state Medicaid office to find out whether an asset test applies where you live.
How to Apply
Medicare Savings Programs are administered by your state Medicaid agency, not by Medicare directly. You apply through your state. The process varies, but here’s what to expect in most states:
- Where to start: Contact your state Medicaid office or visit their website. You can find contact information by calling 1-800-MEDICARE or visiting Medicare.gov. Many states also let you apply through your local Department of Social Services or Area Agency on Aging.
- Documentation you’ll typically need: Proof of identity (driver’s license or state ID), your Medicare card or Medicare number, proof of income (Social Security award letter, pay stubs, pension statements), and bank or investment statements if your state has a resource test.
- How to submit: Most states accept applications online, by mail, by fax, or in person. Some states allow phone applications.
Processing times vary by state but generally take 45 days or less. If you’re approved, your state will begin paying the relevant premiums or cost-sharing. For QMB, your state notifies Medicare, and your coverage is updated so providers know not to bill you for deductibles or copayments on covered services.
Automatic Extra Help With Drug Costs
One of the most valuable side benefits of qualifying for any Medicare Savings Program is automatic enrollment in Extra Help, also known as the Part D Low Income Subsidy. Extra Help reduces what you pay for prescription drugs under a Medicare Part D plan, covering most or all of the premium, deductible, and copayments for medications. You don’t need to apply separately. Once your MSP enrollment is processed, Social Security will notify you that you qualify for Extra Help. This alone can save hundreds or even thousands of dollars per year on prescriptions.
What to Do if You’re Denied
If your application is denied, your state must send you a written notice explaining why. Common reasons include income or resources slightly above the limit, missing documentation, or an error in the application. You have the right to appeal the decision, and the notice will explain how. If your income recently dropped (for example, you stopped working or a spouse passed away), reapplying with updated income documentation can change the outcome.
State Health Insurance Assistance Programs (SHIPs) offer free, one-on-one counseling to help you navigate the application or appeal. SHIP counselors can review your finances, help you gather the right documents, and make sure applicable income exclusions are being applied correctly. You can find your local SHIP by calling 1-800-MEDICARE.