Medicare Savings Programs (MSPs) are state-run programs that help people with limited income pay some or all of their Medicare costs. Depending on which program you qualify for, an MSP can cover your monthly premiums, deductibles, copayments, and coinsurance. There are four separate programs, each designed for a different income level or situation, and they’re administered through your state Medicaid office.
The Four Medicare Savings Programs
Each program covers a different slice of Medicare costs. The most comprehensive is the Qualified Medicare Beneficiary (QMB) program, and the others fill in narrower gaps.
- Qualified Medicare Beneficiary (QMB): Covers Part A premiums (if you don’t get premium-free Part A), Part B premiums, and all deductibles, coinsurance, and copayments for Medicare-covered services. This is the broadest program by far.
- Specified Low-Income Medicare Beneficiary (SLMB): Covers Part B premiums only. You need both Part A and Part B to qualify.
- Qualifying Individual (QI): Also covers Part B premiums only. You must have Part A and Part B, and you cannot qualify for any other Medicaid coverage.
- Qualified Disabled and Working Individual (QDWI): Covers Part A premiums only. This one is specifically for people under 65 who have a disability but lost their free Part A coverage because they returned to work.
What QMB Actually Covers
QMB deserves a closer look because it goes well beyond premium help. If you’re enrolled in QMB, you have no legal obligation to pay Part A or Part B deductibles, coinsurance, or copayments for any Medicare-covered item or service. Federal law prohibits Medicare providers, suppliers, and pharmacies from billing you for those cost-sharing amounts. That means if a doctor or hospital tries to charge you a copay, they’re violating federal rules.
This protection can save thousands of dollars a year. The standard Part B deductible, plus 20% coinsurance on doctor visits, imaging, and outpatient procedures, adds up quickly for people managing chronic conditions. QMB eliminates all of it.
How SLMB and QI Differ
SLMB and QI both do the same thing: pay your Part B premium, which in 2024 is $174.70 per month for most people. The difference between the two is income. SLMB has a lower income threshold than QI, so if your income is slightly too high for SLMB, you may still qualify for QI.
The key restriction on QI is that it’s only available to people who don’t qualify for any other form of Medicaid. If you’re already receiving Medicaid benefits, you won’t be placed in QI, though you may qualify for one of the other savings programs instead.
The QDWI Program for Disabled Workers
QDWI fills a very specific gap. When someone under 65 with a disability returns to work, they can lose their Social Security disability benefits and, with them, their free Medicare Part A coverage. Part A doesn’t disappear entirely, but you’d have to pay a monthly premium to keep it. QDWI covers that premium so you can maintain hospital insurance while you work.
To qualify, you must continue to have a disabling impairment, sign up for premium Part A, have limited income, and have countable resources below $4,000 as an individual or $6,000 as a couple. Your home, generally one car, and certain insurance policies don’t count toward the resource limit. You also can’t already be eligible for Medicaid through another pathway.
Who Qualifies: Income and Asset Rules
All four programs are means-tested, meaning eligibility depends on your income and, in most states, your countable assets. The income limits are set as percentages of the federal poverty level and increase slightly each year. QMB has the lowest income ceiling, followed by SLMB, then QI. Each state processes applications through its Medicaid office, and the specific thresholds can vary because some states apply different income disregards or use higher limits than the federal minimum.
Asset limits also vary by state. Most states count things like bank accounts, stocks, and bonds but exclude your primary home and one vehicle. Some states have moved to eliminate the asset test altogether. California, for example, dropped its asset test for Medicare Savings Programs on January 1, 2024, meaning residents there qualify based on income alone regardless of savings. If you’re close to the limits, it’s worth checking your state’s specific rules, because they may be more generous than the federal baseline.
Automatic Extra Help With Drug Costs
One benefit many people don’t realize: enrolling in any Medicare Savings Program that helps pay your Part B premium automatically qualifies you for Extra Help, the federal program that reduces the cost of prescription drugs under Medicare Part D. Extra Help covers most of the premium for a Part D plan and significantly lowers copayments at the pharmacy. You don’t need to apply separately. Once your state enrolls you in an MSP, Medicare identifies you as eligible for Extra Help and applies it to your drug coverage.
This makes MSPs even more valuable than they appear at first glance. A person enrolled in QMB, for instance, gets full cost-sharing protection on medical services plus substantial savings on prescriptions, all from a single application.
How to Apply
Medicare Savings Programs are run at the state level, so you apply through your state Medicaid agency, not through Medicare itself. The process typically involves filling out a form that documents your income, assets, and Medicare enrollment status. You can usually find the application on your state’s Medicaid or health department website, or by calling your local Medicaid office.
If you’re not sure which program you qualify for, that’s fine. The state reviews your information and places you in the appropriate program based on your income and circumstances. If you don’t qualify for QMB but meet the criteria for SLMB or QI, the state should offer you the program that fits. You can also contact your State Health Insurance Assistance Program (SHIP) for free, personalized help with the application. SHIP counselors are specifically trained to help people navigate Medicare costs and can walk you through the paperwork.