Do I qualify for financial assistance programs with Medicare?

Different Medicare Savings Programs

There are four types of Medicare Savings Programs designed to help with paying costs for Original Medicare or Medicare Part B. They are distinguished by their income limits and what costs they help pay for. The programs include:

• Qualified Medicare Beneficiary Program (QMB)

   

  • This program helps to pay Medicare Part A and Part B premiums and copayments. It also helps to pay deductibles and coinsurance for both Part A and Part B.
  • A single person can qualify for the program in 2024 with an income up to $1,275 per month.
  • A couple can qualify with a combined income of $1,724 per month.
  • The Medicare asset limits are $9,430 for an individual and $14,130 for a couple.
    
• Specified Low-Income Medicare Beneficiary Program (SLMB)

   

  • This program helps with paying Medicare premiums for Part B.
    
  • A single person can qualify in 2024 with an income up to $1,526 per month.
    
  • A couple can qualify with a combined income of $2,064 per month.
    
  • The Medicare asset limits are $9,430 for an individual and $14,130 for a couple.
    
• Qualified Individual Program (QI)

   

  • This program helps with paying Medicare premiums for Part B, but does not cover as large a percentage of the premium as the Specified Low-Income Medicare Beneficiary Program. 
    
  • In 2024 a single person can qualify with an income up to $1,715 per month.
    
  • A couple can qualify with a combined income of $2,320 per month.
    
  • The Medicare asset limits are $9,430 for an individual and $14,130 for a couple.
    
• Qualified Disabled and Working Individuals (QDWI) Program

   

  • This program helps to pay premiums for Medicare Part A. You may qualify if you have a disability, you’re working, and you lose your Social Security disability and premium-free Part A because you returned to work.
    
  • In 2024 a single person can qualify with an income up to $5,105 per month.
    
  • A couple can qualify with a combined income of $6,899 per month.
    
  • The Medicare asset limits are $4,000 for an individual and $6,000 for a couple.   

It is important to note that income limits to qualify for these Medicare Savings programs are slightly different in Alaska and Hawaii. To learn more about the income limits in those states, see details on the Social Security Administration website.

Medicare and Medicaid dual eligibility coverage

Medicaid is a health insurance program operated by each state. It’s meant to provide coverage for low-income and low-asset individuals. Each state sets its own limits on income, assets and the type of benefits they include in their Medicaid program. It’s possible to get financial assistance from Medicare and Medicaid. If you qualify for Medicare and Medicaid, you may be eligible for a Dual Eligible Special Needs plan (D-SNP) that gives you more benefits than Original Medicare. In fact, about 16 percent of people who receive Medicare benefits also receive help paying for Original Medicare. And most of these people also receive Medicaid benefits.*

If you receive Medicare benefits and meet your state’s Medicaid eligibility requirements, you may be full-benefit dual eligible.

Medicaid eligibility conditions include income and asset requirements, plus citizenship and residency requirements.

If you are a full-benefit dual eligible, you may receive benefits included in both Medicaid and Medicare coverage. Here are some examples of what’s covered under Medicaid:

• Some types of care you get at your home, like nursing that focuses on helping a person get in and out of bed or get dressed
• Care delivered in a nursing home
• Some prescription drugs not covered by Medicare Part D plans

Paying for a prescription drug plan with Medicare Extra Help

If you qualify for the Qualified Medicare Beneficiary Program (QMB), Specified Low-Income Medicare Beneficiary Program (SLMB) or Qualified Individual Program (QI) Medicare Savings Programs, then you also automatically qualify for a program called Extra Help. This program offers extra help paying for Medicare Part D prescriptions. Prescription drug coverage is provided through Medicare Part D, which is why Extra Help is also known as the Part D Low-Income Subsidy. Part D coverage generally comes with a premium, a deductible and a copayment or coinsurance. Learn more about Medicare Part D.

But you don’t have to be in a Medicare Savings Program to receive help paying for your prescriptions under Extra Help. If your monthly income as an individual is up to $1,882.50 per month or $2,555 as a couple in 2024, you may be eligible. Asset limits in 2024 are up to $17,220 for an individual or $34,360 for a couple.

Depending on which Medicare Part D plan you choose, the program can reduce or eliminate your plan’s premium and deductible. It can also lower the cost you pay for the prescription drugs covered under your plan.

Finding out if you qualify for Medicare financial assistance programs

With so many different programs providing assistance for so many different types of costs, it’s easy to get confused. Fortunately, there is help available to find out if you qualify for Medicare financial assistance programs. A good place to start is with BenefitsCheckup.org.

The site has a free online tool from the National Council on Aging that connects people with benefits they may qualify for. Insurance brokers and state-area offices on aging are also excellent resources.

Don’t be afraid to reach out for help to find out if you qualify for help paying for your Medicare coverage.

About the author

Mark Pabst has worked as a writer and researcher in the health care field for almost two decades. When not writing about health he tries to stay healthy through activities like hiking, climbing and paddling in the far flung corners of his native state of California. However, despite his best efforts he still has a few unhealthy habits he can’t shake, most notably a weakness for jelly donuts.