Medicare Savings Programs (MSPs) are run by state Medicaid agencies and help people on Medicare pay costs. The Qualified Medicare Beneficiary (QMB) programme pays Part A and B premiums, deductibles, coinsurance and copays; Specified Low-Income Medicare Beneficiary (SLMB) and Qualifying Individual (QI) programmes pay the Part B premium. Apply through your state Medicaid office. Qualifying also automatically enrols you in Extra Help for prescription drugs.
How it works
The short version, before the detail.
Medicare covers hospital care (Part A), medical care (Part B) and prescriptions (Part D), but most people pay a monthly Part B premium deducted from their Social Security, plus deductibles and a share of each bill. For someone living on a small Social Security cheque, those costs can force a choice between medicine, food and rent.
Medicare Savings Programs exist to close that gap. Although they are part of Medicaid, you do not need to qualify for full Medicaid to get one. There are three main levels. QMB is the most generous: it pays Part A premiums (for those who owe them), Part B premiums, and Medicare deductibles, coinsurance and copays. Providers are not allowed to bill QMB enrollees for Medicare cost-sharing - a strong protection many patients and even providers do not know about.
SLMB pays the Part B premium for people with incomes a little above the QMB limit. QI pays the Part B premium for people with slightly higher incomes still, on a first-come, first-served basis funded each year. A fourth programme, QDWI, helps certain working people with disabilities pay Part A premiums.
Getting any MSP has a valuable side effect: you are automatically enrolled in Extra Help, the federal programme that lowers Part D prescription drug costs. And because the Part B premium is no longer deducted from your Social Security, your monthly payment goes up.
Income and asset limits are set federally as minimums, but states can be more generous - and several states have eliminated the asset test entirely or disregard more income. Federal rules finalised in recent years also simplified enrolment. Even if you believe your savings are too high, check your state's rules.
Who usually qualifies
Factors the agency looks at. Only they make the final decision.
Many states count income and assets more generously than the federal minimum. The only way to know is to apply.
How to apply, step by step
Find your state Medicaid office
Search your state's name with 'Medicare Savings Program', call your state Medicaid agency, or call your State Health Insurance Assistance Program (SHIP) for free help.
Get help from a SHIP counsellor
SHIP counsellors are free, unbiased Medicare advisers in every state. They can check your eligibility and help you apply.
Gather documents
Medicare card, Social Security award letter, pension statements, bank statements, and information on any life insurance or investments.
Apply
Online, by mail or in person depending on the state. Some states use a short dedicated MSP application.
Respond to requests
Send any additional documents by the deadline.
Watch your Social Security payment
Once approved, the Part B premium stops being deducted, sometimes after a short delay with a refund.
Show your QMB status to providers
If you are QMB, tell your doctors so they do not bill you for Medicare cost-sharing.
What to have ready
Missing one item is rarely a reason to wait - start now.
- Medicare card
- Social Security award letter or other income proof
- Pension and annuity statements
- Bank, savings and investment statements
- Life insurance policy information
- Proof of address and ID
What happens after you apply
How it compares
Similar programmes, and which one fits which need.
| Programme | What it covers | Best for |
|---|---|---|
| QMB | Part A and B premiums plus deductibles and copays | Lowest incomes on Medicare |
| SLMB / QI | Part B premium | Slightly higher incomes |
| Extra Help | Lower Part D drug costs | Automatic with any MSP |
| Full Medicaid | Medicare gaps plus long-term care and extras | Very low income and assets |
Real situations
How this plays out for people in common circumstances.
Retired cashier on Social Security
A 70-year-old living on a modest Social Security benefit sees her Part B premium deducted every month and struggles with copays.
A SHIP counsellor helps her apply for QMB. Her Part B premium stops being deducted, her Social Security payment rises, and she is no longer billed for Medicare copays.
Savings above the federal limit
A widower has some savings and assumed he would not qualify.
His state has no asset test for MSPs, and his income qualifies him for SLMB.
Billed by a doctor despite QMB
A QMB enrollee receives a bill for Medicare coinsurance.
She shows the provider her QMB status and calls Medicare; providers may not bill QMB enrollees for Medicare cost-sharing.
Under 65 with disability
A 55-year-old on SSDI has Medicare and very low income.
He qualifies for QMB, which also automatically enrols him in Extra Help.
What people miss
True, rarely explained, and it changes the outcome.
You do not need full Medicaid
MSPs have their own, higher limits.
QMB means no Medicare cost-sharing bills
Providers cannot bill you for Medicare deductibles and copays.
Extra Help comes free with it
Any MSP automatically qualifies you.
Some states have no asset test
Savings may not matter where you live.
SHIP counsellors are free
Every state has one.
Common reasons people get stuck
Assuming savings disqualify you
Check your state's rules.
Not telling providers about QMB
You may be wrongly billed.
Missing recertification
Coverage can stop.
Not applying because income is 'a bit high'
SLMB and QI cover higher incomes.
Paying for Medicare 'advice'
SHIP is free.
How it differs by state
States run MSPs and many are more generous than federal minimums - higher income disregards or no asset test at all. Application forms and processing times differ. Your State Health Insurance Assistance Program knows the local rules.
Key terms explained
The words on forms and letters, in plain English.
- QMB
- Qualified Medicare Beneficiary - pays premiums and Medicare cost-sharing.
- SLMB
- Specified Low-Income Medicare Beneficiary - pays the Part B premium.
- QI
- Qualifying Individual - pays the Part B premium for slightly higher incomes.
- SHIP
- State Health Insurance Assistance Program offering free Medicare counselling.
Questions people ask
What is a Medicare Savings Program?
How do I apply for a Medicare Savings Program?
What is QMB?
What is the difference between QMB and SLMB?
Do Medicare Savings Programs have an asset limit?
Will a Medicare Savings Program increase my Social Security check?
Do I automatically get Extra Help with a Medicare Savings Program?
Can a doctor bill me if I have QMB?
Can I get a Medicare Savings Program if I have a pension?
How long does it take to get approved?
What is SHIP?
Can I get help paying Medicare premiums if I am under 65?
Can I get a Medicare Savings Program if I have a Medicare Advantage plan?
Will a Medicare Savings Program refund premiums I already paid?
Numbers to call
Free lines. We are not affiliated with any of them.
Official sources
Current figures and applications live here.