Your dad lives on Social Security alone, and the Part B premium comes out of his check every month. On top of that, he pays a share of every doctor visit, and he's started skipping follow-ups to save money. A friend mentions a program that could pay his Medicare premiums. You've never heard of it, and you're not sure he'd qualify.
This guide uses Medicare.gov and the federal Medicaid statute. We don't list the income and resource limits, because they change every year and many states use higher ones. Medicare.gov publishes the current federal limits, and your state Medicaid office can tell you its own. A free State Health Insurance Assistance Program (SHIP) counselor can help your family sort it out3.
What Medicare Savings Programs do
Medicare Savings Programs (MSPs) help pay Medicare Part A and Part B premiums. In some cases they also pay Part A and Part B deductibles, coinsurance and copayments1. They are run by states as part of Medicaid, and when your parent applies, the state decides which program they qualify for1. Federal law defines the main program, the Qualified Medicare Beneficiary group, and the Medicare cost-sharing it covers4.
For a parent on a fixed income, the premium savings alone can add a meaningful amount back to every monthly check. And because MSPs link to Extra Help for prescriptions, the savings can reach the pharmacy counter too2.
The four programs
- Qualified Medicare Beneficiary (QMB). Helps pay Part A premiums if your parent doesn't have premium-free Part A, plus Part B premiums, deductibles, coinsurance and copayments for services and items Medicare covers1.
- Specified Low-Income Medicare Beneficiary (SLMB). Helps pay Part B premiums only. Your parent must have both Part A and Part B1.
- Qualifying Individual (QI). Helps pay Part B premiums. Your parent must reapply every year, states approve applications first come, first served with priority for people who had QI the year before, and it's only for people who don't qualify for other Medicaid1.
- Qualified Disabled and Working Individual (QDWI). Helps pay Part A premiums for some people under 65 with a disability who lost premium-free Part A after returning to work1.
Each program has a monthly income limit and a resource limit, and the limits are a little higher for married couples and in Alaska and Hawaii1. QMB has the lowest income limit, then SLMB, then QI. Medicare.gov lists the current figures1.
Who qualifies
In most cases, your parent's income and resources must be below certain limits, which go up each year1. Medicare stresses two points families often miss (for coverage choices, see Medigap vs. Medicare Advantage, and our Medicare Open Enrollment guide covers the yearly plan review). First, your parent may qualify in their state even if their income or resources are higher than the federal limits. Second, some states don't count certain types or amounts of income or resources at all1.
That's why Medicare's advice is simple: even if you don't think your parent qualifies, apply1. While you gather paperwork, check SNAP for seniors too. The state will check every program for them. Resources usually mean things like bank accounts and investments; a home and one car are typically not counted, but ask your state how it treats each item.
Your parent must have Medicare. For SLMB and QI, they need both Part A and Part B1.
QMB billing protections
QMB comes with an important protection. If your parent is in the QMB program, Medicare providers aren't allowed to bill them for services and items Medicare covers, including deductibles, coinsurance and copayments1. They may get a bill for a small Medicaid copayment if one applies1.
To make this work, your parent should show both their Medicare card and their Medicaid or QMB card every time they get care. With Original Medicare, they can also show a Medicare Summary Notice, which shows they're in QMB1. If a provider sends a bill anyway, call the provider, explain that your parent is a QMB member, and call 1-800-MEDICARE if the bill isn't corrected.
The link to Extra Help for prescriptions
People who get help from their state paying Part B premiums through a Medicare Savings Program get Extra Help automatically2. Extra Help lowers Part D premiums, deductibles and copays, and people who get it don't pay a Part D late enrollment penalty2. Medicare.gov confirms that QMB, SLMB and QI members all get Extra Help1.
It works the other way too. When your parent applies for Extra Help through Social Security, Social Security sends the information to the state to start an MSP application unless your parent says not to2. So one application can open both doors. See Extra Help for Medicare Part D for how the drug program works.
How to apply
- Contact your state Medicaid office. MSPs are run by states, so you apply there, not through Medicare1.
- Or start with Extra Help. An Extra Help application through Social Security can trigger an MSP application2.
- Gather proof. Medicare card, Social Security award letter, pension statements, and recent bank and investment statements.
- Ask which programs were checked. The state decides which program fits1.
- Watch the mail. Approval notices explain what's covered and when it starts.
- Mark renewals. QI requires a new application every year1, and other programs need periodic renewal.
A SHIP counselor can help free of charge3. For broader Medicaid steps, see how to apply for Medicaid for an elderly parent.
Signs your parent may qualify
You don't need to know the exact limits to spot a parent who should apply. Consider an application if any of these sound familiar:
- Social Security is their main or only income. Many older adults living mainly on Social Security fall near the MSP limits, especially in states with more generous rules1.
- They have modest savings. Resource limits apply, but a home and car are usually not counted. Ask your state how it treats each asset.
- They skip care because of copays. QMB covers Medicare deductibles, coinsurance and copays1.
- They struggle with prescription costs. MSP approval brings Extra Help automatically2.
- They already get SSI or Medicaid. They may already have help, or qualify easily. Check their notices.
If your parent is married, both spouses' income and resources usually count, and the limits are higher for couples1.
Questions to ask the state office
- Which programs did you check my parent for? The state decides which program fits1.
- Does our state use higher limits or disregard any income? Many states do1.
- When does coverage start? Ask when the state will begin paying premiums and whether any months are paid retroactively.
- How often must my parent renew? QI requires a yearly application1.
- Who do we call if a provider bills a QMB member? Keep the number with your parent's cards.
Write down the name of the person you spoke with and the date. If anything changes in your parent's income, such as a new pension or the death of a spouse, report it promptly.
Tips for adult children helping a parent
Many older adults feel uneasy about applying for anything that sounds like public assistance. It can help to explain that MSPs exist to help people keep up with Medicare costs they've earned the right to through years of work. The decision is still your parent's, and they'll need to sign the application unless someone has legal authority to act for them. See power of attorney for an elderly parent.
Keep copies of everything, set calendar reminders for renewals, and check your parent's Social Security statement a few months after approval. When the state starts paying the Part B premium, the deduction from their check should stop. If you manage your parent's money, see managing an elderly parent's finances. If your parent receives benefits through a representative payee, that person can help track changes; see Social Security representative payee.
Common mistakes
- Not applying because the federal limits look too low. Many states use more generous rules1.
- Forgetting QI renewals. QI requires a new application each year1.
- Paying bills a QMB member doesn't owe. Providers can't bill QMB members for Medicare-covered cost-sharing1.
- Not showing both cards. Show the Medicare and Medicaid or QMB cards at every visit1.
- Missing Extra Help. It comes automatically with MSPs that pay Part B premiums2.
If your parent is denied, the notice explains how to appeal. A SHIP counselor can help decide whether to ask for a hearing3.
How MSPs fit with other help
An MSP doesn't replace full Medicaid. If your parent also needs long-term care, such as nursing home care or in-home help, they may qualify for full Medicaid under different rules. See Medicaid waivers for home care and how to pay for a nursing home. If your parent has Medicare Advantage, MSPs can still help pay the Part B premium.
Families sometimes worry about estate recovery. Federal law excludes Medicaid help with Medicare cost-sharing from the optional estate recovery states may pursue5. If your parent later gets long-term care through full Medicaid, those services are treated differently, so ask your state. See Medicaid estate recovery.
An example
Rosa, 76, lives alone on Social Security and has a small savings account. Her son contacts the state Medicaid office, and the state approves her for QMB1. The state now pays her Part B premium, and providers can no longer bill her for Medicare-covered deductibles and coinsurance1. A few weeks later she gets a notice that she qualifies for Extra Help, lowering her prescription costs2. Her son sets a calendar reminder for her renewal, keeps copies of the approval letters in a folder, and tapes a note to her wallet reminding her to show both cards at every appointment. Within a couple of months, the premium deduction disappears from her Social Security deposit. This is an illustration; your parent's result depends on their state and finances.
Getting help
Start with your State Health Insurance Assistance Program for free, unbiased counseling3, or call your state Medicaid office. For prescription help, see Medicare.gov's Extra Help page2.
