What a Medicare Savings Program Does

A Medicare Savings Program is a state program that pays some of your Medicare costs on your behalf — specifically your premiums, deductibles, and copayments. The program sends the payment directly to Medicare or your provider, not to you. You do not pay the program back.

These programs exist because Medicare itself does not cover all costs. Even with Part A and Part B, you still owe a monthly premium for Part B, an annual deductible before coverage starts, and a share of the cost each time you use a service. For people with limited income, those costs add up quickly. A Medicare Savings Program reduces or eliminates what you pay out of pocket.

The program you may be able to use depends on your state and your income. Each state runs its own program under rules set by the federal government, so the name, the income limit, and what costs are covered can differ from state to state.

Key Takeaways

  • Medicare Savings Programs are run by your state and pay your Part B premium, deductible, and copayments directly to Medicare or your provider.
  • You must have Medicare Part A and Part B already enrolled, and your income must fall below a limit that varies by state.
  • There are four different programs with different income limits; the one you may use depends on your state and how much you earn.
  • You contact your state Medicaid office to learn whether you meet the income and resource limits and to submit the information they need.
  • Once approved, the program pays automatically — you do not have to submit bills or ask for reimbursement.

The Four Medicare Savings Programs and Their Income Limits

There are four separate programs, each with its own income limit. Your state may offer all four, or only some of them. The income limits change each year, and they are different in each state.

The may have access to Medicare Beneficiary (QMB) Program has the lowest income limit. It covers your Part B premium, your Part A and Part B deductibles, and your copayments and coinsurance. This is the broadest coverage of the four programs.

The Specified Low-Income Medicare Beneficiary (SLMB) Program covers only your Part B premium. Its income limit is slightly higher than QMB, so some people do not meet QMB's limit but do meet SLMB's.

The may have access to Individual (QI) Program also covers only your Part B premium. Its income limit is higher still. This program is often the easiest to meet if you are close to the edge of income limits.

The may have access to Disabled and Working Individuals (QDWI) Program covers your Part A premium only. It is for people under 65 who are working and have lost Medicare coverage because of earnings. It has a different income limit and different rules than the other three.

Who Can Use a Medicare Savings Program

To use any Medicare Savings Program, you must already have Medicare Part A and Part B. You cannot use the program to help you pay for Part D (prescription drug coverage) or Medigap (supplemental insurance). If you have not enrolled in Part B yet, you need to do that first through Social Security.

Your income must be below your state's limit for the program you are trying to use. Income includes wages, Social Security, pensions, interest, and rental income. Some income does not count — for example, the first $65 per month of unearned income is often excluded, but the rules vary by state.

You also have a resource limit — a cap on how much money and property you can own. Resources usually include bank accounts, stocks, and bonds, but not your home or car. The resource limit is the same across all states for each program, but it is higher than most people expect. For QMB in 2024, the resource limit is $8,550 for a single person and $12,830 for a couple, though these amounts increase each year.

You must be a U.S. citizen or a may have access to immigrant. Some immigrants with certain visa statuses do not meet this requirement.

How to Find Your State's Income Limits and explore

Income limits change every year on January 1, so you need to check your state's current limits, not last year's. The easiest way is to call your state Medicaid office directly and ask what the income limit is for each program in your state. You can find your state Medicaid office phone number by visiting the Centers for Medicare & Medicaid Services (CMS) website or by calling 1-800-MEDICARE.

You can also use the Medicare Savings Programs screening tool on the CMS website, which asks you questions about your income and state and tells you which programs you may be able to use based on your answers.

Once you know which program to explore for, contact your state Medicaid office. They will tell you what documents to bring or mail — usually proof of income (like a recent tax return or Social Security statement), proof of citizenship or immigration status, and proof of your Medicare enrollment. Some states let you explore online, by mail, or in person at a local office.

Processing time varies by state, but most decisions come within 30 to 60 days. Once you are approved, the program pays automatically. You do not have to do anything else or submit receipts.

What Happens After You Are Approved

Once approved, your state sends notice to Medicare and to your healthcare providers. Medicare updates your account to show that a Medicare Savings Program is paying your costs. When you see a doctor or use a service, you show your Medicare card as usual — the provider bills Medicare, and the program pays the portion you would normally owe.

You will receive a notice from your state Medicaid office confirming your approval and explaining what costs are covered under your specific program. Keep this notice. If a provider tells you that you owe money, you can show them the notice to clarify what the program covers.

Your approval is usually good for one or two years, depending on your state. Your state will send you a renewal notice before your coverage ends. You will need to report any changes in income or resources, because if your income goes above the limit, you will no longer be able to use the program.

When to Reapply or Switch Programs

If your income changes during the year, tell your state Medicaid office. If your income drops, you may become able to use a program you did not meet before, or you may move from SLMB or QI to QMB, which covers more costs. If your income rises above the limit, your coverage will end, but you can reapply if your income drops again later.

Some people move between programs as their income changes. For example, you might start in the QI Program because your income is just above the SLMB limit. If your income drops, you can ask to move to SLMB, which covers the same costs but is easier to stay in because the income limit is lower.

If you turn 65 and enroll in Medicare for the first time, you can explore for a Medicare Savings Program at the same time. If you are already on Medicaid for another reason, your state may automatically check whether you also meet the Medicare Savings Program limits and enroll you without a separate process.

What Medicare Savings Programs Do Not Cover

Medicare Savings Programs pay only the costs that Medicare itself requires you to pay — premiums, deductibles, and copayments. They do not cover services that Medicare does not cover, such as dental, vision, or hearing care. They do not cover prescription drugs; for help with drug costs, you need a separate Part D plan or a program like the Low-Income Subsidy.

If you have a Medigap policy (supplemental insurance), a Medicare Savings Program and Medigap can work together, but the program does not pay your Medigap premium. Some people have both because Medigap covers costs that Medicare Savings Programs do not, such as excess charges from out-of-network providers.

Frequently Asked Questions

Do I lose my Medicare Savings Program if I earn a little extra money?

Not when ready. Your income is usually checked once a year when you renew. If you earn extra money during the year but your total income for the year is still below the limit, you stay covered. If your income goes above the limit at renewal time, your coverage ends. You can reapply if your income drops again.

Can I use a Medicare Savings Program if I also have a job and employer health insurance?

Yes. You can have both Medicare and employer coverage at the same time. A Medicare Savings Program pays your Medicare costs, and your employer plan covers what it covers. The two work together. Tell your employer's benefits office that you have Medicare so they understand the coordination.

What if my state does not offer the program I need?

Not all states offer all four programs. If your state does not offer QMB, you may still meet SLMB or QI. If none of the programs your state offers match your income, you may be able to use a different program in a neighboring state if you have recently moved or have ties there, but this is rare. Ask your state Medicaid office what other programs may help.

Do I have to report my Medicare Savings Program to Social Security?

No. Your state Medicaid office reports it to Medicare and to Social Security on your behalf. You do not need to notify Social Security yourself. If you receive Supplemental Security Income (SSI), your state may count the Medicare Savings Program benefit as income, so ask your caseworker before you explore.

Can I use a Medicare Savings Program while I am still working and have not turned 65 yet?

Only if you are disabled or blind and already on Medicare before 65. The QDWI Program is specifically for people under 65 who are working and lost Medicare coverage because of earnings. If you are under 65 and not yet on Medicare, you cannot use a Medicare Savings Program until you enroll in Medicare.