What Medicare Savings Programs Do

A Medicare Savings Program is a state-run benefit that pays some or all of your Medicare premiums, deductibles, and copayments — but only if your income and resources fall below certain limits. The program does not give you money directly. Instead, the state pays Medicare on your behalf, reducing what comes out of your pocket when you see a doctor or fill a prescription.

There are three separate Medicare Savings Programs, each covering different costs. Which one you may be able to use depends on your income level. All three are administered by your state, not by Medicare itself, which means the income limits and exact benefits vary by state.

You do not automatically get into a Medicare Savings Program just because you have Medicare. You must contact your state's Medicaid office and provide proof of income and citizenship. The process is straightforward but requires paperwork, and approval can take several weeks.

Key Takeaways

  • Medicare Savings Programs are run by your state Medicaid office, not Medicare, and each state sets its own income limits and processes.
  • The three programs — may have access to Medicare Beneficiary, Specified Low-Income Medicare Beneficiary, and may have access to Individual — cover different costs depending on your income level.
  • You must contact your state Medicaid office directly to request information and submit proof of income, citizenship, and Medicare enrollment.
  • Income limits are typically between 100% and 200% of the federal poverty level, which means a single person earning roughly $1,400 to $2,800 per month may be within range.

The Three Medicare Savings Programs and What Each Covers

The may have access to Medicare Beneficiary (QMB) Program covers the most. If your income is at or below 100% of the federal poverty level, QMB pays your Part B premium, your Part A deductible, your Part B deductible, and your copayments for most services. This is the most generous of the three programs.

The Specified Low-Income Medicare Beneficiary (SLMB) Program covers less. If your income is between 100% and 120% of the federal poverty level, SLMB pays only your Part B premium — not your deductibles or copayments. This program helps with the monthly cost but leaves you responsible for other out-of-pocket expenses.

The may have access to Individual (QI) Program is the narrowest. If your income is between 120% and 135% of the federal poverty level, QI pays only your Part B premium, and only up to a set dollar amount each year. Your state may have a waiting list for QI because federal funding is limited.

Income limits change each year. Your state Medicaid office can tell you the exact thresholds for your state and which program you may fit into based on your current income.

How to Request Information and Submit Your Details

Contact your state Medicaid office directly — not Medicare. You can find your state office by calling 1-800-MEDICARE (1-800-633-4227) and asking for the Medicaid office phone number, or by visiting your state health department website and searching for "Medicaid" or "Medicare Savings Program."

When you call, tell them you want to learn about Medicare Savings Programs and ask what documents you need to bring. Most states will ask for proof of income (recent pay stubs, tax returns, or a letter from your employer), proof of citizenship (birth certificate, passport, or naturalization papers), and proof of Medicare enrollment (your Medicare card). Some states accept applications by mail or online; others require you to visit in person.

Do not wait until you are in financial hardship to contact your state office. Processing takes time, and benefits usually start the month after approval. If you are already struggling to pay your premiums, call anyway — your state may be able to backdate benefits in some cases.

Income Limits and Resource Limits by State

Income limits for all three programs are tied to the federal poverty level, which changes each year. For 2024, the federal poverty level for a single person is roughly $1,550 per month, which means QMB covers people earning up to about $1,550, SLMB covers people earning up to about $1,860, and QI covers people earning up to about $2,090. These are national figures; your state may use slightly different thresholds.

Most states also set a resource limit — a cap on how much money and property you can own and still be covered. Resource limits are usually $7,000 to $10,000 for a single person, though some states are higher. Your home and one car do not count toward the resource limit. Ask your state Medicaid office what the resource limit is in your state.

Income includes wages, Social Security, pensions, and interest from savings. It does not include food stamps, housing information, or some other benefits. If you are unsure whether your income counts, ask your state office before you submit your request.

What Happens After You Submit Your Information

Your state Medicaid office will review your income, resources, and citizenship status. This review usually takes two to four weeks. If you are missing documents, the office will contact you and ask you to send them. Do not ignore these requests — if you do not respond within the timeframe given, your request may be denied.

If you are approved, your state will send you a notice in the mail stating which program you may have access to for and when your coverage begins. Coverage usually starts the first day of the month after approval. Your state will also tell Medicare to stop billing you for the costs the program covers.

If you are denied, the notice will explain why. Common reasons include income above the limit, insufficient proof of citizenship, or failure to provide required documents. You have the right to ask for a hearing to dispute the decision. Your state notice will explain how to request one.

How Your Benefits Work Once You Are Covered

Once approved, you keep your Medicare card and use it the same way. The difference is that your state pays certain costs directly to Medicare or to your provider. You will not see a bill for the costs your program covers — or if you do, you can send it to your state Medicaid office and they will handle it.

If you see a provider who does not accept Medicare, the Medicare Savings Program will not help, because the program only covers Medicare-approved costs. Make sure your doctors and hospitals accept Medicare before you rely on the program to cover the visit.

Your coverage continues as long as you remain may be able to access. Your state will ask you to renew your information every year or every few years, depending on state rules. You will receive a notice in the mail telling you when to renew. If you do not renew by the important date, your coverage may end.

Common Mistakes to Avoid

The biggest mistake is waiting too long to contact your state office. Many people do not realize the program exists until they are already behind on bills. Contacting your state early gives you time to gather documents and get approved before you face a financial crisis.

Another mistake is not reporting changes in income or resources. If you get a raise, inherit money, or experience a major change in your situation, tell your state Medicaid office. Failing to report changes can result in overpayment, which the state may ask you to repay.

A third mistake is assuming you do not may have access to because your income is slightly above the limit. Income limits change each year, and some states have slightly higher thresholds than others. It costs nothing to ask, and your state office can tell you in minutes whether you might be covered.

Frequently Asked Questions

Can I have both Medicare Savings Program coverage and Medicaid?

Yes. In fact, if you are covered by both, you are called "dual may be able to access." Your state Medicaid office can tell you whether you may have access to for full Medicaid in addition to a Medicare Savings Program. Some people may have access to for both; others may have access to for only one.

What if my income goes up after I am approved?

Tell your state Medicaid office right away. If your income rises above the limit for your program, your coverage will end. Your state will give you notice before this happens, usually with a few weeks' warning. You may still be able to move to a different program if your new income falls within a higher bracket.

Do I have to pay back any money if I am approved?

No. Medicare Savings Programs are not loans. The state pays your costs as a benefit, and you do not repay it. However, if you were approved in error or failed to report a change in your situation, your state may ask you to repay some costs.

Can I use a Medicare Savings Program with a Medicare Advantage plan?

Yes, but the coverage works differently. With a Medicare Advantage plan, your program may pay your plan premium and some copayments, but not all costs are covered the same way as with Original Medicare. Ask your state Medicaid office how the program works with your specific plan.

What if my state has a waiting list for the QI program?

Some states run out of federal funding for QI and create a waiting list. If your state has a list, you can still request information and get on it. When funding becomes available, your state will contact you. In the meantime, you may be able to move to SLMB or QMB if your income qualifies.