If you're 65 or older and you pay the standard Medicare Part B premium, $202.90 leaves your account every month, and for most people it comes out of the Social Security payment before the money arrives. A program run by your state pays that premium for you if your income and savings fall under lines Medicare publishes every year. Nothing about it arrives in the post. You ask for it.
The programs are called Medicare Savings Programs, there are three that matter for most people on Medicare, and the gap between who qualifies and who's enrolled is the whole reason this page exists. In the top tier, only 15 of every 100 eligible people are in it.
What is a Medicare Savings Program?
It's a state-run program that pays Medicare costs for people under published income and resource limits. Medicare's page puts the mechanics in one line: you apply through your state, and when you apply, your state determines which program you qualify for. The same page adds a sentence worth reading twice, because it contradicts how most people decide whether to bother: "Even if you don't think you qualify, you should still apply."Source: medicare.gov, Medicare Savings Programs.
Three tiers apply to someone who has both Part A and Part B. They're separated by income and share one resource limit. A fourth, QDWI, covers Part A premiums for certain working people with disabilities under 65 and runs on different figures.
What are the 2026 income and resource limits?
| Program | What it pays | Monthly income, one person | Monthly income, couple | Resources |
|---|---|---|---|---|
| QMB Qualified Medicare Beneficiary | Part A premiums if you owe them, the Part B premium, and deductibles, coinsurance and copayments | $1,350 | $1,824 | $9,950 / $14,910 |
| SLMB Specified Low-Income Medicare Beneficiary | The Part B premium only | $1,616 | $2,184 | $9,950 / $14,910 |
| QI Qualifying Individual | The Part B premium only. Apply every year; first come, first served, with priority for last year's enrollees; not for people who qualify for Medicaid | $1,816 | $2,455 | $9,950 / $14,910 |
| QDWI Qualified Disabled and Working Individual | Part A premiums only | $5,405 | $7,299 | $4,000 / $6,000 |
Source: medicare.gov, Medicare Savings Programs, 2026 federal figures for the 48 States and D.C. Income limits are slightly higher in Alaska and Hawaii.
Two things about that table matter more than the numbers in it. The first is that a figure above the line isn't automatically a no: Medicare's page says you may still qualify in your state even if your income or resources are higher, because some states don't count certain types or specific amounts of income or resources. The second is that the resource limit is generous by the standards people expect. Most of a retirement account, a car and a house aren't what stops these applications. An unasked question is.
Who pays your Part B premium, and how much is it worth?
The standard Part B premium is $202.90 a month in 2026, which is $2,434.80 over a full year of eligibility.Source: CMS, 2026 Medicare Parts A & B Premiums and Deductibles. When your state enrolls you in any of the three tiers, that premium stops coming out of your Social Security payment, and the payment goes up by the same amount. It's a monthly line rather than a lump sum, and your first year depends on the effective date the state assigns.
QMB does more than the other two. Under it, the state also covers your deductibles, coinsurance and copayments, and Medicare providers aren't allowed to bill you for services and items that Medicare covers. SLMB and QI stop at the premium.
If your income is too high for any of this, the surcharge system works in the opposite direction and has its own appeal route. That's IRMAA, and the form most people actually need is on the appeal page.
Does a Medicare Savings Program also help with drug costs?
Yes, and this is the part people miss. Enrollment in QMB, SLMB or QI qualifies you for Extra Help, the Medicare program for prescription drug costs, automatically.Source: medicare.gov, Help with drug costs.
What Extra Help is worth in 2026
- Plan premium $0 on a plan under the program's benchmark, and a $0 deductible.
- No more than $5.10 for a covered generic and $12.65 for a covered brand-name drug.
- Nothing more for covered drugs once your total drug costs reach $2,100 for the year.
- No Part D late-enrollment penalty for as long as you have it.
- On its own, the 2026 limits are $23,940 in yearly income and $18,090 in resources for one person, or $32,460 and $36,100 for a married couple.
- Source: medicare.gov, Help with drug costs. Extra Help isn't available in Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands or American Samoa.
You can apply for both at once. Medicare's page says Social Security will send your information to your state to start the savings-program application unless you tell it not to. If your plan's own costs are what's changing, the 2027 Part D figures are a separate page, and so is the letter that tells you a plan is ending.
Why do so few eligible people get this?
MACPAC, the commission that advises Congress on Medicaid and CHIP, measured participation across the three tiers: 53 percent for QMB, 32 percent for SLMB and 15 percent for QI.Source: MACPAC, Medicare Savings Programs.
The figures don't explain themselves. What they do establish is that this isn't a fringe case: in the tier with the highest income line, five of every six eligible people aren't enrolled. Nobody is required to notify you, and no federal law entitles an individual to be told. The application is the whole mechanism.
Does it ever cost you something to be approved?
Once, in a way worth planning for, and it involves food assistance rather than Medicare. A household with a member 60 or older can deduct unreimbursed medical costs over $35 a month from the income its food-assistance office counts, and Medicare premiums are on the list of allowable costs. When your state starts paying your Part B premium, that premium is no longer your expense, so it leaves the deduction.
Here's the scale of it, using a worked example rather than a person. Ellen is 70, a widow renting in Pennsylvania on $1,700 a month of Social Security with $4,000 in savings, a $40 drug plan and $60 a month of prescriptions. She isn't a client, and every figure below is either a published 2026 number or a stated assumption.
Ellen, before and after the state takes over the premium
- Her $1,700 is above the QMB and SLMB lines and under the QI line, and her savings are well under $9,950, so on the federal figures she looks like a QI case. Only her state can decide that.
- QI pays her Part B premium: $2,434.80 over a full year of eligibility, back in her Social Security payment.
- While she pays her own premiums, her medical costs on the food-assistance file are $202.90 plus $40 plus $60, and the federal formula produces about $89 a month in food benefits.
- Once the state pays the Part B premium and Extra Help takes the plan premium to zero, only the $60 of prescriptions is still hers, and the same formula produces the $25 minimum.
- She's far ahead: $64 a month less in food benefits against $202.90 a month she no longer pays. The rules are in the SNAP rules for households over 60.
- Arithmetic on the 2026 federal figures plus Ellen's stated assumptions, treating her utility bill as the figure her state counts. Only her state's calculation governs. Sources: medicare.gov; 7 CFR 273.9; USDA FNA FY2027 memo.
One action follows from that: ask your food-assistance office whether and when the premium change has to be reported. The rules apply to what your file says.
How do you apply, and who helps for free?
You apply through your state, and there are two free people to ask for on the way.
The first number is 1-800-677-1116, the Eldercare Locator, a public service of the Administration for Community Living, part of HHS. It connects you to the Area Agency on Aging covering your city, county or multi-county district, and every part of the country is covered by one.Source: eldercare.acl.gov; ACL, Area Agencies on Aging.
The second is your State Health Insurance Assistance Program. SHIP gives free one-on-one Medicare counselling and has nothing to sell: 54 programs cover every state, D.C. and three territories, delivered through state units on aging or departments of insurance with the local area agencies.Source: ACL, State Health Insurance Assistance Program; shiphelp.org, 877-839-2675.
What to do this week
- Find the Social Security letter that shows your monthly benefit and the Medicare premium deducted from it. Those two numbers are what any of these applications start from.
- Compare your own monthly income with $1,350, $1,616 and $1,816, and your savings with $9,950. Being over a line isn't a decision, because states count income and resources differently.
- Call 1-800-677-1116, give your county, and ask: "Which of these can I apply for, and who handles each one?" Name the Medicare Savings Programs and Extra Help first.
- Ask who provides SHIP counselling in your county, and book the free appointment before you fill in anything.
- Apply for Extra Help and the savings program together, and let Social Security pass your information to the state.
- Write down the name of the person you spoke to and the date. If an application is denied, ask in writing for the reason and the deadline to appeal.
- If a state program does approve you, tell your food-assistance office and ask whether the change has to be reported.
The honest verdict
"The government is paying seniors" is a slogan that gets the mechanism backwards. No federal law entitles an individual to these services, nothing arrives by itself, and the largest items are tested against published income and resource lines. What's true is narrower and more useful: if your figures are near the lines above, a state program can take $202.90 a month off your costs and hand you $0 drug premiums along with it, and the only thing standing between most eligible people and that outcome is an application nobody asked them to make.
Check the rule. Not the slogan.
Educational only
This is general information, and it isn't legal, tax or financial advice. Ellen is a worked example, not a person. Figures are the 2026 federal figures for the 48 States and D.C.; Alaska and Hawaii are higher, and states may count income and resources differently. Only the agency that runs each program can apply its rules to your case. Confirm anything that matters at medicare.gov, at 1-800-MEDICARE (1-800-633-4227), or with your state.
Sources
- medicare.gov: Medicare Savings Programs (the four programs, what each pays, 2026 income and resource limits, apply through your state, apply even if you don't think you qualify, QMB balance-billing protection)
- medicare.gov: Help with drug costs (Extra Help 2026 limits, $0 premium and deductible, $5.10 and $12.65 copays, $2,100 threshold, automatic qualification through a savings program, Social Security passing information to the state)
- CMS: 2026 Medicare Parts A & B Premiums and Deductibles ($202.90 standard Part B premium)
- MACPAC: Medicare Savings Programs (participation 53 percent QMB, 32 percent SLMB, 15 percent QI)
- ACL: Eldercare Locator (1-800-677-1116, a public service of the Administration for Community Living) and Area Agencies on Aging
- ACL: State Health Insurance Assistance Program (free one-on-one counselling, 54 grantees)
- ACL: Older Americans Act (no individual is entitled to Title III services)
- govinfo.gov: 7 CFR 273.9 (the food-assistance medical deduction that Medicare premiums count toward)
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Common questions
What is a Medicare Savings Program?
It's a program run by your state that pays Medicare costs for people whose income and resources fall under published lines. There are four, and three matter for someone with Part A and Part B: QMB pays Part A premiums if you owe them, the Part B premium, and your deductibles, coinsurance and copayments; SLMB and QI pay the Part B premium only. You apply through your state, and your state decides which program you qualify for. Medicare's own page says that even if you don't think you qualify, you should still apply. Source: medicare.gov, https://www.medicare.gov/basics/costs/help/medicare-savings-programs
What are the Medicare Savings Program income limits for 2026?
For one person in the 48 States and D.C. in 2026: QMB up to $1,350 a month, SLMB up to $1,616, and QI up to $1,816. For a married couple the lines are $1,824, $2,184 and $2,455. All three share a resource limit of $9,950 for one person and $14,910 for a couple. Alaska and Hawaii are higher. Medicare's page also says you may still qualify in your state even if your income or resources are above these figures, because some states don't count certain types or amounts of income or resources. Source: medicare.gov, Medicare Savings Programs
Who pays my Medicare Part B premium if I qualify?
Your state does, through whichever Medicare Savings Program it enrolls you in. The standard Part B premium is $202.90 a month in 2026, which is $2,434.80 over a full year of eligibility, and for most people it comes out of the Social Security payment before it reaches the bank. When the state takes it over, that amount stays in the payment instead. Your first year depends on the effective date your state assigns. Source: CMS, 2026 Medicare Parts A & B Premiums and Deductibles; medicare.gov, Medicare Savings Programs
What is the difference between QMB, SLMB and QI?
QMB has the lowest income line and pays the most: Part A premiums if you owe them, the Part B premium, and deductibles, coinsurance and copayments. Under QMB, Medicare providers aren't allowed to bill you for services and items Medicare covers. SLMB sits at a higher income line and pays the Part B premium only. QI has the highest line and also pays the Part B premium only, but you must apply every year, applications are taken first come first served with priority for last year's enrollees, and it isn't available to people who qualify for Medicaid. Source: medicare.gov, Medicare Savings Programs
Do I get Extra Help with drug costs too?
Yes, automatically. Anyone enrolled in QMB, SLMB or QI qualifies for Extra Help, the Medicare program for prescription drug costs. In 2026 Extra Help means a $0 plan premium on a plan under the program's benchmark, a $0 deductible, no more than $5.10 for a covered generic and $12.65 for a covered brand-name drug, nothing more for covered drugs once total drug costs reach $2,100, and no Part D late-enrollment penalty while you have it. You can also apply for Extra Help on its own: the 2026 limits are $23,940 in yearly income and $18,090 in resources for one person. Source: medicare.gov, https://www.medicare.gov/basics/costs/help/drug-costs
How many people who qualify are actually enrolled?
A minority in every tier. MACPAC, the commission that advises Congress on Medicaid and CHIP, found participation rates of 53 percent for QMB, 32 percent for SLMB and 15 percent for QI. The figures don't say why people aren't enrolled. They say how many are missing. Source: MACPAC, https://www.macpac.gov/subtopic/medicare-savings-programs/
How do I apply for a Medicare Savings Program?
You apply through your state, and nothing is mailed to you first. Two free starting points: call 1-800-677-1116, the Eldercare Locator, a public service of HHS's Administration for Community Living, which connects you to the Area Agency on Aging for your county, and ask who runs your State Health Insurance Assistance Program, which gives free one-on-one Medicare counselling and sells nothing. You can apply for Extra Help and a Medicare Savings Program at the same time, and Social Security will send your information to the state to start the savings-program application unless you tell it not to. Source: eldercare.acl.gov; acl.gov, State Health Insurance Assistance Program; medicare.gov, Help with drug costs