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Do I qualify for financial assistance programs with Medicare?

When it comes to Medicare, you’ve earned each and every benefit. But it’s important to recognize early on in your Medicare journey that the program is not without costs. Some of these are up front, like the monthly premium payments you make to maintain your Medicare coverage. Others are associated with your share of medical services, like the payments you make at the doctor’s office to cover your portion of the care you received. Or the percentage of the cost of a hospital stay you may have to pay.

 

These payments can add up, and not everyone is able to afford them. But there’s good news: you may be able to qualify for help paying for your Medicare costs. Here are some available options.



I need help paying for my Medicare premiums

 

Medicare Savings Programs (MSPs) are programs run by state governments. They may pay for Medicare Part A and/or Part B premiums, deductibles, copayments and coinsurance associated with Medicare for people with limited income and assets.

 

To learn more about the costs of Medicare, read “The Most Frequently Misunderstood Medicare terms”.

 

Income is the amount of money you earn during the year.

 

Assets are any money you have in the bank, and the value of certain investments (i.e., stocks, bonds and real estate). However, the house you live in and up to one car you own are not counted as assets when it comes to qualifying for a Medicare Savings Program.

 

 

What counts as an asset?

 

Medicare Savings Programs are only open to people who qualify based on income and asset requirements. So, what counts as an asset when it comes to qualifying?
 

 

Counts as an asset:

 

Any money you have in the bank

Stocks you may own

Bonds you may hold

Any real estate you own that you don’t live in

Investments held through a financial institution, like a certificate of deposit (CD) or mutual fund

 
 
 

Doesn’t count as an asset:

 

The house you live in

One vehicle like a car, motor home or motorcycle (additional vehicles count as assets)

Household items (for example, your television or computer)

Burial funds up to $1,500 per person

 

Different Medicare Savings Programs

 

There are four types of Medicare Savings Programs designed to help with paying costs for Original Medicare or Medicare Part B. They are distinguished by their income limits and what costs they help pay for. The programs include:

 

  • Qualified Medicare Beneficiary Program (QMB)

     

    • This program helps to pay Medicare Part A and Part B premiums and copayments. It also helps to pay deductibles and coinsurance for both Part A and Part B.
    • A single person can qualify for the program in 2025 with an income up to $1,325 per month.
    • A couple can qualify with a combined income of $1,783 per month.
    • The Medicare asset limits are $9,660 for an individual and $14,470 for a couple.
  • Specified Low-Income Medicare Beneficiary Program (SLMB)

     

    • This program helps with paying Medicare premiums for Part B.
    • A single person can qualify in 2025 with an income up to $1,585 per month.
    • A couple can qualify with a combined income of $2,135 per month.
    • The Medicare asset limits are $9,660 for an individual and $14,470 for a couple.
  • Qualified Individual Program (QI)

     

    • This program helps with paying Medicare premiums for Part B but does not cover as large a percentage of the premium as the Specified Low-Income Medicare Beneficiary Program. 
    • In 2025 a single person can qualify with an income up to $1,781 per month.
    • A couple can qualify with a combined income of $2,400 per month.
    • The Medicare asset limits are $9,660 for an individual and $14,470 for a couple.
  • Qualified Disabled and Working Individuals (QDWI) Program

     

    • This program helps to pay premiums for Medicare Part A. You may qualify if you have a disability, you’re working, and you lose your Social Security disability and premium-free Part A because you returned to work.
    • In 2025 a single person can qualify with an income up to $5,302 per month.
    • A couple can qualify with a combined income of $7,135 per month.
    • The Medicare asset limits are $4,000 for an individual and $6,000 for a couple.   

It is important to note that income limits to qualify for these Medicare Savings programs are slightly different in Alaska and Hawaii. Learn more about the income limits in those states.

It’s important to recognize early on in your Medicare journey that the program is not without costs. But if you need help paying for Medicare, there are options available.

 

Medicare and Medicaid dual eligibility coverage

 

Medicaid is a health insurance program operated by each state. It’s meant to provide coverage for low-income and low-asset individuals. Each state sets its own limits on income, assets and the type of benefits they include in their Medicaid program. It’s possible to be eligible for both/get financial assistance from Medicare and Medicaid. If you qualify for Medicare and Medicare, you may be eligible for a Dual Eligible Special Needs plan (D-SNP) that gives you more benefits than Original Medicare.

 

If you receive Medicare benefits and meet your state’s Medicaid eligibility requirements, you may be full-benefit dual eligible.

 

Medicaid eligibility conditions include income and asset requirements, plus citizenship and residency requirements.

 

If you are a full-benefit dual eligible, you may receive benefits included in both Medicaid and Medicare coverage. Here are some examples of what’s covered under Medicaid:

 

  • Some types of care you get at your home, like nursing that focuses on helping a person get in and out of bed or get dressed
  • Care delivered in a nursing home
  • Some prescription drugs not covered by Medicare Part D plans

Paying for a prescription drug plan with Medicare Extra Help

 

If you qualify for the Qualified Medicare Beneficiary Program (QMB), Specified Low-Income Medicare Beneficiary Program (SLMB) or Qualified Individual Program (QI) Medicare Savings Programs, then you also automatically qualify for a program called Extra Help. This program offers extra help paying for Medicare Part D prescriptions. Prescription drug coverage is provided through Medicare Part D, which is why Extra Help is also known as the Part D Low-Income Subsidy. Part D coverage generally comes with a premium, a deductible and a copayment or coinsurance. Learn more about Medicare Part D.


But you don’t have to be in a Medicare Savings Program to receive help paying for your prescriptions under Extra Help. If your monthly income as an individual is up to $1,978 per month or $2,665 as a couple in 2025, you may be eligible. Asset limits in 2025 are up to $17,600 for an individual or $35,130 for a couple.

 

Depending on which Medicare Part D plan you choose, the program can reduce or eliminate your plan’s premium and deductible. It can also lower the cost you pay for the prescription drugs covered under your plan.

 

Finding out if you qualify for Medicare financial assistance programs

 

With so many different programs providing assistance for so many different types of costs, it’s easy to get confused. Fortunately, there is help available to find out if you qualify for Medicare financial assistance programs. A good place to start is with BenefitsCheckup.org.

 

The site has a free online tool from the National Council on Aging that connects people with benefits they may qualify for. Insurance brokers and state-area offices on aging are also excellent resources.

 

Don’t be afraid to reach out for help to find out if you qualify for help paying for your Medicare coverage.
 

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