Frequently Asked Questions
What programs help low-income seniors pay for Medicare?
The main programs are: Medicare Extra Help (saves up to $5,300/year on drug costs), Medicare Savings Programs (pay Part B premiums and sometimes Part A and cost-sharing), PACE (comprehensive managed care for dual-eligible seniors), State Pharmaceutical Assistance Programs (vary by state), and the Qualified Medicare Beneficiary program (eliminates most Medicare cost-sharing). Medicaid for dual-eligible seniors provides the most comprehensive coverage.
What income qualifies for Medicare Extra Help?
For 2026, Extra Help eligibility is approximately $22,590/year for individuals and $30,660/year for couples. These thresholds are updated annually. Resource limits (savings and assets, not counting home and car) are approximately $16,600 for individuals and $33,240 for couples. Apply at ssa.gov/extrahelp — those who qualify automatically receive savings without needing to enroll in a specific plan.
What is the Medicare Savings Program?
Medicare Savings Programs (MSPs) are state Medicaid programs that help pay Medicare premiums and sometimes cost-sharing for low-income seniors. There are four levels: Qualified Medicare Beneficiary (QMB) — pays Parts A and B premiums plus all Medicare cost-sharing. Specified Low-Income Medicare Beneficiary (SLMB) — pays Part B premium only. Qualifying Individual (QI) — pays Part B premium. Qualified Disabled and Working Individuals (QDWI) — pays Part A premium for disabled workers.
What is PACE and who qualifies?
PACE (Program of All-inclusive Care for the Elderly) provides comprehensive medical and social services to seniors who are nursing-home eligible but can live safely in the community with support. It serves dual-eligible (Medicare + Medicaid) seniors. PACE covers all Medicare and Medicaid services at one location, including primary care, specialist visits, prescription drugs, dentistry, transportation, and adult day health services. Not available in all areas — find your local PACE at npaonline.org.
Can I get Medicare and Medicaid at the same time?
Yes — this is called being dual-eligible. Approximately 12 million Americans have both Medicare and Medicaid simultaneously. Medicare pays first for Medicare-covered services; Medicaid covers remaining costs that Medicare doesn't pay. Dual-eligible seniors typically pay little to nothing for healthcare. Eligibility is based on income and assets — contact your state Medicaid office to apply.
Millions of low-income seniors are paying far more for Medicare than they need to — because they only know about one or two of the available assistance programs, or don't know they qualify. This guide puts every program in one place: who qualifies, how much it saves, and how to apply.
1. Medicare Extra Help (Low Income Subsidy)
What it does: Dramatically reduces Part D drug costs — copays of $1–$10 per prescription instead of standard copays. Eliminates the Part D deductible. Saves up to $5,300/year.
Income limits (2026): Approximately $22,590 (individual) or $30,660 (couple). Resources: $16,600 individual, $33,240 couple — not counting your home, car, or personal belongings.
How to apply: Online at ssa.gov/extrahelp, call SSA at 1-800-772-1213, or visit a local SSA office. If you receive Medicaid, SSI, or a Medicare Savings Program — you're automatically enrolled.
2. Medicare Savings Programs (MSP)
Four different MSP levels pay Medicare premiums and sometimes cost-sharing for qualifying seniors. Apply through your state Medicaid office — not SSA.
| Program | What It Pays | Approx. Income Limit |
|---|---|---|
| QMB | Part A + B premiums + all Medicare cost-sharing | $1,275/mo individual |
| SLMB | Part B premium only ($174.70/mo saved) | $1,526/mo individual |
| QI | Part B premium only | $1,714/mo individual |
| QDWI | Part A premium for disabled workers | $4,615/mo individual |
Important: QMB enrollment also automatically qualifies you for Extra Help at the highest subsidy level.
3. PACE — Program of All-Inclusive Care for the Elderly
PACE is the most comprehensive program for dual-eligible seniors who are nursing-home eligible but want to remain in the community. It provides all Medicare and Medicaid services through one coordinated program: primary care, specialist visits, prescriptions, hospital care, physical and occupational therapy, dentistry, nutrition counseling, transportation to the PACE center, and adult day health services.
PACE serves seniors who are 55+, live in a PACE service area, are certified as nursing-home eligible by their state, and can live safely in the community with PACE support. Most PACE participants pay little to nothing — Medicaid covers PACE for dual-eligible seniors. Find your local PACE at npaonline.org or call 1-800-MEDICARE.
4. State Pharmaceutical Assistance Programs (SPAPs)
Many states offer additional prescription drug assistance beyond federal programs. Programs like California's PACE (not the same as federal PACE), New York's EPIC, and similar state programs provide additional drug cost reduction that stacks on top of federal Extra Help. Find your state's program at medicare.gov or call your State Health Insurance Assistance Program (SHIP).
How to Apply — In Order
- Apply for MSP first — through your state Medicaid office. MSP enrollment automatically triggers Extra Help enrollment.
- Apply for Extra Help separately if you don't qualify for MSP — at ssa.gov/extrahelp
- Call your SHIP (shiphelp.org) for free help identifying all programs you qualify for in your state
- Ask about state programs — your SHIP counselor knows which state-specific programs are available
- Even if your income is above the limits, apply anyway — assets are often excluded, and limits change
- Applying is free and never reduces other benefits
- SHIP counselors provide free help identifying every program you qualify for
- If you qualify for QMB, providers are prohibited from billing you for Medicare cost-sharing — know your rights
→ Medicare Extra Help — Complete Application Guide
→ 10 Ways to Lower Medicare Costs
→ Part D Drug Cost Cap 2026