Medicare · Cornerstone
Medicare Savings Programs, QMB, SLMB, and QI
Last reviewed June 11, 20264 min readBy the Goodsurance editorial team Reviewed by the Goodsurance editorial team
The Medicare Savings Programs are the most underused help on the whole menu, and the reason is mostly that they sound like paperwork. They are run by your state's Medicaid office, they go by initials, and the rules vary by state, so people assume they will not qualify and never check. That is a costly assumption, because the headline benefit, having your Part B premium paid, is worth roughly $2,400 a year at the standard rate, money that either comes back to you or never leaves your Social Security check in the first place.
1What these programs actually pay for
There are three tiers, separated mainly by income, and they pay for progressively less as the income limit rises. The Part B premium is the common thread: all three help with it. The differences are at the top, where the most generous tier reaches into the rest of your Medicare cost-sharing.
- QMB (Qualified Medicare Beneficiary): the top tier. It can cover your Part B premium and also your Part A and Part B deductibles, coinsurance, and copays.
- SLMB (Specified Low-Income Medicare Beneficiary): pays the Part B premium only, with a higher income limit than QMB.
- QI (Qualifying Individual): also pays the Part B premium, with the highest income limit of the three. It is funded annually and granted first-come, so applying early in the year matters, and you cannot have QI if you also qualify for Medicaid.
There is a fourth, narrower program (QDWI) for certain people working with disabilities who have lost premium-free Part A; it is uncommon enough that most readers will only need the three above.
The three Medicare Savings Program tiers
Rising income limits; dollar limits vary by state and year. Source: CMS.
The covered Part B premium comes back to you, or never leaves your Social Security check in the first place.
2The income limits are probably higher than you think
The single most common reason people skip these programs is a guess about their own income that turns out to be wrong. The limits are set as a percentage of the federal poverty level and they move every year, and the QI tier in particular reaches well up into modest fixed incomes. Some income is also not counted the way people expect, and a portion of earned income is disregarded in the math. The practical move is to check the current year's figures for your state rather than rely on a number you heard once.
3The asset test has changed in many states
These programs historically counted assets as well as income, and the asset rules scared off a lot of people who would have qualified on income alone. That has been shifting: a number of states have raised or eliminated the asset limit for the Medicare Savings Programs. Even where an asset test remains, your home and your car are typically not counted, which surprises people who assume any savings disqualify them. Because this varies most by state, your state's current rule is the only one that matters for you.
4The QMB billing protection almost no one uses
This is a real federal right that goes routinely unused. If you have QMB, Medicare providers are prohibited from billing you for Medicare cost-sharing, the deductibles, coinsurance, and copays QMB is meant to absorb. It is called the balance-billing protection.
In practice, billing systems often do not know a patient has QMB, so bills go out anyway and people pay them, assuming they owe the money. They usually do not. If you have QMB and get a bill for a Medicare deductible or coinsurance, you can tell the provider you are a QMB beneficiary, ask them to stop billing and refund what you paid, and contact Medicare if it continues.
5One application, two kinds of help
Here is the part that makes the paperwork worth it: enrolling in any of the three Medicare Savings Programs automatically makes you eligible for Extra Help, the Part D low-income subsidy that lowers prescription costs. So a single application to your state can unlock both premium help and drug help at once. That linkage is the strongest argument for checking even if you are unsure, because the downside is a short application and the upside is two benefits.
6How to apply, and staying enrolled
Because the states run these, you apply through your state Medicaid agency, not Social Security (Extra Help is the one that goes through Social Security). The application asks about income and, depending on your state, assets. A SHIP counselor or a licensed agent can walk you through it at no cost.
Plan for one thing: these are not always permanent. The program asks you to confirm you still qualify on a periodic basis, a redetermination, and people sometimes lose coverage simply by missing a renewal notice rather than by becoming ineligible. Keep your address current with the agency and open anything they send.
Common questions about Medicare
Quick answers to common questions
Tap any question to expand. Each question links to a fuller standalone answer.
What is Extra Help for Medicare?
Extra Help is a federal program that lowers the cost of Medicare prescription drug coverage (Part D) for people with limited income and resources.
It can reduce or eliminate your Part D monthly premium and yearly deductible, and it lowers what you pay at the pharmacy for covered drugs. Extra Help is also called the Low-Income Subsidy. You apply through Social Security, and qualifying is based on your income and savings, not your health. Many people who qualify do not realize it, so it is worth checking even if you are unsure. People who get Extra Help also gain more flexibility to change drug plans during the year. To see whether you might qualify and how to apply, reach out to a licensed Goodsurance advisor at 1-888-301-8091 (TTY 711), Mon to Fri 8 am to 5 pm PT.
How do I lower my Medicare costs?
You can lower your Medicare costs through a few different paths, depending on your income and situation.
If you have limited income and resources, you may qualify for help: Medicare Savings Programs (state programs that can pay your Part B premium and other costs), Extra Help (a federal program that lowers prescription drug costs), or Medicaid alongside Medicare. Choosing coverage that matches your actual medication and provider needs also avoids paying for things you do not use. Enrolling on time matters too, since late penalties add a permanent surcharge to your premiums. Reviewing your plan each year during the fall enrollment period can catch cost increases. To compare your options and check whether you qualify for help, reach out to a licensed Goodsurance advisor at 1-888-301-8091 (TTY 711), Mon to Fri 8 am to 5 pm PT.
What are Medicare Savings Programs?
Medicare Savings Programs are state-run programs that help people with limited income and resources pay their Medicare costs.
Depending on which program you qualify for, they can pay your Part B (medical) monthly premium, and some can also cover your Medicare deductibles, copayments, and coinsurance. There are several tiers, each with its own income and resource limits, so the level of help varies. You apply through your state Medicaid office, and qualifying for many of these programs also automatically qualifies you for Extra Help, the federal program that lowers prescription drug costs. The limits change yearly, so it is worth checking even if you did not qualify before. To find out which program you might qualify for and how to apply, reach out to a licensed Goodsurance advisor at 1-888-301-8091 (TTY 711), Mon to Fri 8 am to 5 pm PT.
Can I get help paying my Part B premium?
Yes, you may be able to get help paying your Part B (medical) monthly premium through a Medicare Savings Program.
These are state-run programs for people with limited income and resources, and depending on which one you qualify for, the program can pay your Part B premium in full, and sometimes your deductibles and other cost sharing too. The Part B premium is $202.90 per month in 2026 for most people, so this help can make a real difference in your budget. You apply through your state Medicaid office, and qualifying is based on income and savings, not health. Income limits change each year, so check even if you did not qualify before. To see whether you qualify and get help applying, reach out to a licensed Goodsurance advisor at 1-888-301-8091 (TTY 711), Mon to Fri 8 am to 5 pm PT.
Does Extra Help lower drug costs?
Yes, Extra Help directly lowers your Medicare prescription drug costs.
Extra Help, also called the Low-Income Subsidy, is a federal program for people with limited income and resources. It can reduce or eliminate your Part D (drug coverage) monthly premium and yearly deductible, and it lowers the amount you pay at the pharmacy for covered medications. It applies only to drug costs under Part D, not to your Part B medical premium, which is a separate kind of help. You apply through Social Security, and qualifying is based on your income and savings. Getting Extra Help also lets you change drug plans more flexibly during the year. To check whether you qualify and how it would affect your drug costs, reach out to a licensed Goodsurance advisor at 1-888-301-8091 (TTY 711), Mon to Fri 8 am to 5 pm PT.
References
- Medicare.govMedicare Savings Programs, the QMB balance-billing protection, and program tiers.
- Medicaid.govState Medicaid agencies that administer the programs.
- SSA, Social Security AdministrationThe automatic link between MSP enrollment and Extra Help. ssa.gov
- Medicare Rights CenterFree counseling on cost-assistance programs. medicarerights.org