May 2021: Medicare Cost Assistance Programs

What is the Medicare Savings Program?

Medicare Savings Programs (MSPs) are state programs that assist you with paying your Medicare costs. To qualify for a MSP, you must meet your state’s income and asset limits. Below are the baseline federal income and asset limits for each MSP. Most states use these limits, but some states have different guidelines. There are three main programs, each with different benefits and eligibility requirements:

MSP Benefits Monthly income limit Asset limit
Qualified Medicare Beneficiary (QMB) – Pays Part A and B premiums

– Eliminates cost-sharing for Medicare-covered services

Individual: $1,094

Couple: $1,472

Individual: $7,970

Couple: $11,960

Specified Low-income Medicare Beneficiary (SLMB) – Pays Part B premium Individual: $1,308

Couple: $1,762

Individual: $7,970

Couple: $11,960

Qualifying Individual (QI) – Pays Part B premium Individual: $1,469

Couple: $1,980

Individual: $7,970

Couple: $11,960

What is Extra Help?

Extra Help is a federal program that helps pay for some to most of the out-of-pocket costs of Medicare prescription drug coverage. If you are enrolled in Medicaid, Supplemental Security Income, or a MSP, you will automatically qualify for Extra Help regardless of whether you meet Extra Help’s eligibility requirements. If you are not enrolled in these programs, the eligibility requirements are below:

Income limit Asset limit Program Copayments
Below $1,630 ($2,198 for couples) per month Up to $14,790 ($29,520 for couples) Partial Extra Help

– Premium depends on your income

– $92 deductible or the plan’s standard deductible, whichever is cheaper

– 15% coinsurance or the plan copay, whichever is less

– After $6,550 in out-of-pocket drug costs, you pay $3.70/generic and $9.20/brand-name or 5% of the drug cost, whichever is greater

Up to $1,469 ($1,980 for couples) per month Up to $9,470 ($14,960 for couples) Full Extra Help

$0 premium and deductible

– $3.70 generic copay

– $9.20 brand-name copay

– No copay after $6,550 in out-of-pocket drug costs

You can apply for Extra Help through the Social Security Administration (SSA). Visit or call 800-839-2675 to learn more.

What other programs can help me save money on my care?

State Pharmaceutical Assistance Programs (SPAPs)

  • Many states offer SPAPs to help residents pay for prescription drugs
  • Each program works differently and has different requirements for eligibility

Facilities that may offer care at a reduced cost

  • Human Resources and Services Administration (HRSA) facilities
    • HRSA facilities may also be called Federally Qualified Health Centers (FQHCs)
    • Hundreds of these government-funded health centers around the country provide medical care regardless of your ability to pay
  • The Hill-Burton Program
    • The Hill-Burton Program offers free or reduced cost care at Hill-Burton facilities
    • Most states have the Hill-Burton program
    • Services that are fully covered by other types of insurance (like Medicare or Medicaid) are not eligible for Hill-Burton coverage
    • Eligibility for the Hill-Burton program is based on your income and family size
    • To apply, call the Admission, Business, or Patient Accounts office at a Hill-Burton facility


  • People can be eligible for both Medicare and Medicaid
  • Medicaid can cover services that Medicare does not, like long-term care
  • It can also pick up Medicare’s out-of-pocket costs, like copayments or coinsurances
  • Generally, your income and assets must be below a certain amount to qualify, but this amount varies from state to state and from program to program
  • Call your local Medicaid office to learn about Medicaid programs in your state