How to Get Help Paying Your Medicare Costs

What Medicare Savings Programs Do

Medicare Savings Programs (MSPs) are state-run Medicaid programs that pay some or all of your Medicare premiums, deductibles, and copayments. You stay enrolled in Medicare — MSPs don't replace it. Instead, they cover the out-of-pocket costs that Medicare doesn't pay. Each state runs its own program, so what's covered and how much you pay depends on where you live.

There are three main programs: may have access to Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), and may have access to Individual (QI). QMB covers the most — it pays your Part B premium, deductible, and copayments. SLMB pays only your Part B premium. QI pays part of your Part B premium. Which one you can join depends on your income and resources.

Key Takeaways

• Medicare Savings Programs are run by your state Medicaid office, not Medicare, and you must contact your state directly to apply.
• Income limits vary by state and program, but generally range from 100 to 200 percent of the federal poverty level — you can find your state's exact limits on the Centers for Medicare & Medicaid Services website.
• You need to provide proof of income (recent pay stubs, tax returns, or Social Security statements), proof of citizenship or legal residency, and proof of Medicare enrollment.
• Once approved, the program pays your costs directly to Medicare and providers, so you don't handle the money yourself.
• Processing typically takes 30 to 60 days, though some states are faster; you can call your state Medicaid office to check on your status.

Income Limits and Which Program Fits Your Situation

Each of the three programs has its own income ceiling. QMB covers people with income up to 100 percent of the federal poverty level in most states. SLMB covers people up to 120 percent of poverty. QI covers people up to 135 percent of poverty. The federal poverty level changes each year — for 2024, it's about $1,600 per month for a single person, though your state may use a slightly different figure.

Your resources (savings, investments, property you own) also matter. Most states set a resource limit of around $8,000 for a single person and $12,000 for a couple, but this varies. If you have more than your state's limit, you won't be approved, even if your income qualifies. Contact your state Medicaid office to learn the exact limits where you live — they're the only source that can tell you whether you fall within range.

If your income is too high for MSPs, ask about other Medicaid programs your state offers. Some states have separate low-income programs for people over 65 or with disabilities that might cover some costs.

Documents You'll Need Before You Apply

Gather these documents before you contact your state Medicaid office. You'll need proof of income from the last 30 days — a recent pay stub, Social Security statement, pension letter, or tax return. If you're retired or unemployed, a letter from Social Security or your pension provider works. If you have no income, bring a statement saying so.

You'll also need proof of citizenship or legal residency. A birth certificate, passport, naturalization papers, or permanent resident card all work. Some states accept a driver's license or state ID instead. Bring your Medicare card to prove you're enrolled in Medicare Part A and Part B.

If you have a spouse, bring their income and residency documents too. Some states count household income together. Have your bank account information ready — your state will ask for it so they can verify your resources, though you don't have to provide it until they ask.

How to Contact Your State Medicaid Office

Your state Medicaid office is the only place that processes MSP applications. You can find your state office's phone number and website on the Centers for Medicare & Medicaid Services website — search for "Medicare Savings Programs" and your state name. You can also call 1-800-MEDICARE and ask for your state Medicaid office's contact information.

When you call, tell them you want to apply for a Medicare Savings Program. They'll tell you whether you likely meet income limits based on what you tell them, and they'll either mail you an application or let you apply over the phone. Some states let you apply online through their Medicaid portal. Ask which method is fastest in your state.

If you're having trouble reaching your state office or understanding the application, you can also contact your State Health Insurance Assistance Program (SHIP). SHIP is a free counseling service in every state, and counselors can walk you through the process and help you gather documents. Find your local SHIP by calling 1-877-839-2675.

What Happens After You Submit Your Application

Your state Medicaid office will review your application and contact you if they need more information. This usually takes 30 to 60 days, though some states are faster. If they approve you, they'll send you a letter saying which program you've been placed in and what costs are now covered. Your coverage usually starts the month after you're approved.

Once you're approved, the program pays providers and Medicare directly — you don't receive money or handle payments yourself. When you go to the doctor, show your Medicare card and any Medicaid card your state sends. The provider bills Medicare first, then the MSP pays what Medicare doesn't cover, up to the limits of your program.

Your approval is usually good for one or two years, depending on your state. Your state will send you a renewal notice before your coverage ends. You'll need to resubmit proof of income and resources to stay enrolled.

What to Do If You're Denied or Don't Hear Back

If your state denies your application, they must send you a letter explaining why. Common reasons are income too high, resources too high, or not meeting citizenship requirements. Read the letter carefully — it will tell you how to appeal and what deadline you have to do so. You usually have 30 days to request a hearing.

If you don't hear back after 60 days, call your state Medicaid office and ask about your application status. Bring your application number or the date you applied. If they can't find your application, ask them to start a new one. If you're still stuck, contact your State Health Insurance Assistance Program — they can advocate for you and help you figure out what went wrong.

If you were denied because your income was slightly too high, ask whether your state has a spend-down option. Some states let you deduct medical expenses from your income to bring you under the limit. This is uncommon, but worth asking about.

Medicare Savings Programs vs. Other Help With Costs

If your income is too high for MSPs, you might still get help through other programs. The Low-Income Subsidy (LIS) program helps with prescription drug costs under Medicare Part D — it's separate from MSPs and has higher income limits. The Medicare Catastrophic Coverage program kicks in if your out-of-pocket costs reach a certain threshold in a year, though you still pay a lot before that happens.

Some pharmaceutical companies offer patient assistance programs that cover the cost of specific drugs. Hospitals and community health centers sometimes have financial assistance programs for uninsured or underinsured patients. Your doctor's office or the hospital billing department can tell you what's available where you get care.

If you're not yet 65 and have a disability, you might be on Medicare already. Check whether you also meet income limits for your state's regular Medicaid program — that could cover more than an MSP would.

Frequently Asked Questions

Can I apply for a Medicare Savings Program if I'm still working?

Yes. Your total household income is what matters, not whether you're employed. If your income from work plus any other sources falls below your state's limit for the program you're applying to, you can join. Your employment status doesn't disqualify you.

What if I'm already on regular Medicaid?

You can still apply for an MSP. In fact, if you're on Medicaid and enrolled in Medicare, you should apply — MSPs often cover costs that regular Medicaid doesn't. Some states automatically enroll people who may have access to for both, but most require you to apply separately. Call your state Medicaid office to ask.

Do I lose my Medicare Savings Program if my income goes up?

If your income rises above your state's limit, you'll lose coverage when your approval period ends and you renew. Some states will tell you immediately if they learn your income has changed; others won't know until renewal. If your income increases, call your state Medicaid office and tell them — they may be able to move you to a different program with a higher income limit.

How long does it take to get approved?

Most states process applications within 30 to 60 days. Some are faster. Call your state Medicaid office and ask what their current processing time is. If you've been waiting longer than that, follow up with a call to check your status.

Can I apply if I'm not a U.S. citizen?

It depends on your immigration status. U.S. citizens and permanent residents can apply. Some states also cover certain other legal residents. Call your state Medicaid office with information about your status — they can tell you whether you're covered.