Who these programs are for
If you have Medicare and your income is modest, there are two separate benefit systems that can cut your costs to almost nothing. Extra Help handles prescription drugs. Medicare Savings Programs handle your Part B premium and, at the top level, nearly all of your hospital and doctor costs. They are not the same program, they are not full Medicaid, and you do not have to be destitute to qualify.
The reason to read this even if you think you earn too much: the limits are higher than most people assume, several states have no asset test at all, and millions of people who qualify have never applied. CMS counts about 12.5 million Part D enrollees receiving Extra Help and estimates another 2 to 3 million eligible people who never filed.
Extra Help (Low-Income Subsidy): what it pays for
Extra Help, formally the Part D Low-Income Subsidy, pays your prescription drug costs. In 2026 it covers your Part D plan premium up to a benchmark amount, wipes out the annual deductible entirely, and caps what you pay at the pharmacy at roughly $5.10 for a generic and $12.65 for a brand-name drug. Some people with the lowest incomes pay less, around $1.60 and $4.90, and people in a nursing home pay nothing.
Two things make this more valuable than it looks on paper. First, Extra Help also eliminates the Part D late enrollment penalty, which otherwise follows you permanently if you delayed drug coverage. Second, the $2,100 annual out-of-pocket cap on Part D drugs still applies, so once your copays reach that number, covered drugs are free for the rest of the year. In practice, almost nobody with Extra Help gets anywhere near $2,100 in copays.
One change is worth knowing about because older articles still get it wrong. Before 2024 there was a partial subsidy tier with higher copays for people between 135% and 150% of the federal poverty level. The Inflation Reduction Act eliminated that tier. Everyone approved now receives the full subsidy, which moved roughly 300,000 people to the better benefit.
Extra Help also comes with a continuous special enrollment period. If you have it, you can change your Part D or Medicare Advantage drug plan once per quarter during the first three quarters of the year, rather than waiting for fall open enrollment. That matters if your plan drops a drug you take.
The subsidy pays your premium only up to your region’s benchmark. If you choose an expensive plan, you pay the difference. Picking a benchmark plan in your area means a genuinely $0 premium.
Current income and resource limits
For 2026, Extra Help uses a limit of 150% of the federal poverty level: about $2,015 a month for a single person and $2,725 a month for a married couple living together, which works out to roughly $24,200 and $32,700 a year.
Countable resources must stay under $18,090 for an individual and $36,100 for a couple. Those figures already include a $1,500 per person allowance set aside for burial expenses. Without the burial allowance, the underlying limits are $16,590 and $33,100.
Medicare Savings Programs use tighter income limits but far more generous asset limits, and they vary by program. In most states in 2026, the countable resource limit for QMB, SLMB, and QI is $9,950 for one person and $14,910 for a married couple, again before the burial allowance.
Do not rule yourself out on these numbers alone. States may use more generous rules, and many do. Connecticut sets its QMB income limit at $2,752 for a single person, more than double the federal figure. Indiana and New York run higher limits too. A dozen states have eliminated the asset test for Medicare Savings Programs entirely, including Alabama, Arizona, Delaware, Louisiana, Maine, Mississippi, New Mexico, New York, Oregon, and Vermont. California went the other direction and reinstated an asset test on January 1, 2026, though at $130,000 for an individual, which is high enough that few people fail it.
If you live in Alaska or Hawaii, every limit on this page is higher for you, because the federal poverty guidelines are higher there.
What counts as a resource and what doesn’t
This is where people talk themselves out of applying, usually because they misjudge what gets counted.
Counted: money in checking and savings accounts, certificates of deposit, stocks, bonds, mutual funds, and IRAs and other retirement accounts.
Not counted: the home you live in, regardless of what it is worth. One car. Household goods and personal belongings. Your burial plot, and life insurance with a face value under $1,500. Property you use to earn a living. Interest you earn on money already set aside for burial.
The house is the big one. A retiree with a paid-off home worth $400,000 and $9,000 in the bank can qualify for QMB in most states, because the house is invisible to the calculation. So can someone driving a nearly new car.
On the income side, states subtract a standard $20 a month from your counted income before comparing it to the limit, and the published limits above already include that disregard. A few states are more generous: Illinois disregards $25, Mississippi disregards $50. If you are still working, part of your earnings is excluded as well, which is why the working-person limits end up meaningfully higher than the raw numbers suggest.
The four Medicare Savings Programs
These are run by your state Medicaid agency, not by Medicare, though they are separate from full Medicaid coverage. They form a ladder: the lower your income, the more the program pays.
QMB (Qualified Medicare Beneficiary)
Income at or below 100% of the poverty level, which in 2026 means $1,350 a month for a single person and $1,824 for a couple in most states.
QMB is the one worth fighting for. It pays your Part B premium of $202.90 a month, your $283 Part B deductible, your Part A hospital deductible of $1,736 per benefit period, your Part A premium if you owe one (up to $565), hospital coinsurance for days 61 and beyond, skilled nursing coinsurance of $217 a day for days 21 through 100, and your 20% Part B coinsurance. That is essentially your entire Medicare cost exposure.
QMB also carries a billing protection that many people never learn about: providers who accept Medicare are prohibited by federal law from billing a QMB enrollee for deductibles, coinsurance, or copays. If you get a bill anyway, and this happens often, the bill is improper.
SLMB (Specified Low-Income Medicare Beneficiary)
Income between 100% and 120% of poverty: $1,616 a month single, $2,184 married.
SLMB pays your Part B premium and nothing else. That is $202.90 a month, or $2,434.80 a year, which for most people on this income shows up as a larger Social Security deposit each month rather than a check.
QI (Qualifying Individual)
Income between 121% and 135% of poverty: $1,816 a month single, $2,455 married.
QI also pays the Part B premium only. Two rules make it different. It is funded by a limited annual federal allotment, so states approve applications first come, first served, with priority for people who had it the previous year. And you must reapply every single year. If a renewal notice arrives from your state, do not let it sit. A missed renewal ends your premium help. You also cannot have QI and full Medicaid at the same time.
QDWI (Qualified Disabled and Working Individual)
This one applies to a narrow group: people under 65 who have a disability, went back to work, and lost their premium-free Part A because their earnings rose.
QDWI pays the Part A premium, up to $565 a month in 2026. Income limits are far higher, up to 400% of poverty at $5,405 a month for a single person, but the asset limit is much stricter at $4,000 for an individual and $6,000 for a couple. QDWI is also the only one of the four that does not bring Extra Help with it.
Names vary by state, which trips people up when they call. New York eliminated SLMB in 2023. Connecticut calls QI the ALMB. Maryland calls it SLMB II. North Carolina calls the three programs MQB, MQB-B, and MQB-E. Describe your situation rather than asking for a program by name.
How an MSP can automatically qualify you for Extra Help
If you are enrolled in QMB, SLMB, or QI, you are automatically enrolled in Extra Help. You do not fill out a second application, you do not meet a second income test, and you do not wait for a second decision. CMS gets your information from your state through routine data sharing and deems you eligible.
The same automatic qualification applies if you have full Medicaid or receive SSI.
This is the single most useful piece of sequencing in this whole area. Extra Help has an $18,090 asset limit, while the Medicare Savings Programs are stricter at $9,950. But the programs run in one direction: getting an MSP hands you Extra Help, while getting Extra Help does not hand you an MSP. So if there is any chance you qualify for QMB, SLMB, or QI, apply for that first and let the drug subsidy follow.
Two practical notes. Being deemed eligible does not put you in a drug plan. You still need to be enrolled in one, and if you do not pick, you may be assigned a plan that does not match the drugs you take. And if you lose your MSP, the deemed Extra Help continues to the end of that calendar year rather than stopping immediately.
How to apply through Social Security and your state Medicaid office
Extra Help goes through the Social Security Administration. Apply online at ssa.gov/extrahelp, call 1-800-772-1213, or go to a local Social Security office. The form is short, it is free, and there is no penalty for applying and being told no.
Medicare Savings Programs go through your state Medicaid office, not Social Security. Every state runs its own application, and the process ranges from a two-page form to a full Medicaid application.
Here is the connection most guides leave out. When you apply for Extra Help through Social Security, SSA is required to send your information to your state as an MSP application, unless you decline. Your state must then contact you. So one Extra Help application can start both processes. It does not always work smoothly, and states vary in how fast they follow up, so treat it as a head start rather than a substitute for calling your state directly.
Timing works in your favor. SLMB, QI, and QDWI can pay retroactively for up to three months before your application, provided you met the rules in those months. QMB is the exception: coverage starts the first of the month after your eligibility is documented, with no retroactive payment. Apply as early in the month as you can.
For free help with the paperwork from someone earning no commission, contact your State Health Insurance Assistance Program (SHIP) or your local Area Agency on Aging. Both are federally funded and both do this work daily.
What to do if you’re denied
A denial is not the end, and denials get reversed regularly, usually over a resource that was counted incorrectly or income that was double counted.
For Extra Help, you can appeal an SSA decision within 60 days. You can file online, by phone, or in writing, and asking for a case review or a hearing costs nothing.
For a Medicare Savings Program, you have the right to a state fair hearing. The deadline is set by your state and commonly falls between 30 and 90 days, so read the denial letter for your exact window rather than assuming.
Before you appeal, look at the reason given. If a retirement account or a second vehicle was counted, or if the value of your home crept into the calculation, that is a factual error worth correcting with documents. If your income was genuinely a little over the line, check whether your state uses more generous limits than the federal baseline, and reapply if your circumstances change. Nothing stops you from applying again.
