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Healthcare costs in America are high and continuing to ascend. You may qualify for government subsidies to offset these costs.
Subsidies that are offered to those on Medicare have distinct income and subsidy requirements. These requirements are based on income and resources. If an individual or family falls below the income level and their resources are below the allowed resource level for the program, they should consider applying.
Subsidies can help with a few things when a person has Medicare. The subsidy might pay for monthly premiums, copays, deductibles, coinsurance, and prescription drug costs depending on the program.
QMB helps pay for Part A premiums, Part B premiums, deductibles, coinsurance, and copayments.
| QMB 2026 Limits | Amount |
|---|---|
| Individual monthly income limit | $1,350 |
| Married couple monthly income limit | $1,824 |
| Individual resource limit | $9,950 |
| Married couple resource limit | $14,910 |
Limits are slightly higher in Alaska and Hawaii. If you have income from working, you may qualify for benefits even if your income is higher than the limits listed.
SLMB helps pay for Medicare Part B premiums only.
| SLMB 2026 Limits | Amount |
|---|---|
| Individual monthly income limit | $1,616 |
| Married couple monthly income limit | $2,184 |
| Individual resource limit | $9,950 |
| Married couple resource limit | $14,910 |
Limits are slightly higher in Alaska and Hawaii. If you have income from working, you may qualify for benefits even if your income is higher than the limits listed.
You must apply every year for QI benefits. QI applications are granted on a first-come, first-served basis, with priority given to people who got QI benefits the previous year. You cannot get QI benefits if you qualify for Medicaid.
| QI 2026 Limits | Amount |
|---|---|
| Individual monthly income limit | $1,816 |
| Married couple monthly income limit | $2,455 |
| Individual resource limit | $9,950 |
| Married couple resource limit | $14,910 |
The QI program helps pay Medicare Part B premiums only. These amounts may increase. If your income and resources are slightly higher, you should still apply.
Medicare providers are not allowed to bill you for services and items Medicare covers, including deductibles, coinsurance, and copayments, except outpatient prescription drugs. Pharmacists may charge you up to a limited amount for prescription drugs covered by Medicare Part D.
To make sure your provider knows you are in the QMB program, show both your Medicare and Medicaid or QMB card each time you get care. If you are enrolled in a Medicare Advantage plan, show your Medicare Advantage card along with your QMB card.
If you get a bill for medical care that Medicare covers, call your provider or plan about the charges. Tell them you are in the QMB program and cannot be charged for Medicare deductibles, coinsurance, and copayments. If this does not resolve the billing problem, call Medicare at 1-800-MEDICARE for more information.
Countable resources include:
Countable resources do not include:
If you answer yes to these three questions, call your State Medicaid Program to see if you qualify for a Medicare Savings Program in your state:
It is important to call or fill out an application if you think you could qualify for savings, even if your income or resources are higher than the amounts listed here.
Medicare offers a program called the Low-Income Subsidy, or Extra Help, for eligible people with limited incomes and resources. If you are enrolled in Medicare and meet the income and resource requirements for the program, you may apply for the Low-Income Subsidy and receive Extra Help from Medicare.
If you qualify, you will get help paying for your Medicare Part D costs, which may include premiums, deductibles, and cost sharing.
You may be automatically eligible for Extra Help if you are in one of the following circumstances:
| LIS Extra Help 2026 Limits | Amount |
|---|---|
| Individual monthly income limit | $2,015 |
| Married couple monthly income limit | $2,725 |
| Individual resource limit | $16,590 |
| Married couple resource limit | $33,100 |
If you qualify for Extra Help but do not enroll in a Medicare Prescription Drug Plan yourself, Medicare will enroll you in a plan so that you will get help paying for your prescription drugs. Medicare will send you a letter telling you when your coverage begins.
If you want to change Medicare Prescription Drug Plans, you can do so with a Special Election Period. For more information about Extra Help, contact your local Social Security office, call 1-800-MEDICARE, or give us a call at 443-537-0555.
The Annual Election Period is one of the times that you can enroll in a Medicare Prescription Drug Plan or Medicare Advantage Prescription Drug plan, or make changes to your prescription drug coverage. However, if you are enrolled in Extra Help, you may be able to make changes outside this period with a Special Election Period.
The SPAP programs are offered in specific states. Each state that offers a program has its own unique rules for joining the program.
Typically, if a person applies for one of these programs, they may be able to get other benefits. These benefits can include help with monthly premiums associated with a Part D Prescription Drug plan or Medicare Advantage plan, copays, or help in the coverage gap. This is determined by the state SPAP program and the individual benefits offered by that program.
In addition, signing up for an SPAP program in your state can sometimes create a Special Enrollment Period for programs like Medicare Advantage and Part D Prescription RX plans outside of the Annual Enrollment Period.
Please keep in mind that most subsidies require you to apply for them and will not automatically enroll you even if you qualify. Give us a call and we will help you with your individual situation.
Medicare Insurance Subsidies are programs that may help people with limited income and resources pay for Medicare costs such as premiums, deductibles, coinsurance, copayments, and prescription drug costs.
Not always. Many subsidy programs require an application even if you qualify. Healthcare American can help you understand the rules and the application process for your situation.
The Qualified Medicare Beneficiary program may help pay Part A premiums, Part B premiums, deductibles, coinsurance, and copayments for services and items Medicare covers.
The Specified Low Income Medicare Beneficiary program helps pay Medicare Part B premiums only. If you qualify, you may also get Extra Help paying for prescription drug costs.
The Qualified Individual program helps pay Medicare Part B premiums only. You must apply every year, and applications are granted on a first-come, first-served basis with priority for people who received QI benefits the previous year.
Extra Help, also called the Low-Income Subsidy, helps eligible people with limited income and resources pay Medicare Part D prescription drug costs, including premiums, deductibles, and cost sharing.
Countable resources can include money in checking or savings accounts, stocks, and bonds. Your home, one car, burial plot, certain burial funds, furniture, and other household or personal items generally do not count.
In some cases, yes. Programs such as Extra Help or certain state pharmaceutical assistance programs may allow you to make changes to Medicare Advantage or Part D coverage outside the Annual Enrollment Period.
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