Four Medicare Savings Programs
If your income and resources are limited, your state may pay some of your Medicare costs. There are four programs, they pay for different things, and people often qualify for one without knowing the others exist.
| Program | What it helps pay |
|---|---|
| Qualified Medicare Beneficiary (QMB) | Part A premiums if you have them, Part B premiums, and Medicare deductibles, coinsurance and copayments |
| Specified Low-Income Medicare Beneficiary (SLMB) | Part B premium only |
| Qualifying Individual (QI) | Part B premium only, for people not receiving other Medicaid benefits |
| Qualified Disabled and Working Individuals (QDWI) | Part A premium only, for certain people who returned to work |
Source: Medicare & You 2027, CMS
QMB also stops providers billing you
QMB carries a protection most people are never told about. Medicare providers are not allowed to bill a person in the QMB program for Medicare deductibles, coinsurance or copayments for covered services.
If you receive a bill anyway, you can tell the provider or debt collector that you are in QMB and cannot be charged. If you have already paid, you have the right to a refund. Showing both your Medicare and your Medicaid or QMB card at each visit is what prevents it happening.
Extra Help is about drugs specifically
Extra Help, also called the Part D Low-Income Subsidy, lowers what you pay for prescription drug coverage: the premium, the deductible and the cost of each prescription. It is separate from the Medicare Savings Programs, although qualifying for some of them enrolls you automatically.
People who qualify for Extra Help also do not pay the Part D late enrollment penalty, which matters for anyone who went years without drug coverage.
Where the figures and the applications live
Income and resource limits change annually and some vary by state, so this guide does not reproduce them. Quoting a limit that has since moved would be worse than sending you to the source.
Apply for Extra Help through Social Security. Apply for a Medicare Savings Program through Florida’s Medicaid agency. If you are unsure which you might qualify for, applying for Extra Help is the usual starting point because Social Security forwards the information toward the state program.
Florida also has SHINE, the state health insurance assistance program, which gives free unbiased counseling on these applications at 1-800-96-ELDER and sells nothing.
Frequently asked questions
What is the difference between Extra Help and a Medicare Savings Program?
Extra Help is a federal subsidy that lowers prescription drug costs under Part D. Medicare Savings Programs are run by your state and help pay Medicare premiums and, in the case of QMB, deductibles and coinsurance. You can qualify for both.
Can a provider bill me if I am in the QMB program?
No. Medicare providers are prohibited from billing QMB enrollees for Medicare deductibles, coinsurance or copayments on covered services. If you are billed, tell the provider you are in QMB, and if you have already paid you are entitled to a refund.
What are the income limits for these programs?
They change each year and some vary by state, so the only reliable figures are the current ones published by Medicare and your state Medicaid agency. This guide links to both rather than quoting limits that may have moved.
Does Extra Help remove the Part D late enrollment penalty?
Yes. People who qualify for Extra Help do not pay the Part D late enrollment penalty, which can be significant for someone who went several years without creditable drug coverage.
Sources
This guide explains officially published rules and figures. It is not an insurance quote and not an eligibility determination. Only HealthCare.gov, Medicare.gov, Social Security or the carrier can determine your eligibility and your actual price.
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options. Not connected with or endorsed by the U.S. government or the federal Medicare program.
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