Health· Edited by Dracure · July 22, 2026 · Updated August 26, 2026

Medicare Savings Programs and Extra Help Explained

Correction: An earlier version of this article said Medicare.gov does not state a year for the Extra Help income and resource limits. It does; the page prints that year directly above the table. Corrected July 22, 2026, and all five tables now carry the year they describe.

Four government programs share one job: paying Medicare bills for people whose income sits near the bottom of the scale. Their names read like filing codes — QMB, SLMB, QI, QDWI. They pay for different things, and most people who qualify never find out they do.

The four Medicare Savings Programs help pay Medicare premiums, and some cover deductibles and coinsurance too. Each has its own income and resource limits. Extra Help is separate and lowers drug-coverage costs under Part D. You apply through your state, and your state decides which program you land in — not Medicare.

Four programs, four different bills they pay

Start with the one that covers the most. The Qualified Medicare Beneficiary program helps pay Part A premiums for people who don’t have premium-free Part A, plus Part B premiums, deductibles, coinsurance, and copayments for services and items Medicare covers.

That last part matters more than the premium. Part B coinsurance is usually 20% of the cost of each covered service, with no yearly cap unless you carry supplemental coverage. QMB is the only one of the four whose own description reaches into that 20% — though Medicare.gov also notes more generally that a Savings Program might pay Part A and Part B deductibles, coinsurance, and copayments.

The Specified Low-Income Medicare Beneficiary program is narrower. It helps pay Part B premiums, and you must have both Part A and Part B to qualify. Nothing about deductibles or coinsurance.

The Qualifying Individual program also helps pay Part B premiums, with the same requirement that you hold both Part A and Part B. There’s one extra condition: QI is only available to people who don’t qualify for any other Medicaid coverage or benefits. If you already have Medicaid, this door is closed — though another Medicare Savings Program may be open. QI also carries a deadline the others don’t: you must apply every year to stay in it.

The fourth, Qualified Disabled & Working Individual, is the odd one out on the numbers. Its income limit runs three to four times the others, while its resource limit is under half.

Why the premium matters at all is a fair question. In 2026 the standard Part B premium is $202.90 each month, or higher depending on income, and you pay it every month whether or not you use any Part B service. The Part B deductible is $283 in 2026. Over a year, a program that only covers the premium is still covering more than $2,400.

Income and resource limits, side by side

Each program publishes its own pair of limits, one for an individual and one for a married couple. Medicare.gov lists them separately, so here they are as the source presents them.

Qualified Medicare Beneficiary (QMB) Program — monthly income and resource limits for 2026, Medicare.gov

Specified Low-Income Medicare Beneficiary (SLMB) Program — monthly income and resource limits for 2026, Medicare.gov

Qualifying Individual (QI) Program — monthly income and resource limits for 2026, Medicare.gov

Qualified Disabled & Working Individual (QDWI) Program — monthly income and resource limits for 2026, Medicare.gov

* Income limits are slightly higher in Alaska and Hawaii.

Notice the pattern in the first three. The resource limit never moves — $9,950 for an individual, $14,910 for a couple — while the income ceiling climbs by a few hundred dollars per step. The three programs are essentially one ladder, and where you sit on it decides how much of your Medicare bill gets covered.

Medicare.gov says these limits go up each year. It also says something easy to skim past: you may still qualify in your state even if your income or resources are higher than the federal numbers listed, because some states don’t count certain types or specific amounts of income or resources.

That single sentence undoes the certainty a table gives you. The numbers above are a federal floor, not a verdict.

Extra Help works on a separate track for drug costs

Extra Help is a Medicare program for people with limited income and resources, and it applies to Medicare drug coverage — Part D premiums, deductibles, coinsurance, and other costs. It is not one of the four Medicare Savings Programs, and its limits are far higher.

Extra Help — income and resource limits for 2026, Medicare.gov

One thing worth noticing in that table. The couple’s resource limit ($36,100) is double the individual’s ($18,090), while in the four savings programs the couple’s limit is only about 50% higher.

Extra Help does more than shave the premium. You won’t pay a Part D late enrollment penalty while you’re getting it. Once your total drug costs reach $2,100 — including certain payments made on your behalf, such as through Extra Help — you pay $0 for each covered drug.

People who also have full Medicaid coverage and are in the QMB program pay no more than $4.90 for each covered drug. That’s the floor beneath the floor.

Some people qualify for Extra Help automatically and some have to apply. If you qualify, a notice arrives in the mail telling you how much you’ll pay and naming your new Medicare drug plan if you didn’t already have one — enrollment happens automatically so the savings can actually reach you.

There are gaps. Extra Help isn’t available in Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, or American Samoa, though other programs exist in those areas and vary by location. There’s also a bridge program for the awkward in-between: Medicare’s Limited Income Newly Eligible Transition program gives temporary Part D coverage to people who qualify for Extra Help or Medicaid but aren’t enrolled in a drug plan yet. Its number is 1-800-783-1307, staffed 8 a.m. to 7 p.m. Eastern.

One more practical difference. Most people with Medicare can only switch drug plans at certain times of year — the enrollment windows that govern the rest of Medicare. People with Medicaid or Extra Help may be able to change drug coverage once per month.

Why your state, not Medicare, makes the call

Here’s the part that confuses people. You apply for Medicare Savings Programs through your state, and when you apply, your state determines which program or programs you qualify for.

That’s not an administrative quirk. Medicaid is a joint federal and state program, and the rules around who’s eligible are different in each state. Generally you have to meet your state’s rules for income and resources, plus other rules such as residency.

States get real discretion inside the federal frame. They can decline to count certain types or specific amounts of income or resources. Alaska and Hawaii run slightly higher income limits. Some states allow a “spend down,” where you pay non-covered medical expenses and cost sharing — Medicare premiums and deductibles among them — until your income drops to a qualifying level.

So the federal table tells you the shape of the program. Your state tells you the answer. Honestly, this is the single most misunderstood thing about the whole system: a national number that a state office can override in your favor.

This isn’t a question a calculator settles. Medicare.gov points people to their State Medical Assistance office — the Medicaid office — to ask about help for people with limited resources, and notes that free help with an Extra Help application is available through the local State Health Insurance Assistance Program.

A note on that phone call, since these programs attract imitators. If a call about your Medicare costs feels wrong, the patterns behind government impersonation scams are worth knowing before you dial back.

What this means if you are close to the line

Look at the QMB individual limit again: $1,350 a month. That’s a hard number, and it’s tempting to compare your own income to it and stop reading.

But Medicare.gov’s own page says to apply even if you don’t think you qualify, precisely because state rules can move the line. The federal figures are the most conservative version of the eligibility question, not the final one.

The four programs also form a sequence rather than four separate lotteries. When your state processes one application, it looks at which of them fits. Landing above QMB’s ceiling doesn’t end the conversation; it may just move you to SLMB or QI.

And Extra Help is a genuinely separate question with much higher limits — $23,940 for an individual. Someone who clears every Medicare Savings Program ceiling can still fall well under that one.

None of this is a recommendation about your situation. Whether these programs fit, how a spend-down would work in your state, and what any of it does to the rest of your finances are questions for your State Medical Assistance office or a qualified professional who can see your full picture.

What I’d hold onto is smaller than that. The limits are federal, the decision is your state’s, and those two facts don’t always agree.

This article is general information, not professional advice. For decisions about your money or health, consult a qualified professional.

Tags: medicare, health insurance, retirement, cost-of-living