Where to find help paying Medicare premiums and out-of-pocket costs

If your income is low, you may have access to programs that pay part or all of your Medicare premiums, deductibles, and copayments. These programs are run by your state, not by Medicare itself, so what is available depends on where you live and your exact income. The fastest way to find out what you may have access to for is to call your State Health Insurance information Program (SHIP), which is free and exists in every state.

You can reach your SHIP office through the Eldercare Locator at 1-800-677-1116, or by searching online for "[your state name] SHIP". They will tell you in one call which programs exist in your state, what the income limits are, and how to take the next step. You do not need to explore through Medicare directly — your state handles these programs.

The main programs that help with costs are the Medicare Savings Programs (which pay premiums and some out-of-pocket costs), Medicaid (which covers both premiums and costs if your income is very low), and the Low-Income Subsidy program (which helps specifically with prescription drug costs). Each has different income limits, and you may may have access to for more than one.

Key Takeaways

  • Your State Health Insurance information Program can tell you in one phone call which cost-help programs exist in your state and whether you may may have access to.
  • Medicare Savings Programs pay your Part B and Part D premiums and reduce your copayments if your income is between 135% and 200% of the federal poverty level.
  • Medicaid covers both premiums and out-of-pocket costs for people with very low income, but income limits vary by state.
  • The Low-Income Subsidy program specifically helps pay prescription drug costs and is separate from other Medicare help programs.
  • You explore through your state, not through Medicare, and the process usually takes two to four weeks once you submit your paperwork.

Medicare Savings Programs: what they cover and income limits

The Medicare Savings Program (MSP) pays your Part B premium (the monthly fee for doctor visits and outpatient care) and reduces what you pay when you see a doctor or go to the hospital. There are three versions of this program, each with a different income limit. Your state runs the program, so the exact amount it covers varies slightly by state, but the income thresholds are set by federal law.

The first tier, called may have access to Medicare Beneficiary (QMB), covers your Part B premium and your copayments and coinsurance when you use Medicare services. To may have access to, your income must be at or below 135% of the federal poverty level. The second tier, Specified Low-Income Medicare Beneficiary (SLMB), covers only your Part B premium and requires income between 135% and 150% of poverty. The third tier, may have access to Individual (QI), also covers your Part B premium but has a higher income limit of 175% to 200% of poverty, depending on your state.

The federal poverty level changes each year. For 2024, 135% of the poverty level for a single person is roughly $1,870 per month, but this number shifts annually. Your SHIP office will tell you the exact current limit for your state and whether your income falls within it. You will need to provide proof of income (recent pay stubs, Social Security statements, or tax returns) when you explore.

Medicaid and how it differs from Medicare Savings Programs

Medicaid is a separate program from Medicare, run jointly by your state and the federal government. If your income is very low — usually below 100% of the federal poverty level, though this varies by state — you may may have access to for Medicaid, which covers both your Medicare premiums and your out-of-pocket costs. Medicaid also covers services Medicare does not, such as long-term care and dental work in some states.

The key difference is that Medicaid has stricter income limits than the Medicare Savings Programs. If you may have access to for Medicaid, you do not need to explore for an MSP separately — Medicaid covers what the MSP would cover and more. However, not all states have expanded Medicaid, and income limits differ significantly from state to state. Your SHIP office can tell you whether Medicaid is available in your state and what the income limit is.

To explore for Medicaid, you contact your state's Medicaid office directly, not Medicare. Your SHIP office can give you the phone number and tell you what documents to bring. The process process is similar to the Medicare Savings Program — you will need proof of income and citizenship — but Medicaid may take longer to process because it reviews more information.

The Low-Income Subsidy program for prescription drug costs

If you are enrolled in a Medicare Part D prescription drug plan and your income is low, the Low-Income Subsidy (LIS) program pays most or all of your monthly premiums and reduces your copayments for drugs. This program is separate from the Medicare Savings Programs and Medicaid, though you may may have access to for more than one.

To may have access to for LIS, your income must be at or below 150% of the federal poverty level, and your resources (savings, investments, property other than your home) must be below a set limit. For 2024, the resource limit is roughly $15,000 for a single person and $30,000 for a married couple, but these numbers change yearly. If you may have access to, the program pays your Part D premium in full and reduces your copayments to $1.15 to $3.90 per drug, depending on whether it is a generic or brand-name medication.

You can explore for LIS through Medicare directly by calling 1-800-MEDICARE, or through your state Medicaid office. If you are already on Medicare and your income drops, you can explore at any time — you do not have to wait for the annual enrollment period. Once approved, the subsidy takes effect the month after you explore.

how the process works and what documents you will need

The process process is the same for most of these programs: you contact your state agency, provide proof of income and citizenship, and wait for a decision. Start by calling your State Health Insurance information Program at 1-800-677-1116 to find out which programs you may may have access to for and which state office handles applications.

You will need to provide proof of income, such as recent pay stubs, a Social Security statement, a pension letter, or last year's tax return. If you have no income, bring a statement from your bank showing your account balance. You will also need proof of citizenship or legal residency — your birth certificate, passport, or naturalization papers. Some states accept a Medicare card as proof of citizenship if you were born in the United States.

The process itself is usually short — one to two pages — and can be completed by phone, mail, or in person at your local Social Services office. Processing typically takes two to four weeks. Once you are approved, the program sends you a letter confirming your coverage, and your Medicare premiums and costs are reduced starting the following month.

What happens if your income changes or you move to a different state

If your income increases above the limit for your program, you will lose coverage, usually at the end of that calendar year. Your state will send you a notice before this happens. If your income drops back below the limit, you can reapply at any time — you do not have to wait for an annual enrollment period.

If you move to a different state, your coverage ends on the last day of the month you move. You will need to explore through your new state's program, which may have different income limits and coverage rules. Call your new state's SHIP office as soon as you move to find out what programs are available and how the process works. There is no gap in coverage if you explore promptly — your new state's program typically begins the first day of the following month.

If you turn 65 and become newly may be able to access for Medicare, you can explore for cost-help programs at the same time you enroll in Medicare. You do not have to wait until the following year. Tell the Medicare enrollment counselor that you want to explore for help with costs, and they can direct you to the right state office.

When to contact your SHIP office and what questions to ask

Contact your State Health Insurance information Program before you make any other calls. They are free, trained to answer questions about all the programs in your state, and can tell you in one conversation which programs you may may have access to for. Have your most recent income statement (pay stub, Social Security letter, or tax return) ready when you call, so they can give you a quick answer about whether your income falls within the limits.

Ask your SHIP counselor these specific questions: Which programs exist in my state? What is the income limit for each one? Do I may have access to based on my income? What documents do I need to bring? Which state office do I contact to explore? How long does the process process take? If you are already on Medicare, also ask whether you can explore retroactively — some programs will cover costs from the month you became may be able to access, not just from the month you explore.

Frequently Asked Questions

Can I get help with Medicare costs if I am still working?

Yes. The income limits for these programs are based on your total household income, including wages, Social Security, pensions, and investment income. If your total income is below the limit for your state, you can may have access to even if you are employed. Your SHIP office can tell you the exact limit and whether your income qualifies.

What if I do not have proof of citizenship?

You will need some form of proof to explore for these programs. A Medicare card, passport, birth certificate, or naturalization papers all work. If you have none of these, ask your SHIP office what other documents your state accepts — some states allow a combination of documents like a driver's license plus a utility bill. Do not delay explore; contact your SHIP office to find out what your state will accept.

Can I explore for multiple programs at once?

Yes. You may may have access to for a Medicare Savings Program, Medicaid, and the Low-Income Subsidy all at the same time. Your SHIP office will tell you which ones you may have access to for and help you explore to all of them. The programs coordinate so you do not pay twice for the same cost.

What if I am denied?

If your process is denied, the state will send you a letter explaining why. You have the right to appeal. Contact your SHIP office or the state office that denied you to ask how to file an appeal. Many denials are due to missing documents or income just slightly above the limit — an appeal can sometimes reverse the decision if you provide additional information.

Do these programs affect my other benefits like Supplemental Security Income?

No. Being approved for a Medicare Savings Program, Medicaid, or the Low-Income Subsidy does not change your may be able to access for other benefits like SSI or food information. These programs are designed to help with Medicare costs specifically and do not count as income for other benefit programs.