For many individuals, state-run assistance programs can help cover certain Medicare costs, including premiums. Eligibility criteria vary, but your monthly income and resource level are two important factors.
Medicare is a federal health insurance program for adults ages 65 years and older and people living with certain health conditions and disabilities.
It offers extensive coverage for a range of inpatient and outpatient medical services. Despite this coverage, beneficiaries still have out-of-pocket costs, including monthly premium payments.
For some individuals, these costs can be a financial burden. To help relieve this burden, states offer qualifying individuals assistance through various programs.
In this article, we discuss how these state-run assistance programs work, who qualifies, and how to apply to reduce your out-of-pocket healthcare expenses, including your monthly premium.
Medicare costs change every year. Individuals who paid Medicare taxes for 40 quarters while working pay no Part A premium. If you don’t meet this requirement, your Part A premium will be either $285 or $518 per month in 2025.
Part B has a monthly premium that starts at $185. Individuals with higher incomes will pay more.
According to the Centers for Medicare & Medicaid Services (CMS), states pay the Part A premium for more than 700,000 people and the Part B premium for more than 10 million people annually.
The primary way that states assist individuals in their premium payments is through Medicare savings programs (MSPs). These programs receive funding from the federal government but are administered by Medicaid in each state.
MSPs cover premiums and other out-of-pocket costs, including deductibles, copayments, and coinsurance.
In 2025, these costs can include the following:
- Deductibles: Part A has a $1,676 deductible per benefit period. Part B has a $257 annual deductible.
- Copayments and coinsurance: With Part A, a person will typically pay a daily copayment for inpatient hospital or skilled nursing care after a certain point. The amount can vary based on how long a person is in the facility. With Part B, you typically pay a 20% coinsurance on the Medicare amount for covered services that you receive (after meeting your deductible).
There are four different MSPs. They differ in what they cover and their eligibility criteria. Some MSPs cover both Medicare premiums, whereas others cover just a single premium.
The programs and the costs they cover are:
- Qualified Medicare Beneficiary (QMB) program: The QMB program covers Part A premiums, Part B premiums, deductibles, coinsurances, and copayments.
- Specified Low-Income Medicare Beneficiary (SLMB) program: The SLMB program covers the Part B premium only.
- Qualifying Individual (QI) program: The QI program covers the Part B premium only.
- Qualified Disabled and Working Individuals (QDWI) program: The QDWI program covers the Part A premium only.
Enrolling in the QMB, SLMB, or QI program also qualifies you for the Extra Help program, which assists with the cost of prescription drugs.
Eligibility criteria vary based on the program, but they involve a person’s income and resource level and certain other factors. In the lower 48 states, these criteria are as follows:
| MSP | Individual monthly income limit | Married couple monthly income limit | Individual resource limit | Married couple resource limit | Other criteria |
|---|---|---|---|---|---|
| QMB | $1,325 | $1,783 | $9,660 | $14,470 | — |
| SLMB | $1,585 | $2,135 | $9,660 | $14,470 | must have both Part A and Part B |
| QI | $1,781 | $2,400 | $9,660 | $14,470 | must have both Part A and Part B; must apply every year you qualify to remain in the program; must not qualify for other Medicaid coverage |
| QDWI | $5,302 | $7,135 | $4,000 | $6,000 | must have a disability, be working, and have lost Social Security disability benefits and premium-free Part A due to work |
For MSP eligibility, “income” refers to things such as wages, salaries, and pension payments. “Resources” refers to assets such as bank accounts, stocks, and retirement accounts. It excludes things such as your primary residence, car, furniture, and tools.
Since MSPs are managed by individual states, it’s possible that your state has unique rules or allowances.
As MSPs are run by individual states, it’s best to contact your state Medicaid office if you wish to apply.
The CMS has a list of state resources and contact information. If you’re thinking of applying, consider these steps:
- Gather any required documents, such as proof of income and resources, your Medicare card, and your ID.
- Complete your state’s Medicaid application, either in person, online, or by mail.
- Submit the application to your state Medicaid office.
- Wait for a decision. This may take 30 to 90 days.
- Respond promptly to any requests for additional information.
MSP enrollment does not guarantee full Medicaid benefits, though some individuals will be dually eligible.
Whether the state will pay your Medicare premium depends on your income level and resources, and whether you’re enrolled in Original Medicare.
If you meet specific income limits, you may qualify for an MSP. There are four MSPs that offer coverage for Medicare premiums. The QMB program offers the most extensive coverage and has the strictest income and resource criteria for eligibility.
For more information, contact your local Medicaid office or reach out to your State Health Insurance Assistance Program (SHIP).