Medicare Part B is not automatically free for anyone based on income, but several programs can pay your Part B premium in full if you qualify. The standard Part B premium is $185 per month in 2025, and low-income beneficiaries can get that cost covered through Medicare Savings Programs or full Medicaid coverage.
How Low-Income Programs Cover Part B Costs
The federal government offers four Medicare Savings Programs (MSPs) that help pay Medicare costs for people with limited income and resources. These programs are run by your state Medicaid office, but they follow federal guidelines. The level of help you get depends on which program you qualify for.
The most comprehensive is the Qualified Medicare Beneficiary (QMB) program. QMB pays your Part B premium, your Part A premium if you have one, and your deductibles, copayments, and coinsurance. If you qualify for QMB, your out-of-pocket Medicare costs essentially drop to zero. This program has the strictest income limits of the four.
The next two programs focus specifically on the Part B premium. The Specified Low-Income Medicare Beneficiary (SLMB) program covers your monthly Part B premium if your income is slightly above the QMB threshold. The Qualifying Individual (QI) program does the same for people with income a step above SLMB limits. Neither SLMB nor QI helps with deductibles or copayments, just the monthly premium itself.
A fourth program, the Qualified Disabled and Working Individuals (QDWI) program, pays only the Part A premium for certain working disabled people. It does not cover Part B costs.
Who Qualifies Based on Income and Assets
Each of the four programs has its own income ceiling, and all of them also look at your countable resources (savings and investments). Income limits are slightly higher in Alaska and Hawaii. Your state may also apply somewhat more generous thresholds than the federal minimums, so it’s worth applying even if you think you’re borderline.
When calculating your resources, not everything counts. Your home, one car, burial plots, up to $1,500 in burial funds, furniture, and personal belongings are all excluded. What does count includes money in checking or savings accounts, stocks, and bonds. If your countable resources are relatively modest, you may still qualify even if you have a home and a vehicle.
Full Medicaid Also Covers Part B
If your income is low enough to qualify for full Medicaid coverage in your state, your state will pay your Part B premium automatically. Depending on the level of Medicaid you qualify for, your state may also cover your share of Medicare costs like deductibles, coinsurance, and copayments. People who have both Medicare and full Medicaid (sometimes called “dual eligibles”) typically pay very little out of pocket for healthcare.
This is separate from Medicare Savings Programs, though in practice many people who qualify for full Medicaid also qualify for QMB. The key difference is that full Medicaid may provide additional benefits Medicare doesn’t cover, such as long-term care or dental services, depending on your state.
Extra Benefits You Get Automatically
Qualifying for any Medicare Savings Program or full Medicaid triggers an automatic enrollment in Extra Help, the federal program that reduces prescription drug costs under Medicare Part D. Extra Help covers most of the premiums, deductibles, and copayments for Part D drug plans. You don’t need to apply separately for it. If you’re approved for an MSP, Extra Help kicks in on its own.
People receiving Supplemental Security Income (SSI) also get Extra Help automatically, and many SSI recipients qualify for Medicare Savings Programs as well.
Late Enrollment Penalties Get Waived
One often-overlooked benefit: enrolling in a Medicare Savings Program generally eliminates the Part B late enrollment penalty. Normally, if you don’t sign up for Part B when you’re first eligible, you pay a permanent surcharge of 10% for every full 12-month period you delayed. That penalty can add up significantly over time. But qualifying for an MSP wipes it out, which makes these programs even more valuable for people who delayed enrollment because they couldn’t afford the premium.
How to Apply
Medicare Savings Programs are administered at the state level, so you apply through your state Medicaid office rather than through Medicare directly. Each state has its own application form and process. You can find your state’s contact information through Medicare.gov or by calling 1-800-MEDICARE (1-800-633-4227).
Many states allow you to apply online, by mail, or in person. Some states have simplified applications that screen you for multiple assistance programs at once. Social workers at hospitals, local Area Agencies on Aging, and State Health Insurance Assistance Programs (SHIPs) can also help you navigate the application at no cost. The process typically requires proof of income, bank statements, and identification, but the paperwork is straightforward compared to many government programs.