Medicare Savings Programs (MSPs) are state-administered Medicaid programs designed to provide financial relief for low-income individuals enrolled in Medicare. These programs function to reduce the out-of-pocket costs associated with Medicare coverage, such as premiums, deductibles, co-payments, and co-insurance. Eligibility for each program is determined by specific income and resource thresholds, creating a tiered system of assistance. The three most common programs offer progressively less comprehensive coverage as the income level increases.
Qualified Medicare Beneficiary (QMB)
The Qualified Medicare Beneficiary program represents the most comprehensive tier of assistance. Individuals who qualify for QMB receive help with the Medicare Part A and Part B premiums. This level of coverage is significant, especially for those who must pay the premium for Part A Hospital Insurance because they did not accrue 40 quarters of Medicare-covered employment.
A defining benefit of QMB status is the elimination of liability for Medicare cost-sharing amounts. This means the program pays for Part A and Part B deductibles, co-payments, and co-insurance for all services covered by Medicare. Protecting beneficiaries from the typical out-of-pocket expenses required by Original Medicare.
A crucial protection for QMB enrollees is that Medicare providers are not permitted to bill them for Medicare-covered services. If a provider attempts to charge a QMB beneficiary for a deductible or co-payment, that charge is considered an improper bill. This protection ensures that recipients face zero out-of-pocket costs for medically necessary services.
To qualify for this extensive coverage, an individual’s monthly income must be at or below 100% of the Federal Poverty Level (FPL). For 2025, this limit is approximately $1,325 per month for an individual, with a resource limit of $9,660.
Specified Low-Income Medicare Beneficiary (SLMB)
The Specified Low-Income Medicare Beneficiary program offers more limited benefits than the QMB program. Qualification for SLMB is based on a slightly higher income threshold, which is set between 100% and 120% of the Federal Poverty Level. For 2025, this generally means an individual’s monthly income must be no more than about $1,585.
The primary benefit provided by SLMB is the payment of the beneficiary’s Medicare Part B premium. This assistance can provide substantial budget relief. Like QMB, the resource limit for SLMB is set at $9,660 for an individual.
Unlike QMB, the SLMB program does not provide assistance with other out-of-pocket costs. Beneficiaries must still pay the Part A and Part B deductibles, co-payments, and co-insurance for services they receive. The assistance is focused solely on covering the monthly Part B premium.
Qualifying Individual (QI)
The Qualifying Individual program targets individuals whose income is higher than the limits for QMB and SLMB. The income threshold for QI is set between 120% and 135% of the Federal Poverty Level. In 2025, this limit is approximately $1,781 per month for an individual.
The benefit provided by the QI program is limited to the payment of the Medicare Part B premium, similar to SLMB. This program does not help with any deductibles or co-payments for Medicare services. It is designed to assist those who are just above the income cutoffs for the more comprehensive programs but still require help with their premium costs.
A notable distinction of the QI program is that its funding is capped each year and administered on a first-come, first-served basis. States are required to give priority to individuals who were enrolled in the QI program the previous year, but new applicants may be denied if the federal funding allocated to the state has been exhausted. Furthermore, beneficiaries cannot be eligible for full Medicaid benefits while receiving QI assistance, and they must reapply for the program annually.
General Eligibility Requirements and Application Process
Eligibility for all Medicare Savings Programs is determined by two main financial standards: monthly income and countable resources. The income limits are directly tied to the Federal Poverty Level (FPL) and are updated annually to account for cost-of-living adjustments.
Countable resources include items like money in bank accounts, stocks, and bonds. An individual’s primary residence and one vehicle are typically excluded from this calculation. For the three main programs—QMB, SLMB, and QI—the federal resource limit is currently $9,660 for an individual and $14,470 for a married couple. However, some states have chosen to eliminate the resource limit entirely, allowing more people to qualify based on income alone.
A fourth, less common program exists, called the Qualified Disabled and Working Individuals (QDWI) program. This program pays the Medicare Part A premium for certain disabled individuals under age 65 who have returned to work and consequently lost their premium-free Part A coverage. The income limit for QDWI is significantly higher, set at 200% of the FPL, but it only covers the Part A premium and not other cost-sharing amounts.
Because Medicare Savings Programs are administered by state Medicaid offices, applications must be submitted directly to the applicant’s state Medicaid agency or Department of Social Services. The application process generally requires documentation to verify an individual’s financial status and Medicare enrollment. Applicants should be prepared to provide proof of income, such as Social Security award letters or pay stubs, as well as information regarding their assets and current Medicare status.