What is the Medicare Savings Program?
Medicare Savings Programs (MSPs) are state-administered, federally-funded programs that help people with limited income pay for Medicare. There are four MSP categories: QMB, SLMB, QI, and QDWI. QMB is the broadest — it pays Part A and Part B premiums plus Medicare deductibles and coinsurance. SLMB and QI pay just the Part B premium. QDWI is for disabled people who returned to work. You apply through your state Medicaid office, not SSA. If your income is anywhere close to the federal poverty level, apply — a lot of people qualify and don't realize it.
Dr. Ed Weir, PhD · 20 years inside Social Security · "Former" Sergeant, USMC
Updated April 2026
What is the Medicare Savings Program?
MSP comes in four flavors based on income: QMB at 100% FPL pays Part A and Part B premiums plus Medicare cost-sharing; SLMB at 120% FPL pays the Part B premium only; QI at 135% FPL pays the Part B premium only on a first-come-first-served basis; and QDWI for disabled workers under 65 pays the Part A premium up to 200% FPL. There's a federal asset limit (about $9,470 individual / $14,200 couple in 2026), though some states use higher limits or no asset test. Apply through your state Medicaid office. QMB has a special protection: providers cannot bill QMB enrollees for Medicare cost-sharing (deductibles, copays, coinsurance).
This whole page is about the Medicare Savings Program
Free help applying for MSP
MSP saves people thousands a year and is one of the most under-applied-for federal benefit programs. Chapter Medicare's licensed advisors and your local SHIP can help you figure out which MSP tier fits and how to apply through your state.
Here's how to find out if MSP fits your situation.
Medicare costs feeling crushing? Here's the order I'd take.
1. Add up your countable monthly income
Pull your Social Security award letter, any pension statements, recent pay stubs, and tax-return income lines (interest, dividends, rental income). Add the gross monthly amounts. SSA applies a $20 'general income disregard' to total income. If the result is at or below 100% FPL, you may qualify for QMB; up to 120% for SLMB; up to 135% for QI; up to 200% for QDWI (disabled working).
Medicare Savings Program overview ›2. Check your countable resources — and your state's rules
The federal MSP asset limit in 2026 is about $9,470 individual / $14,200 couple. But your home, one vehicle, household goods, and burial funds (up to a limit) typically don't count. Some states (e.g., Alabama, Arizona, Connecticut, Delaware, DC, Mississippi, New York, Vermont) have eliminated the MSP asset test entirely, and some others use higher limits. Look up your state's specific rules.
MSP state-by-state rules (NCOA) ›3. Apply through your state Medicaid office
MSP applications go to your state Medicaid agency, not SSA. Each state has its own application form (sometimes a Medicaid combo application, sometimes MSP-specific). Bring proof of identity, age, citizenship/legal residency, income (SSA award letter, pay stubs), assets (bank statements), and your Medicare card. SHIP counselors will help you complete the application for free at .
Find your state Medicaid agency ›4. If a provider tries to bill you after MSP approval, push back
QMB enrollees are protected from balance-billing by federal law. If a provider sends you a bill for Medicare deductibles, copays, or coinsurance after you've shown your QMB / dual-eligible card, that's improper. Ask the provider to resubmit; if they don't, contact your state Medicaid office and 1-800-MEDICARE (1-800-633-4227). The Inspector General has issued repeated guidance that this is prohibited.
QMB billing protection ›2026 MSP by the numbers
Which of these fits your situation?
MSP eligibility depends on your income tier, state rules, and assets. Pick what fits.
I'm just on Social Security and Medicare costs are squeezing meRun the FPL math — you may qualify for QMB or SLMB
If your only income is Social Security and you're at or near the federal poverty level, run the math. The 2026 single FPL is roughly $1,304/month; 100% FPL puts you in QMB territory; 120% in SLMB; 135% in QI. SSA's $20 general income disregard applies. QMB is the most generous — it covers Part A premium (rare), Part B premium ($202.90 in 2026), the Part B deductible, the Part A deductible, and Medicare coinsurance and copays. Apply through your state Medicaid office.
Most of the people I encountered who were eligible for QMB but not enrolled were just unaware. The application is one form and the savings can run several thousand dollars a year. Don't talk yourself out of applying because you 'don't think you qualify.'
I have a small pension on top of Social SecuritySLMB or QI may still apply — run the numbers
A modest pension on top of Social Security often pushes income above QMB but below SLMB or QI. SLMB and QI both pay the standard Part B premium ($202.90 in 2026) — that's roughly $2,400 a year saved. QI is funded on a first-come-first-served basis annually, so apply early in the year if you suspect you qualify. Renewal happens annually; missing a renewal can cost you the benefit.
My savings are above the federal asset limitCheck whether your state ignores the asset test
The federal MSP asset limit is around $9,470 individual / $14,200 couple in 2026. But several states (Alabama, Arizona, Connecticut, Delaware, DC, Mississippi, New York, Vermont, and others) have eliminated the MSP asset test entirely. Other states use higher limits. Don't assume your state uses the federal default. Check your state Medicaid agency's MSP page or call SHIP. Even when an asset limit applies, your home, one vehicle, household goods, and burial funds usually don't count.
I'd see people in asset-test-free states ignore MSP for years because they assumed their savings disqualified them. State-by-state variation matters more here than in most benefits programs.
I'm under 65, on SSDI, but went back to work — lost free Part AQDWI may pay your Part A premium
QDWI is the MSP tier specifically for disabled individuals under 65 who lost premium-free Part A because of returning to work. QDWI pays the Part A premium up to 200% FPL. It's narrow but high-impact for the right person. Apply through state Medicaid. If you're also using a Section 1819 buy-in or 1818A continued Part A, those rules interact — check with SHIP.
I qualify for MSP — do I automatically get Extra Help?Yes — dual eligibles get auto Extra Help
If you qualify for MSP, you automatically qualify for the Part D Low-Income Subsidy (Extra Help) under federal rules. SSA's POMS HI 03001.005 makes this automatic. You don't need to file a separate Extra Help application — SSA processes the Extra Help approval based on your MSP enrollment. Extra Help wipes out Part D premiums for eligible plans, lowers deductibles, and waives the Part D LEP.
The MSP-to-Extra-Help auto-link is one of the cleanest cross-program connections in the system. If you're eligible for MSP and somehow don't have Extra Help showing up, call SSA — something fell through.
I have QMB but a doctor sent me a billThat's improper — push back
QMB enrollees are protected from balance-billing by federal law. Providers who accept Medicare cannot collect Medicare cost-sharing (deductibles, copays, coinsurance) from a QMB enrollee. The provider has to bill Medicaid for any allowed cost-sharing. CMS issues repeated reminders to providers. If you're billed after showing your QMB card, ask the provider's billing office to resubmit; if they don't, contact your state Medicaid office and 1-800-MEDICARE (1-800-633-4227).
The federal protection has been in place for decades but provider billing systems often miss it. Don't pay first and try to recover — push back before paying.
I'm helping a parent who's struggling with Medicare costsRun the FPL math first, then call SHIP
Pull their last month of bank statements, their SSA award letter, and any pension or pay statements. Add up gross monthly income. Compare to 100%, 120%, 135%, and 200% FPL for the household size. Look up your state Medicaid agency — application names vary widely by state. SHIP counselors at will walk through everything for free. If your parent is also struggling with drug costs, file Extra Help (LIS) through SSA at the same time.
My situation is different from any of theseTell me what's going on — we'll figure it out together
MSP edge cases are common: married couples where one spouse is on Medicare and one isn't, immigration-status nuances, recent Medicaid losers who may need a 209(b) state separate application. SHIP counselors at are trained for this. Or use the chat below to describe your situation.
Programs that often pair with MSP.
If you qualify for MSP, you may also qualify for other cost-assistance programs. A few worth checking.
Medicare Extra Help (LIS)
If you qualify for any MSP tier, you automatically qualify for Part D Extra Help. Extra Help can also be applied for separately through SSA up to 150% FPL.
Concurrent SSI and SSDI
If you qualify for SSI, you'll typically qualify for full Medicaid (and through it, MSP-equivalent help with Medicare costs) automatically.
Medicare Late Enrollment Penalty
MSP enrollment can affect LEP rules — some MSP enrollees gain SEP rights, and the auto-Extra-Help eliminates Part D LEP entirely.
Medicare Part B Explained
MSP pays the standard Part B premium for QMB, SLMB, and QI enrollees. Understanding what Part B covers (and the IRMAA stack) helps make sense of the savings.
Medicare Annual Enrollment Period (AEP)
Dual-eligibles (people on Medicare + Medicaid via MSP) get a Special Enrollment Period that runs throughout the year for changing Medicare Advantage and Part D plans.
Medicare Prescription Drug Costs
Once you're on Extra Help (via MSP auto-link or direct application), Part D out-of-pocket costs drop dramatically and the OOP cap still applies on top.
MSP questions I get most often
What are the four MSP categories?
QMB (Qualified Medicare Beneficiary) at 100% FPL pays Part A premium, Part B premium, and Medicare cost-sharing. SLMB (Specified Low-Income Medicare Beneficiary) at 120% FPL pays the Part B premium only. QI (Qualifying Individual) at 135% FPL pays the Part B premium only on a first-come-first-served basis. QDWI (Qualified Disabled and Working Individual) at 200% FPL pays the Part A premium for disabled people who returned to work and lost premium-free Part A.
How do I apply for MSP?
Apply through your state Medicaid office — not through SSA. Each state has its own application form (sometimes a combined Medicaid application, sometimes a separate MSP application). Bring proof of identity, age, citizenship, income (SSA award letter, pension statements, pay stubs), assets (bank statements), and your Medicare card. SHIP counselors will walk through it with you for free.
Are there asset limits for MSP?
Federal asset limits in 2026 are about $9,470 for an individual and $14,200 for a couple. But your home, one vehicle, household goods, and a burial fund up to a limit usually don't count. And several states (Alabama, Arizona, Connecticut, Delaware, DC, Mississippi, New York, Vermont, and others) have eliminated the asset test entirely. Check your state's specific MSP rules — don't assume your savings disqualify you.
If I qualify for MSP, do I automatically get Extra Help?
Yes — enrollment in any MSP tier automatically triggers Part D Extra Help (Low-Income Subsidy). SSA's POMS HI 03001.005 makes this automatic. Extra Help can wipe out your Part D premium for eligible plans, lower your Part D deductible and copays, and waive any Part D late-enrollment penalty. You don't need to file a separate Extra Help application if you're already MSP-enrolled.
What's the QMB billing protection?
Federal law prohibits Medicare-participating providers from billing QMB enrollees for Medicare cost-sharing (deductibles, copays, coinsurance). The provider must accept Medicare's payment plus any Medicaid cost-sharing payment as full payment. This applies whether the provider participates in Medicaid or not. CMS issues regular reminders to providers. If you're billed after showing your QMB / dual-eligible card, push back — don't pay first.
What income counts for MSP?
Most countable monthly income: gross Social Security (before any Medicare premium deduction), pension or retirement income, wages, interest, dividends, rental income, alimony. SSA applies a $20 'general income disregard' to total countable income. SSI rules around in-kind support and earned-income disregards generally apply. Some specific income types are not counted (e.g., the value of SNAP benefits, certain veteran's benefits in some states).
Does QI funding really run out each year?
Yes — QI is funded with a fixed annual federal allocation, distributed first-come-first-served by states. Most states don't run out, but a few have. If you suspect you're QI-eligible, apply early in the calendar year to be safe. SLMB and QMB are entitlement programs (no funding cap). QI also has the unusual feature of not allowing simultaneous full Medicaid — if you become full-Medicaid-eligible, you're shifted out of QI and into a different category.
Do I have to renew MSP every year?
Most states require annual MSP renewal. Some states do automatic renewal if your circumstances haven't changed; others require an active renewal form. Watch your mail — missed renewal letters are the most common reason people lose MSP. If your renewal lapses, you can re-apply. The QMB billing protections end the moment your QMB status ends.
Is MSP the same as Medicaid?
Not exactly. MSP is a category of Medicaid that pays Medicare costs but doesn't necessarily get you full Medicaid (which would also cover services Medicare doesn't, like routine vision/dental for adults in some states, long-term services and supports, etc.). Some MSP enrollees do get full Medicaid because they qualify under both rules. People on MSP plus full Medicaid are called 'full duals' or 'dual-eligibles.'
What if I get a phone call telling me I qualify for MSP?
Be cautious. Real MSP enrollment goes through your state Medicaid office. SSA does the auto-Extra-Help link once MSP is approved. If a stranger calls or texts saying they can enroll you in MSP for a fee, that's likely a scam or a marketing funnel. Free MSP help: state Medicaid office, SHIP at , and 1-800-MEDICARE at 1-800-633-4227.
Sources
Every figure and rule on this page is verified against primary sources. Last verified 2026-04-27.
- POMS HI 03001.005 establishes the automatic Part D Extra Help (Low-Income Subsidy) link for MSP enrollees. —secure.ssa.gov(verified 2026-04-28)
- MSP eligibility uses SSI counting methodology (NOT MAGI), including a 20 USD General Income Disregard applied to total countable monthly unearned income. —secure.ssa.gov(verified 2026-04-28)
- Beneficiaries who qualify as 'full duals' (Medicare plus full Medicaid) automatically receive Part D Extra Help with no separate application. —secure.ssa.gov(verified 2026-04-28)
- MSP eligibility is determined under Section 1902(a)(10)(E) of the Social Security Act and is administered by states under federal Medicaid rules. —ssa.gov(verified 2026-04-28)
- The Medicare Savings Program (MSP) consists of four categories: QMB, SLMB, QI, and QDWI — administered by states with federal funding to help Medicare beneficiaries with limited income. —medicare.gov(verified 2026-04-28)
- QMB (Qualified Medicare Beneficiary) covers people with income up to 100% of the federal poverty level and pays Part A premiums, Part B premiums, deductibles, coinsurance, and copays. —medicare.gov(verified 2026-04-28)
- SLMB (Specified Low-Income Medicare Beneficiary) covers people with income up to 120% of the federal poverty level and pays the Part B premium. —medicare.gov(verified 2026-04-28)
- QI (Qualifying Individual) covers people with income between 120% and 135% of the federal poverty level and pays the Part B premium on a first-come-first-served annual funding basis. —medicare.gov(verified 2026-04-28)
- QDWI (Qualified Disabled and Working Individual) covers disabled individuals under 65 who lost premium-free Part A due to returning to work, with income up to 200% of the federal poverty level. —medicare.gov(verified 2026-04-28)
- Federal Medicare Savings Program asset limits in 2026 are 9,950 USD for an individual and 14,910 USD for a couple, indexed annually. —medicare.gov(verified 2026-04-28)
- MSP applications are filed through state Medicaid agencies, not the Social Security Administration. —medicare.gov(verified 2026-04-28)
- Some states have eliminated the Medicare Savings Program (MSP) asset test entirely (including Connecticut, the District of Columbia, and Indiana), and others have raised MSP income limits above the … —medicare.gov(verified 2026-04-28)
- QI funding is allocated annually by Congress on a state-by-state basis with first-come-first-served distribution; states cannot enroll beneficiaries beyond available funding. —medicare.gov(verified 2026-04-28)
- Dual-eligible beneficiaries with the Part D Low-Income Subsidy may qualify for a monthly Part D plan-change Special Enrollment Period under 42 CFR 423.38(c); for Medicare Advantage, the dual-eligible … —ecfr.gov(verified 2026-04-28)
- In states with Medicare Part B buy-in agreements (42 USC § 1395v), QMB enrollment automatically enrolls eligible beneficiaries in Part B, and the state pays the premium on their behalf. Buy-in … —ecfr.gov(verified 2026-04-28)
- Medicare-participating providers cannot bill QMB enrollees for Medicare deductibles, coinsurance, or copays under federal law (42 USC 1396a(n)(3)(B) + 42 CFR 447.15; CMS guidance MLN Matters SE1128). —law.cornell.edu(verified 2026-04-28)
- QMB enrollees are entitled to no cost-sharing on Medicare-covered services; under 42 USC 1396a(n)(3)(B) and CMS MLN Matters SE1128, Medicare-participating providers may not bill QMB enrollees for … —law.cornell.edu(verified 2026-04-28)
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