When Medicaid Covers Your Medicare Premiums and Deductibles

How Medicaid Helps Pay Medicare Costs

Yes, Medicaid can pay some or all of your Medicare premiums, deductibles, and copayments if you have both programs. This happens through programs called Medicare Savings Programs (MSP), which are run by your state's Medicaid office. Medicaid does not automatically pay these costs — you have to be enrolled in the right program, and the amount Medicaid covers depends on your income and which program you may have access to for.

The three main Medicare Savings Programs are may have access to Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), and may have access to Individual (QI). Each one covers different parts of your Medicare bills and has different income limits. Your state sets the exact income threshold, so what qualifies you in one state may not in another.

The key difference from regular Medicaid is that Medicare Savings Programs exist only to help with Medicare costs. They do not cover doctor visits, hospital stays, or prescriptions the way full Medicaid does. If you have both full Medicaid and Medicare, you already have coverage for those things — the MSP just fills in the gaps that Medicare leaves.

Key Takeaways

Medicaid can pay your Medicare Part B premiums, Part A deductibles, and copayments through Medicare Savings Programs if your income is low enough.
You must be enrolled in a Medicare Savings Program separately — it does not happen automatically when you get Medicare or Medicaid.
Income limits vary by state and change each year, so you may may have access to in one year and not the next.
Your state's Medicaid office or Social Security office can tell you which program you may be able to enroll in based on your income and household size.
If you have full Medicaid coverage already, a Medicare Savings Program only covers the Medicare costs Medicaid does not — it does not replace your existing coverage.

The Three Medicare Savings Programs and What Each Covers

may have access to Medicare Beneficiary (QMB) is the broadest program. It pays your Medicare Part A premium (if you have to pay one), your Part B premium, and your Part A and Part B deductibles and copayments. To may have access to, your income must be at or below 100 percent of the federal poverty line. In 2024, that means roughly $1,385 per month for a single person, though your state may use a slightly different figure. QMB is the program most people want because it covers the most.

Specified Low-Income Medicare Beneficiary (SLMB) pays only your Medicare Part B premium. Your income must be between 100 and 120 percent of the federal poverty line — higher than QMB but still very low. SLMB exists for people whose income is just above the QMB cutoff. It does not cover deductibles or copayments, only the monthly Part B bill.

may have access to Individual (QI) also pays only your Part B premium, but for people whose income is between 120 and 135 percent of the federal poverty line. QI has a waiting list in some states because funding is limited. If your state's QI program is full, you may have to wait until money becomes available.

A fourth program, may have access to Disabled and Working Individuals (QDWI), exists for people under 65 who are disabled, work, and lose Medicare coverage because of earnings. It is much narrower and applies to very few people.

How Income Limits Work and Why They Change

Each program has an income limit based on the federal poverty line, which the government updates every year in January. Your state then uses that federal figure to set its own limit — some states use the exact federal number, others round up slightly. This means the income threshold you need to meet changes every January, and you may become ineligible or newly may be able to access depending on whether your income changed and whether the poverty line moved.

Income includes wages, Social Security, pensions, interest, and rental income. It does not include food stamps, housing information, or some other benefits. Your state's Medicaid office can tell you exactly what counts as income for the Medicare Savings Program in your state.

If your income goes above the limit, you lose the program. If it drops back below, you can enroll again. Some people move in and out of these programs as their income shifts — for example, if you work part-time and your hours change seasonally.

How to Find Out Which Program You May may have access to For

The fastest way is to call your state's Medicaid office directly and give them your income and household size. They can tell you in minutes which program, if any, you may be able to enroll in. You can find your state Medicaid office number on the Medicaid website or by calling 1-800-MEDICARE.

You can also contact your local Social Security office. Social Security handles Medicare Savings Program enrollment in many states, and they have your income information on file already. If you call Social Security about Medicare Savings Programs, they can often move faster than Medicaid because they do not have to verify your income from scratch.

Some states let you enroll online through their Medicaid portal. Others require you to mail in a form or visit an office in person. Your state's Medicaid office will tell you which method applies where you live.

What Happens After You Enroll

Once you are enrolled in a Medicare Savings Program, Medicaid pays the bills directly to Medicare or to the provider. You do not have to submit receipts or wait for reimbursement. When you go to the doctor, you show your Medicare card and your Medicaid card, and the provider bills both.

Your enrollment is usually good for one year. Before it expires, your state will send you a notice telling you to renew. You have to renew even if nothing about your situation changed, because the income limits change every year and your state has to verify you still may have access to.

If your income goes up during the year, you should report it to your state's Medicaid office. If you do not and you are later found to have been ineligible, you may have to repay some of the money Medicaid spent on your behalf, though states vary on how strictly they enforce this.

Medicare Savings Programs and Full Medicaid Coverage

If you have both full Medicaid and Medicare, a Medicare Savings Program does not replace your Medicaid — it works alongside it. Full Medicaid covers things Medicare does not, like long-term care, dental, and vision. A Medicare Savings Program only covers the Medicare premiums and cost-sharing that Medicaid does not already cover.

In practice, if you have full Medicaid, you usually do not need a separate Medicare Savings Program because Medicaid already pays your Medicare costs. However, some states have different rules, so it is worth asking your Medicaid office whether you should enroll in an MSP even though you have full coverage.

If you have Medicare and only limited Medicaid (for example, Medicaid that covers only emergency care), then a Medicare Savings Program becomes more important because it fills in the gaps.

What to Do If You Are Denied or Your Income Is Too High

If your income is above the Medicare Savings Program limit, you have a few other options. Some states have their own programs that help people with Medicare costs at higher income levels — ask your state's Medicaid office whether such a program exists where you live.

You can also look into Medicare Extra Help, which helps with prescription drug costs if your income is below 150 percent of the federal poverty line. Extra Help is separate from Medicare Savings Programs and covers a different need, but it may help if drug costs are your biggest burden.

If you are denied a Medicare Savings Program, you have the right to appeal. Your state's Medicaid office will tell you how to request a hearing and what documents to bring. Appeals usually take several weeks, but if you win, the program can pay back to the date you first applied.

Frequently Asked Questions

Do I have to be on Medicare to get a Medicare Savings Program?

Yes. You must be enrolled in Medicare Part A or Part B (or both) to enroll in a Medicare Savings Program. The program exists only to help pay Medicare costs, so without Medicare there is nothing to pay for.

Can I have a Medicare Advantage plan and still get a Medicare Savings Program?

Yes. Medicare Savings Programs work with both Original Medicare and Medicare Advantage plans. If you have Advantage, the MSP pays your Advantage plan premium and your copayments and deductibles the same way it would with Original Medicare.

What if my income is right at the limit?

Most states round slightly in your favor, so if you are within a few dollars of the limit, you usually may have access to. Call your state's Medicaid office with your exact income and they can tell you whether you are in or out.

Do I lose my Medicare Savings Program if I go back to work?

If your work income pushes you above the program's income limit, yes, you lose it. You should report any change in income to your state's Medicaid office right away so they can update your status.

Can I enroll in a Medicare Savings Program anytime, or is there a important date?

Unlike Medicare itself, Medicare Savings Programs do not have enrollment important date. You can enroll whenever you become may be able to access. However, coverage usually starts the month after you enroll, not retroactively, so it is better to enroll as soon as you know you may have access to.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.