"Medicare assistance" can mean two very different things: programs that help pay for your Medicare costs, or help navigating the confusing Medicare system. Both are valuable, and understanding what's available can save you thousands of dollars while ensuring you get the right coverage.
Millions of Medicare beneficiaries qualify for financial assistance programs but don't know it. And many more struggle to understand their options without realizing free, unbiased help exists. This guide covers both types of Medicare assistance so you can access the help you need.
★ Key Takeaway
Over 12 million Medicare beneficiaries receive some form of financial assistance, but millions more qualify and don't know it. Programs like MSP and Extra Help can save eligible beneficiaries $5,000 or more annually, and free SHIP counseling is available in every state.
Two Types of Medicare Assistance
When people search for "Medicare assistance," they're usually looking for one of two things:
- Financial assistance: Programs that help pay for Medicare premiums, deductibles, copays, and prescription drug costs
- Decision-making help: Counselors, advisors, or resources that help you understand and choose the right Medicare coverage
Let's start with the financial assistance programs, since these provide the most immediate monetary benefit.
Medicare Savings Programs (MSP)
Medicare Savings Programs are state-run programs that help pay Medicare costs for people with limited income and resources. There are four types, each with different benefits and eligibility requirements.
QMB: Qualified Medicare Beneficiary Program
QMB is the most comprehensive Medicare Savings Program. It covers:
- Part A premium (if you have to pay one)
- Part B premium ($185/month in 2025)
- Part A deductible ($1,676 in 2025)
- Part B deductible ($257 in 2025)
- Coinsurance and copayments
2025 income limits: Up to 100% of the Federal Poverty Level (FPL): $1,255/month for individuals, $1,704/month for couples. Resource limits: $9,430 for individuals, $14,130 for couples.
SLMB: Specified Low-Income Medicare Beneficiary
SLMB pays only your Part B premium ($185/month in 2025). It doesn't cover deductibles or cost-sharing.
2025 income limits: Between 100-120% FPL: $1,255-$1,506/month for individuals, $1,704-$2,044/month for couples. Same resource limits as QMB.
QI: Qualifying Individual Program
QI also pays your Part B premium only. The key difference from SLMB is that QI has slightly higher income limits but funding is limited and awarded first-come, first-served.
2025 income limits: Between 120-135% FPL: $1,506-$1,695/month for individuals, $2,044-$2,300/month for couples. Same resource limits.
QDWI: Qualified Disabled and Working Individuals
QDWI pays only the Part A premium for disabled individuals who lost premium-free Part A because they returned to work.
2025 income limits: Up to 200% FPL: $2,510/month for individuals, $3,407/month for couples. Resource limits: $4,000 for individuals, $6,000 for couples.
| Program | What It Pays | 2025 Income Limit (Individual) |
|---|---|---|
| QMB | Part A & B premiums, deductibles, cost-sharing | Up to $1,255/month |
| SLMB | Part B premium only | $1,255-$1,506/month |
| QI | Part B premium only | $1,506-$1,695/month |
| QDWI | Part A premium only | Up to $2,510/month |
Apply Even If You Think You Won't Qualify
Income and resource calculations can be complex. Some income (like certain disability payments) and resources (like your home and one car) don't count. Apply anyway and let the state determine your eligibility. There's no cost to apply.
Extra Help (Low-Income Subsidy) for Part D
Extra Help, also called the Low-Income Subsidy (LIS), helps pay for prescription drug costs under Medicare Part D. It can save qualifying beneficiaries an average of $5,300 per year on drug costs.
What Extra Help Covers
- Part D monthly premium (paid in full or reduced)
- Part D annual deductible (eliminated or reduced)
- Copayments for prescriptions (reduced to $0-$11 per prescription in 2025)
- Coverage gap costs (no "donut hole" for Extra Help recipients)
Extra Help Eligibility (2025)
Full Extra Help: Income below 135% FPL ($1,695/month individual, $2,300/month couple) and resources below $17,220 individual or $34,360 couple.
Partial Extra Help: Income below 150% FPL ($1,883/month individual, $2,556/month couple) and resources below $17,220 individual or $34,360 couple.
Automatic Enrollment
If you qualify for QMB, SLMB, QI, or Medicaid, you're automatically enrolled in Extra Help. You'll receive a letter from Medicare explaining your benefits. If you don't receive this letter but think you qualify, apply directly through Social Security.
Medicaid Dual Eligibility
Some people qualify for both Medicare and Medicaid, known as "dual eligibles." If you qualify for both programs, Medicaid can help pay for costs that Medicare doesn't cover.
What Medicaid Covers for Dual Eligibles
- Medicare premiums, deductibles, and cost-sharing
- Long-term care services (nursing home, home health)
- Dental, vision, and hearing services
- Transportation to medical appointments
- Services Medicare doesn't cover
Dual-Eligible Special Needs Plans (D-SNPs)
D-SNPs are Medicare Advantage plans specifically designed for people who qualify for both Medicare and Medicaid. They coordinate benefits between both programs and often include extra benefits like care coordination, transportation, and over-the-counter allowances.
Medicaid Rules Vary by State
Medicaid is run by states, and eligibility rules differ significantly. Some states have expanded Medicaid with higher income limits than others. Contact your state Medicaid office or a SHIP counselor to understand your state's specific rules.
State Pharmaceutical Assistance Programs (SPAPs)
Many states offer their own programs to help residents pay for prescription drugs. These State Pharmaceutical Assistance Programs (SPAPs) can work alongside Medicare Part D to reduce your out-of-pocket drug costs.
How SPAPs Work
- SPAPs vary widely by state in terms of eligibility and benefits
- Some pay Part D premiums, deductibles, or copays
- Some provide assistance beyond what Part D covers
- Income limits are often higher than federal programs
- SPAP payments can count toward your Part D out-of-pocket maximum
Not all states have SPAPs. Contact your state's aging or health department, or ask a SHIP counselor if your state offers pharmaceutical assistance.
Charitable and Patient Assistance Programs
Beyond government programs, charitable organizations and pharmaceutical companies offer assistance programs that can help with Medicare costs.
Patient Assistance Programs (PAPs)
Many pharmaceutical manufacturers offer PAPs that provide free or discounted medications to people who can't afford them. These programs:
- Are specific to each manufacturer and medication
- Have varying income requirements (often more generous than government programs)
- Require a separate application for each medication
- May require you to have Part D coverage first
Charitable Organizations
Several national and local organizations help Medicare beneficiaries with costs:
- Medicare Rights Center: Free hotline for Medicare questions and assistance
- Benefits Checkup (NCOA): Tool to find programs you may qualify for
- Patient Advocate Foundation: Help navigating insurance and accessing medications
- Disease-specific foundations: Many conditions (cancer, diabetes, etc.) have foundations that help with costs
Watch Out for Scams
Legitimate assistance programs never ask for payment or sensitive financial information over the phone. Be wary of unsolicited calls offering Medicare assistance. When in doubt, contact Medicare directly at 1-800-MEDICARE or visit medicare.gov.
How to Apply for Financial Assistance
Applying for Medicare assistance programs is free, but the process varies by program. Here's where to apply:
Medicare Savings Programs (QMB, SLMB, QI, QDWI)
Apply through your state Medicaid office. You can:
- Apply online through your state's Medicaid website
- Call your state Medicaid office
- Visit your local Department of Social Services
- Get help from a SHIP counselor
Extra Help (LIS)
Apply through Social Security:
- Online at ssa.gov/medicare/part-d-extra-help
- By calling Social Security at 1-800-772-1213
- At your local Social Security office
Medicaid
Apply through your state Medicaid office or through the Health Insurance Marketplace at HealthCare.gov (which will route you to your state's Medicaid program if you qualify).
Free Help Navigating Medicare
Beyond financial assistance, many people need help understanding their Medicare options. Several resources offer free, unbiased guidance.
SHIP Counselors
Every state has a State Health Insurance Assistance Program (SHIP) that provides free, unbiased Medicare counseling. SHIP counselors can:
- Explain your Medicare options
- Help you compare plans
- Assist with enrollment
- Help you apply for financial assistance programs
- Answer questions about bills and coverage
Find your local SHIP at shiphelp.org or call 1-800-MEDICARE.
Medicare.gov
Medicare's official website offers tools to compare plans, find doctors who accept Medicare, and access educational resources. The Plan Finder tool helps you compare Medicare Advantage and Part D plans based on your medications and preferences.
1-800-MEDICARE
Medicare's official phone line (1-800-633-4227) provides 24/7 assistance with questions about coverage, enrollment, and finding resources. They can also connect you with your state SHIP.
What SHIP Counselors Can't Do
SHIP counselors provide excellent free help, but they're volunteers with limited time. They can't provide in-depth personalized analysis of your complete financial picture or spend hours researching your specific situation. For comprehensive, personalized guidance, a fee-only Medicare advisor may be worth the investment.
Fee-Only Medicare Advisors: A Different Kind of Help
Most "Medicare help" comes from insurance agents and brokers who are paid commissions by insurance companies. While many are helpful, their compensation creates a conflict of interest: they only get paid when you enroll in a plan they sell.
How Fee-Only Advisors Are Different
Fee-only Medicare advisors charge you directly for their services, just like you'd pay an accountant or attorney. Because they don't receive insurance commissions:
- They can recommend any plan, not just ones they're contracted to sell
- They have no incentive to push more expensive options
- They may recommend Original Medicare + Medigap even though it pays no commission
- Their only goal is finding what's best for your situation
A fee-only advisor typically charges $400-600 for a comprehensive Medicare review. This may seem expensive compared to "free" help from agents, but the right recommendation can save thousands over time.
When a Fee-Only Advisor Makes Sense
- You have a complex situation (multiple health conditions, frequent travel, high prescription costs)
- You want an objective second opinion on what an agent recommended
- You're considering switching from Medicare Advantage to Medigap
- You want thorough analysis without sales pressure
- You value having an ongoing advisor relationship
For more on how fee-only advisors differ from insurance agents, see our guide to getting unbiased Medicare advice.
Getting the Assistance You Need
Whether you need financial help paying for Medicare or guidance choosing the right coverage, here's your action plan:
- Check your eligibility for financial assistance: Use the Benefits Checkup tool at benefitscheckup.org or contact your state SHIP
- Apply for MSP and Extra Help: Even if you're not sure you qualify, there's no cost to apply. Contact Social Security for Extra Help and your state Medicaid office for MSP
- Find your SHIP: For free counseling, visit shiphelp.org or call 1-800-MEDICARE
- Consider a fee-only advisor: If you want personalized, unbiased guidance, a Medicare consultant can provide in-depth analysis
- Review your coverage annually: Your situation and available programs change each year. Review your options during the Annual Enrollment Period (October 15 - December 7)
📋 The Bottom Line
Medicare assistance is available in many forms. Financial programs like MSP and Extra Help can save thousands annually if you qualify. Free SHIP counseling helps you understand your options without sales pressure. And fee-only advisors offer comprehensive, unbiased guidance for those who want deeper analysis. The key is knowing what help exists and how to access it.
Need Personalized Help?
Navigating Medicare assistance programs can be confusing. Whether you need help applying for financial assistance or want unbiased guidance on choosing the right Medicare coverage, we're here to help. Our fee-only approach means we have no ties to insurance companies and only recommend what's best for you.