Medicare can be expensive, but programs exist to help people on disability cover their costs. Here's how to get help paying for premiums, deductibles, and prescriptions.
In this article, we'll cover:
- Extra Help (Low Income Subsidy)
- Medicare Savings Programs
- Dual eligibility with Medicaid
- How to apply
1. Extra Help (Low Income Subsidy)
What it covers:
- Part D premiums
- Drug deductibles
- Copays for prescriptions
- Coverage gap costs
Who qualifies:
- Income below 150% FPL
- Resources under $17,220 (single)
- Resources under $34,360 (couple)
- SSI recipients auto-qualify
Savings amount:
- Full Extra Help: Pays most costs
- Partial Extra Help: Reduces costs
- Can save $5,000+ per year
- Significant prescription savings
Automatic enrollment:
- SSI recipients get automatically
- Medicaid recipients get automatically
- MSP recipients get automatically
- No application needed
Important: If you receive SSI, you automatically qualify for Extra Help with Medicare Part D costs. You don't need to apply separately.
2. Medicare Savings Programs
QMB (Qualified Medicare Beneficiary):
- Pays Part A premium
- Pays Part B premium
- Covers deductibles
- Covers coinsurance
SLMB (Specified Low-Income Medicare Beneficiary):
- Pays Part B premium only
- Higher income limit than QMB
- Still significant savings
- Automatic Extra Help
QI (Qualifying Individual):
- Pays Part B premium
- Higher income limit than SLMB
- Must apply each year
- Automatic Extra Help
QDWI (Qualified Disabled Working Individual):
- Helps working disabled
- Part A premium assistance
- Lost Medicare when working
- Specific eligibility rules
Income limits (2026 estimates): | Program | Individual | Couple | |---------|-----------|--------| | QMB | ~$1,275/mo | ~$1,724/mo | | SLMB | ~$1,526/mo | ~$2,064/mo | | QI | ~$1,715/mo | ~$2,320/mo |
3. Dual Eligibility with Medicaid
What dual eligible means:
- Have both Medicare and Medicaid
- Medicaid fills gaps
- Lower out-of-pocket costs
- Comprehensive coverage
How it helps:
- Medicaid pays Medicare premiums
- Covers services Medicare doesn't
- Eliminates most cost sharing
- Prescription help
Full dual vs partial:
- Full dual: Complete Medicaid
- Partial dual: Medicare Savings Program
- Both get Extra Help
- Coverage varies
Getting dual coverage:
- Apply for Medicaid
- Automatic if on SSI
- State programs vary
- Check eligibility
4. How to Apply
For Extra Help:
- Online at ssa.gov
- Call SSA: 1-800-772-1213
- Visit Social Security office
- Mail application
For Medicare Savings Programs:
- Contact state Medicaid office
- Apply through state
- May be combined with Medicaid
- Annual renewal may be required
What you'll need:
- Income information
- Resource documentation
- Medicare card
- Identification
Processing time:
- Extra Help: Usually within 1 month
- MSP: Varies by state
- Retroactive coverage possible
- Apply as soon as eligible
Maximizing Your Benefits
Check eligibility annually:
- Income limits change
- Your situation may change
- New programs may help
- Don't assume you don't qualify
Combine programs:
- Extra Help + MSP
- Medicaid + Medicare
- Stack the savings
- Minimize out-of-pocket
Appeal if denied:
- Understand why
- Gather documentation
- File appeal
- Seek help if needed
How Purple Helps
Purple supports your benefit management:
- Track healthcare expenses
- Monitor your finances
- Keep organized records
- Manage all benefits
- See the full picture