How to Get Financial Help for Medicare

For many older Americans living on a fixed income, paying for health care can feel overwhelming. Even with Medicare coverage, premiums, deductibles, prescription drug costs, and copays can quickly add up.

The good news is that several federal and state programs are available to help seniors and people with disabilities pay for Medicare-related expenses.

Unfortunately, many people who qualify either do not know these programs exist or assume they do not qualify.

Understanding the available assistance programs can help beneficiaries reduce out-of-pocket costs, improve access to medications, and avoid gaps in care. 

Understanding Medicare and Medicaid

Medicare is the federal health insurance program primarily for people age 65 and older and some younger individuals with disabilities. Medicaid is a joint federal-state program designed for people with limited income and resources.

Some individuals qualify for both programs at the same time. These beneficiaries are known as "dual eligibles."

For dual-eligible individuals, Medicare generally pays first for covered medical services, while Medicaid may help pay Medicare premiums, deductibles, copays and services Medicare does not cover. Many dual eligibles also enroll in specialized Medicare Advantage plans called Dual Eligible Special Needs Plans, which coordinate Medicare and Medicaid benefits under one plan.

Because rules vary by state, seniors should contact their state Medicaid office or local State Health Insurance Assistance Program for guidance.

Medicare Savings Programs

One of the most valuable but underused forms of assistance is the Medicare Savings Program. These state-run programs help pay Medicare Part A and Part B costs for people with limited income and savings. 

There are four main Medicare Savings Programs:

1. Qualified Medicare Beneficiary — The QMB program provides the broadest assistance, helping pay:

   • Medicare Part A premiums

   • Medicare Part B premiums

   • Deductibles

   • Copayments

   • Coinsurance

In many cases, providers are prohibited from billing QMB participants for Medicare-covered services.

2. Specified Low-Income Medicare Beneficiary — This program helps pay Medicare Part B premiums for individuals whose income is slightly above QMB limits.

3. Qualifying Individual — This program also helps pay Medicare Part B premiums. Funding is limited and generally provided on a first-come, first-served basis each year.

4. Qualified Disabled and Working Individual — This program helps certain disabled individuals who returned to work pay their Medicare Part A premiums.

Eligibility requirements vary by state, but qualification is generally based on income and available resources.

Prescription drug program

Another major assistance program is Medicare's Extra Help program. Extra Help assists eligible beneficiaries with Medicare Part D prescription drug costs, including premiums, deductibles, and copays. 

Some people qualify automatically if they already receive:

• Full Medicaid benefits,

• Supplemental Security Income, or

• Assistance through a Medicare Savings Program.

For 2026, the Extra Help program generally uses the following income and resource limits:

Household	Annual income limit	Resource limit
Individual	About $23,475	Approximately $18,210
Married couple	About $31,725	Approximately $36,450

Resource limits generally include bank accounts, investments, and certain other assets, but not a primary residence, vehicle, or personal belongings. Applicants should verify current limits before applying.

State Pharmaceutical Assistance Programs

Some states also operate State Pharmaceutical Assistance Programs (SPAPs), which help residents pay for prescription medications, Part D premiums, or other drug-related expenses.

Programs vary widely by state. Some provide direct financial assistance, while others help seniors coordinate benefits with Medicare Part D coverage.

Not every state offers an SPAP, but where available, these programs can provide meaningful savings for seniors with high medication costs.

Medicaid long-term care assistance

Many seniors are surprised to learn that Medicare generally does not cover long-term custodial nursing home care. Medicaid remains the nation's primary payer for long-term care services.

Depending on state rules and financial eligibility, Medicaid may help cover:

• Nursing home care

• Assisted living services

• In-home caregiving

• Home health aides

• Community-based long-term care services

Because Medicaid long-term care eligibility rules can be complex, seniors often benefit from consulting elder law attorneys, Medicaid planners or local aging agencies.

Where seniors can get help applying

The key is to apply and explore every available option. Fortunately, free counseling and enrollment help are available, including:

• State Health Insurance Assistance Programs

• State Medicaid offices

• Local area agencies on aging

• Social Security offices

• BenefitsCheckUp through the National Council on Aging

• Licensed Medicare insurance professionals like us

Seniors should not assume they earn too much to qualify. Even modest assistance with premiums or prescriptions can save hundreds or thousands of dollars annually.