1. Two programs, constantly confused
Almost every conversation we have about this starts with the two programs being mixed up, so it is worth separating them before anything else. They cover different costs, they are administered by different agencies, and qualifying for one does not automatically mean you applied for the other.
| Program | What it pays | Who runs it |
|---|---|---|
| Extra Help also called the Part D Low Income Subsidy | Your prescription drug coverage — the Part D premium, the deductible, and most of what you pay at the pharmacy counter. | Social Security |
| Medicare Savings Programs QMB, SLMB, QI | Your Medicare premiums. At the highest level, your Part A and Part B deductibles, coinsurance and copayments as well. | Your state Medicaid agency |
The short version: Extra Help works on your drug costs. The Savings Programs work on your Medicare costs. Many households qualify for both, and the two together change the arithmetic of Medicare completely.
2. Extra Help: what it pays and who qualifies
Extra Help is the federal subsidy for Medicare prescription drug coverage. For 2026 you may qualify if your annual income and countable resources fall within these limits:1
| 2026 limit | One person | Married couple |
|---|---|---|
| Annual income | $23,940 | $32,460 |
| Countable resources | $18,090 | $36,100 |
If you qualify, here is what changes:
- Your Part D premium is paid, up to the benchmark amount in your area.
- Your Part D deductible is eliminated.
- Your prescription copays fall to no more than $5.10 for a generic, $12.65 for a brand-name drug.
- Once your total drug costs reach $2,100 in the year, you pay nothing at all for covered drugs for the rest of the year.
- If you also have full Medicaid and are in the QMB program, your copays are lower again — no more than $4.90 per covered drug.
The resource limits are higher than people expect
The home you live in does not count. Generally one car does not count. Personal belongings do not count, and burial funds set aside within limits do not count. What counts is money in the bank and investments. We have sat with people who assumed for years that owning a modest house disqualified them, and it never did.
3. The Medicare Savings Programs
The Medicare Savings Programs are run through your state Medicaid agency and work on your Medicare costs rather than your drug costs. There are three that matter to most people, and they differ by income:2
| Program | Monthly income, one person | Monthly income, couple | What it pays |
|---|---|---|---|
| QMB | $1,350 | $1,824 | Part A and Part B premiums, plus deductibles, coinsurance and copayments. |
| SLMB | $1,616 | $2,184 | Your Part B premium. |
| QI | $1,816 | $2,455 | Your Part B premium. Funding is limited and applications are taken in order, so apply early in the year. |
The resource limit for all three is $9,950 for one person and $14,910 for a married couple — and, as with Extra Help, your home and generally your car do not count toward it.2
QMB also stops the bills
QMB does something the other two do not: providers who accept Medicare are not allowed to bill you for Medicare deductibles, coinsurance or copayments. For someone with a chronic condition and frequent specialist visits, that protection is often worth more than the premium saving.
4. One application can start both
This is the part most people do not know, and it saves a great deal of effort. When you apply to Social Security for Extra Help, Social Security will normally forward your information to your state to begin a Medicare Savings Program application as well — unless you opt out of that during the application.1
So the single most useful thing you can do is file the Extra Help application. It is free, it is short, and it can start both processes at once. It also works the other way round: if the state enrolls you in QMB, SLMB or QI, you get Extra Help automatically without a separate form.
Free, no obligation
We will sit down with your income and savings and tell you which of these you qualify for.
5. The enrollment window nobody mentions
Most people on Medicare can only change their drug plan during Annual Enrollment, October 15 to December 7. People who have Medicaid or Extra Help generally can change their drug coverage once a month instead.1
That matters more than it sounds. Drug formularies change during the year, pharmacies move in and out of preferred networks, and a medication that cost you very little in March can become expensive in August. Everyone else has to live with it until January. If you qualify for Extra Help, you do not.
6. Why South Florida leaves this on the table
These programs are under-claimed everywhere, but a few things make South Florida particularly prone to leaving the money on the table:
- People assume a house disqualifies them. It does not. In a region where long-time residents often own a modest home but live on a small fixed income, this single misunderstanding probably costs more than any other.
- The application is in English by default. For households that operate in Creole, Spanish or French, the paperwork is a real barrier — not the eligibility rules.
- People confuse it with Medicaid and rule themselves out because they have been told they earn too much for Medicaid. The Savings Programs have their own, higher limits.
- Nobody sends you a letter telling you that you might qualify. Unlike a plan renewal notice, this one only happens if you go looking.
The practical consequence is that we regularly meet people who have been paying a Part B premium out of a small monthly cheque for years while qualifying, on paper, to have it paid for them.
7. How to apply
September is a good month to do this, because an approval that lands before October 15 changes which plan is right for you during Annual Enrollment.
- Apply for Extra Help through Social Security, at ssa.gov or by calling them. Ask them to forward your application to the state for the Savings Programs, or simply do not opt out when asked.
- Gather your numbers first: last year’s income, current bank and investment balances, and your Medicare card.
- Do not subtract your house or your car when you total your resources. They are not counted.
- Apply even if you think you are slightly over. Limits change annually, some income is disregarded, and the answer is free.
- If you are approved, tell whoever helps you with your plan — your eligibility changes which drug plans make sense, and it opens the monthly switching window.
These are 2026 figures
The income and resource limits above are the amounts published for 2026 and they are revised every year. The 2027 figures are normally published in the autumn, so if you are reading this later, treat these as a guide rather than a cut-off — and apply anyway.
8. Free help, and what to be careful about
You should never pay anyone to file either of these applications. Both are free. In Florida, the state’s SHINE program — run by the Department of Elder Affairs — provides free, unbiased one-to-one Medicare counselling, including help with these applications, on 1-800-963-5337. Licensed brokers like us are paid by the insurance company, never by you.3
- Nobody legitimate charges a fee to file an Extra Help or Savings Program application.
- Be cautious with anyone who asks for your Medicare number over the phone when they called you.
- An approval affects which drug plan is best for you, so review the plan after the approval, not before.
- If you are told you do not qualify and the reason given is your house or your car, get a second opinion.
9. Frequently asked questions
What is the difference between Extra Help and a Medicare Savings Program?
Extra Help pays for prescription drug coverage — your Part D premium, deductible and copays. A Medicare Savings Program pays your Medicare premiums, and at the highest level your deductibles and coinsurance too. They are separate programs with separate rules, run by different agencies, and you can qualify for both at once. Most people who qualify for one qualify for the other.
I own my home and I have a car. Do those count against the resource limit?
No. The house you live in and generally one vehicle are not counted, and neither are personal belongings or, in most cases, burial funds set aside within limits. What is counted is money in bank accounts, stocks, bonds and similar assets. This is the single most common reason people wrongly assume they do not qualify.
My income is slightly above the limit. Should I still apply?
Yes. The limits published here are the 2026 figures and they are revised every year. Some income is disregarded in the calculation, the limits are higher if you work, and states have some flexibility in how they count. An application is free and being turned down costs you nothing. Applying is the only way to get an actual answer.
Does qualifying for a Medicare Savings Program get me Extra Help too?
Yes. If you are enrolled in the QMB, SLMB or QI program you also get Extra Help with your drug costs automatically — you do not file a second application for it.
If I qualify, when can I change my drug plan?
People who have Medicaid or Extra Help can generally change their drug coverage once a month, rather than waiting for Annual Enrollment. That is a significant advantage: if your plan stops covering a medication in the middle of the year, you are not stuck with it until January.
Where do I apply, and does it cost anything?
Extra Help is applied for through Social Security, at ssa.gov or by calling them. When you apply, Social Security will normally send your information to the state to start a Medicare Savings Program application as well, unless you opt out. Both applications are free. Nobody should charge you to file either one.
Does QMB really stop doctors from billing me?
Yes. If you are in the QMB program, Medicare providers are not permitted to bill you for Medicare deductibles, coinsurance or copayments. Improper billing does happen — if you get a bill you believe you should not have, keep it and get help rather than paying it.
I am still working. Can I qualify?
Possibly. Earned income is treated differently from other income in the calculation, so people who work can qualify at higher gross incomes than the published figures suggest. There is also a separate program, QDWI, for certain disabled people who returned to work and lost their premium-free Part A. Do not rule yourself out on the basis of a paycheque.
10. Sources
- Medicare.gov — Get help with drug costs. Extra Help (Part D Low Income Subsidy) income and resource limits for 2026; drug copays of up to $5.10 for a generic and $12.65 for a brand-name drug; no cost for covered drugs after total drug costs reach $2,100; copays of no more than $4.90 for people with full Medicaid or in the QMB program. Also states that people with Medicaid or Extra Help may be able to change drug coverage once per month, that Extra Help is applied for through Social Security, and that Social Security will send the application to the state to begin a Medicare Savings Program application unless the applicant opts out.
- Medicare.gov — Medicare Savings Programs. 2026 monthly income limits and the $9,950 (single) / $14,910 (married) resource limits for QMB, SLMB and QI; what each program pays; and that people enrolled in QMB, SLMB or QI also receive Extra Help. Limits are slightly higher in Alaska and Hawaii.
- Florida Department of Elder Affairs — SHINE (Serving Health Insurance Needs of Elders), the state’s free Medicare counselling program. Elder Helpline 1-800-963-5337 (1-800-96-ELDER), floridashine.org.
Disclaimer: JCKC Financial Services is a licensed independent insurance brokerage and tax preparation firm. This article is for general educational purposes only and is not tax, legal, medical, or financial advice, nor a substitute for guidance from a licensed professional about your specific situation. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. We are not connected with or endorsed by the United States government or the federal Medicare program. Income and resource limits, copays and program rules change annually. Please contact Medicare.gov, 1-800-MEDICARE (TTY 1-877-486-2048), Social Security, or your local SHINE counsellor to discuss your options.