Similar to Extra Help, there is also the “Medicare Savings Program”. The main difference is that Extra Help is specifically for prescription drugs, while the Medicare Savings Program is to assist beneficiaries who have limited income and resources with their other Medicare costs. This program is not available in Puerto Rico and the U.S. Virgin Islands (DHHS, 2014).

There are four types of Medical Savings Programs. The Qualified Medicare Beneficiary (QMB) Program assists beneficiaries with paying for Part A and/or Part B premiums, deductibles, coinsurance and copayments (DHHS, 2014). The monthly income limit for QMB for 2026:

Your situation:	Monthly income limit:*	Resource limit: What counts in resource limits?
Individual	$1,350	$9,950
Married couple	$1,824	$14,910

* Income limits slightly higher in Alaska and Hawaii. You may qualify in other states for these programs even if your income or resources are higher than the federal limits listed. Contact your state to find out.

If you qualify for the QMB program:

• Medicare providers aren’t allowed to bill you for services and items Medicare covers, including deductibles, coinsurance, and copayments. What should I do if I get a bill?
• You may get a bill for a small Medicaid copayment, if one applies.
• You’ll also get
  Extra Help

  paying for your prescription drugs. You’ll pay no more than $12.65 in 2026 for each drug covered by your Medicare drug plan.

 

The Specified Low-Income Medicare Beneficiary (SLMB) Program assists Medicare beneficiaries with paying for Part B premiums (DHHS, 2014).

Helps pay for: Part B premiums (You must have both Part A and Part B to qualify.)

Monthly income and resource limits for 2026:

* Income limits slightly higher in Alaska and Hawaii. You may qualify in other states for these programs even if your income or resources are higher than the federal limits listed. Contact your state to find out.

If you qualify for the SLMB Program: 

• You’ll also get
  Extra Help

  paying for your prescription drugs.

• You’ll pay no more than $12.65 in 2026 for each drug your Medicare drug plan covers.

Helps pay for: Part B premiums (You must have both Part A and Part B to qualify.)

Monthly income and resource limits for 2026:

* Income limits slightly higher in Alaska and Hawaii. You may qualify in other states for these programs even if your income or resources are higher than the federal limits listed. Contact your state to find out.

If you qualify for the QI program:

• You must apply every year to stay in the QI Program.
• States approve applications on a first-come, first-served basis – priority is given to people who got QI benefits the previous year.
• You’ll also get
  Extra Help

  paying for your prescription drugs. You’ll pay no more than $12.65 in 2026 for each drug your Medicare drug plan covers

QI is only available for people who don’t qualify for any other  Medicaid  coverage or benefits, but you may qualify for help from another Medicare Savings Program.

Qualified Disabled & Working Individual (QDWI) Program

You may qualify for the QDWI Program if you:

• Have a disability
• Are working
• Lost Your Social Security disability benefits and Medicare premium-free Part A because you returned to work

Helps pay for: Part A premiums only

Monthly income and resource limits for 2026:

* Income limits slightly higher in Alaska and Hawaii. You may qualify in other states for these programs even if your income or resources are higher than the federal limits listed. Contact your state to find out.

Programs of All-Inclusive Care for the Elderly (PACE)

PACE offers a wide range of health care services, as well as social services. Most PACE programs offer primary care; hospital care; medical specialty services; prescription drugs (including Part D drugs); nursing home services; nursing services; personal care services; emergency services; home care; physical therapy; occupational therapy; adult day health care; recreational therapy; meals; dental care; nutritional counseling; social services; laboratory and x-ray services; social work counseling; and end of life care. In addition, transportation, hospital, nursing home, home health, and other specialized services are usually provided under contract. In most cases, beneficiaries are given the opportunity to live at home (CMS, 2011b).

In order to qualify for PACE, beneficiaries must be 55 or older, live in a PACE service area, be eligible for nursing home care, and be able to live safely in a community setting at the time of enrollment. PACE is funded through Medicare and Medicaid through capitation payments (CBO, 2013; CMS, 2011b). A capitated payment can be defined as, “a single payment, made on a per-enrollee basis, that covers all care within a specified set of benefits….The recipient of a capitated payment keeps the difference between its cost and the amount of the payment if costs are below the payment, but it is responsible for paying any costs that exceed the capitated payment” (CBO, 2013, p. 39). This means that Medicare and Medicaid will pay a flat capitated payment per enrollee to the PACE organization, which goes into a pool that the provider uses to deliver care to all the enrollees in the program. In return, the PACE organization assumes all financial risk, but does not have to return any funding that is not needed. Since PACE organizations provide services to dually eligible participants, they receive two capitated payments per month per enrollee – one from Medicare and one from Medicaid (CMS, 2011b).

The Centers for Medicare and Medicaid Services clarify that, even though PACE has similarities to Medicare Advantage, it is not an MA plan and it does have many differences to MA plans. One example is the payment structure as already explained. In addition, it is only available in limited areas, and not available in all states; since PACE works in conjunction with Medicaid, a state-run program, the state has to also be involved with the PACE program. Furthermore, it is not available to all Medicare beneficiaries since it is intended for a defined population of frail elderly individuals (PACE, 2011). If you would like to see if you are eligible for PACE, or to see if there is a PACE provider in your area, go to www.pace4you.org or call your state Medicaid office (DHHS, 2014).