North Carolina Medicare Savings Programs

Medicare isn’t free. You’ll still have some costs, such as monthly premiums, deductibles, and co-pays. If you live in North Carolina and have low income, you may qualify for a Medicare Savings Program (MSP) to help pay for some or all of these “out-of-pocket” expenses. MSPs can make Medicare more affordable for people who are already enrolled—or getting ready to sign up. ## What are the North Carolina Medicare Savings Programs? The North Carolina Medicare Savings Programs (MSPs) are state-run Medicaid programs that help people with low income pay for their Medicare costs. These costs include: - **Premiums**: Money you pay to keep your Medicare plan - **Deductibles**: Money you pay before Medicare pays for your care - **Copays**: A set fee you pay to visit your regular doctor or a specialist There are four MSPs, each with different eligibility rules. Older adults and younger adults with disabilities who may not qualify for full Medicaid may still be able to enroll in one of the MSPs. MSPs are available in every state, but not every type of MSP is offered in every state. Most MSPs are run by a state’s Medicaid office. In North Carolina, MSPs are handled by the Department of Health and Human Services (DHHS), the department that runs the NC Medicaid program. ## What are the types of Medicare Savings Programs offered in North Carolina? All four MSPs are available in North Carolina: - **Qualified Medicare Beneficiary (QMB)**: This program has the lowest income limit and covers Medicare Part A and Part B premiums, deductibles, and copayments for those eligible. - **Specified Low-Income Medicare Beneficiary (SLMB)**: For those eligible, SLMB covers the Medicare Part B premium ($202.90 per month in 2026). - **Qualifying Individual (QI)**: QI is a limited program and available on a first-come, first-served basis. For those eligible, QI covers the Medicare Part B premium. - **Qualified Disabled & Working Individual (QDWI)**: This program is less common than the other three MSPs. It helps pay for the Medicare Part A (Hospital Insurance) premium. Most people do not pay a premium for Part A. But if you’re younger than 65 with a disability, and you returned to work (after collecting Social Security Disability benefits while out of work), you no longer qualify for premium-free Part A. QDWI does not cover the Part B premium. **Special Needs Plans (SNPs)** You may also want to find out if you qualify for a Special Needs Plan (SNP). SNPs are a special type of Medicare Advantage (Part C) plan for people who need extra help paying for and managing their care. You may qualify for an SNP if you meet one of the following conditions: - You have both Medicare and Medicaid (including QMB). - You have a serious and disabling chronic medical condition. - You live in a nursing home, or you live at home but have high care needs and could qualify for a nursing home. Different SNPs are available in different areas of the country. Learn more by contacting North Carolina Medicaid at [1-888-245-0179](tel:1-888-245-0179). ## Can I get help paying for my prescription drugs in North Carolina? Once you're enrolled in a North Carolina Medicare Savings Program, you will be signed up for the Medicare Part D [Extra Help program](https://benefitscheckup.org/medicare-rx-extra-help-application/)[.](https://benefitscheckup.org/medicare-rx-extra-help-application/) If you meet the guidelines for Extra Help, you will have a low (or no) deductible and a low (or no) premium. In general, you will pay much less for your prescriptions. You can learn more about Extra Help and [even apply on our website](https://benefitscheckup.org/medicare-rx-extra-help-application-prepare/)[.](https://benefitscheckup.org/medicare-rx-extra-help-application-prepare/) ## How do I know if I'm eligible for an MSP in North Carolina? You must either be enrolled in Medicare or expect to enroll soon. Each program has its own income limit (the most you can earn in a month to qualify) The monthly income limits for MSPs in North Carolina are listed below and are effective as of March 1, 2026 (note that these limits include a $20 income disregard): **Qualified Medicare Beneficiary Program (QMB):** Family size Maximum monthly income (at or below 100% FPL/+ $20 income disregard Individual $ 1,350 Couple $ 1,824 Source: [medicare.gov](https://www.medicare.gov/basics/costs/help/medicare-savings-programs) **Specified Low-Income Medicare Beneficiary (SLMB):** Family size Maximum monthly income (between 100-120% FPL/+ $20 disregard) Individual $ 1,616 Couple $ 2,184 Source: [medicare.gov](https://www.medicare.gov/basics/costs/help/medicare-savings-programs) **Qualifying Individual (QI):** Family size Maximum monthly income (between 121-135% FPL/+ $20 disregard) Individual $ 1,816 Couple $ 2,455 Source: [medicare.gov](https://www.medicare.gov/basics/costs/help/medicare-savings-programs) **Qualifying Disabled Working Individual (QDWI):** Family size Maximum monthly income (at or below 400% FPL/+ $20 disregard) Individual $ 5,405 Couple $ 7,299 Source: [medicare.gov](https://www.medicare.gov/basics/costs/help/medicare-savings-programs) To qualify for the QMB, SLMB, and QI MSP programs in North Carolina, you must also have resources no greater than $9,950 (individual) or $14,910 (couple). Resources are things you own that can be turned into money, like cash, bank accounts, or property (not your home). The resource limits for the QDWI program are $4,000 (individual) and $6,000 (couple). If you need help with your Medicare costs, you should apply for the MSPs—even if you think your income might be too high. Certain types of income are not counted, and the only way to know for certain if you qualify is to apply. ## How do I apply for the North Carolina Medicare Savings Programs? Follow the steps below to apply for the North Carolina MSPs. - **Gather important documents** Before you apply, have the following information handy to make your application process easier: - The amount of income you get from jobs and other sources - Asset information, such as bank and investment account balances - Medicare numbers, Social Security numbers, and birth dates of everyone applying or in your household **2. Complete an application** The quickest and easiest way to apply for Medicaid and the Medicare Savings Programs is online through the [ePASS portal](https://epass.nc.gov/). All your personal information is kept 100% private and protected by special security technology. [Apply on EPASS](https://epass.nc.gov/) **APPLY BY MAIL, PHONE, OR IN-PERSON** To apply for Medicaid and/or the MSPs by mail, over the phone, or in person: - [Call or visit your local DSS office](https://www.ncdhhs.gov/divisions/social-services/local-dss-directory). - Call the NC Medicaid hotline at [1-888-245-0179](tel:+1-888-245-0179). - Call the Medicare and Seniors' Health Insurance Information Program (SHIIP) toll-free at 1-855-408-1212. ## How can I get help with my North Carolina Medicare Savings Programs application? To get help with your application, you can: - Call SHIIP toll-free at [1-855-408-1212](tel:+). - Visit a Benefits Enrollment Center (BEC), if there’s one near you. [See if there’s one in your area](https://benefitscheckup.org/article/how-to-find-a-benefits-enrollment-center-near-you). **NCOA also has a HelpLine you can call to get free support. Call [1-800-794-6559](tel:+18007946559) anytime Monday–Friday, from 8 a.m. to 7 p.m. EST.**