Medicare Savings Program

Medicare isn’t free. You’ll still have some costs, such as monthly premiums, deductibles, and co-pays. If you live in Pennsylvania 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 Medicare Savings Programs?

The Medicare Savings Programs (MSPs) are state-run Medicaid programs in Pennsylvania 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 Pennsylvania, MSPs are handled by the Department of Human Services (DHS), which runs the Medicaid program.

What are the types of Medicare Savings Programs offered in Pennsylvania?

There are three MSPs available in Pennsylvania, including:

• 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 has slightly higher income limits. It’s a limited program and available on a first-come, first-served basis. For those eligible, QI covers the Medicare Part B premium.

Special Needs Plan (SNP)

You may also want to find out if you qualify for a Special Needs Plan (SNP). SNPs are a special type of Medicare Advantage 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 Pennsylvania Medicare Education and Decision Insight at 1-800-783-7067.

Can I get help paying for my prescription drugs in Pennsylvania?

Once you're enrolled in a Medicare Savings Program, you will be signed up for the Medicare Part D Extra Help program. 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 with Extra Help. You can learn more about this program and even apply on our website.

How do I know if I'm eligible for an MSP in Pennsylvania?

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):

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: PA Health Law Project

Specified Low-Income Medicare Beneficiary (SLMB):

Family size Maximum monthly income ( between 100-120% FPL/+ $20 disregard)

Individual $ 1,616

Couple $ 2,184

Source: PA Health Law Project

Qualifying Individual (QI):

Family size Maximum monthly income (between 121-135% FPL/+ $20 disregard)

Individual $ 1,816

Couple $ 2,455

Source: PA Health Law Project

To qualify for an MSP in Pennsylvania, you must also have assets no greater than $9,950 (individual) or $14,910 (couple). Assets are things you own that can be turned into money, like cash, bank accounts, or property (not your home).

Learn more about MSP income limits.

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 Medicare Savings Programs?

Follow the steps below to apply for the Pennsylvania MSPs.

1. Gather important documents

Before you apply, it may be helpful to gather the following information 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 the Medicare Savings Programs and other public assistance benefits is online through the COMPASS website. When you arrive on the site, click ‘Apply Now.’ All your personal information is kept 100% private and protected by special security technology.

Apply Online

APPLY BY MAIL

Download an application form and mail the completed form to your local County Assistance Office. Find an office near you.

How can I get help with my application?

• Contact your local County Assistance Office.

• Contact the PA MEDI program at 1-800-783-7067.

• Visit a Benefits Enrollment Center (BEC), if there’s one near you.https://benefitscheckup.org/article/how-to-find-a-benefits-enrollment-center-near-youSee if there’s one in your area.

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.