Medicare Premium Assistance Programs

For many older adults, especially those with chronic conditions, out-of-pocket Medicare costs can add up quickly. In West Virginia, there are Medicare Premium Assistance Programs that can help pay for Medicare costs. These are known nationally as the Medicare Savings Programs (MSPs).

You may qualify for a West Virginia Medicare Premium Assistance Program if you are enrolled in Medicare—or are about to enroll—and you have a limited income.

What are the Medicare Savings Programs (Medicare Premium Assistance Programs)?

Medicare Savings Programs 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 Medicare Savings Programs, 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 Medicare Savings Programs.

Medicare Savings Programs are available in every state, but not every type of Medicare Savings Program is offered in every state. Most Medicare Savings Programs are run by a state’s Medicaid office. In West Virginia, the Medicare Premium Assistance Programs are handled by the West Virginia Department of Human Services (DoHS).

There are three Medicare Premium Assistance Programs in West Virginia:

• Qualified Medicare Beneficiary (QMB): This program has the lowest income limit and covers your Medicare Part A and Part B premiums, deductibles, and copayments.

• Specified Low-Income Medicare Beneficiary (SLMB): This program has a slightly higher income limit and covers your Medicare Part B Premium ($202.90 in 2026).

• Qualifying Individual (QI-1): QI is a limited program and available on a first-come, first-served basis. For those eligible, QI covers the Medicare Part B premium.

How do I know if I'm eligible for a Medicare Premium Assistance Program?

You must either be enrolled in Medicare or expect to enroll soon. Each Medicare Premium Assistance Program has its own income limit (the most money you can earn in a month to qualify). The monthly income limits for Medicare Premium Assistance Programs in West Virginia are listed below and are effective as of April 1, 2026:

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

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

Qualifying Individual (QI):

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

Individual $ 1,816

Couple $ 2,455

Source: Medicare.gov

You should apply to the West Virginia Medicare Premium Assistance Programs if you need help, 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.

To qualify for a Medicare Premium Assistance program in West Virginia, 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).

How do I apply for a Medicare Premium Assistance Program in West Virginia?

Follow the steps below to apply for the West Virginia Medicare Premium Assistance Programs.

1. 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

• Your assets, such as bank account 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 Premium Assistance Programs and other public assistance benefits is through the WV PATH online application.

Apply Online

When you arrive on the site, click “Apply.” Then click “Click "Create Optum GovID" if you do not have already have an account.

All your personal information is kept 100% private and protected by special security technology.

APPLY BY MAIL

Download and complete West Virginia's Medicare Premium Assistance Program application form and mail it to your local county office. Find yours here.

Download Application

APPLY IN PERSON

Visit your local county office to complete an application. Find yours here.

How can I get help with my application?

• Visit a Benefits Enrollment Center (BEC), if there’s one near you. See if there’s one in your area.

• Call your local county office. Find yours here.

• Contact the West Virginia State Health Insurance Assistance Program (SHIP) at 1-877-987-4463.

NCOA also has a HelpLine that you can call to get free support. To get started today, call [1-800-794-6559](tel:+18007946559).

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 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.

Call the West Virginia State Health Insurance Assistance Program (SHIP) at 1-877-987-4463 to see if an SNP plan is available where you live and if you qualify.

Can I get help paying for my prescription drugs in West Virginia?

Once you're enrolled in a Medicare Premium Assistance 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. You can learn more about Extra Help and even apply on our website.