Updated Eligibility Limits for Medicare Assistance Programs

Medicare is health insurance in the U.S. for people age 65 or older and some people under age 65 with disabilities.  Medicare coverage involves Part A (hospital insurance), Part B (medical insurance), and Part D (prescription drug insurance).  Each of these parts can have additional costs like monthly premiums, deductibles, and copays/coinsurance. This article will explain different assistance programs that are available to help cover those additional Medicare costs, including:

  • Extra Help (Low Income Subsidy)
  • Medicare Savings Program
    • SLMB
    • QMB

All of these assistance programs depend on your level of income and resources/assets. Income can mean Social Security benefits, pension, job income, IRAs, and annuities. Resources means money in checking or savings accounts, IRAs, stocks, bonds, etc.  The income & resource limits for these programs change every year, so if you don’t qualify now, make sure to check back next year, or check back if your situation changes.     

Extra Help (also known as the low-income subsidy)  

The Medicare Extra Help program is prescription drug assistance. If you are eligible for β€œExtra Help,” then your monthly cost (premium) for your drug plan could be a reduced cost or even $0, depending on the plan. You will also have reduced copays for your prescriptions, up to $4.90 for generic or $12.15 for brand name drugs in 2025.

Some people are automatically enrolled in the Extra Help program, like if you receive Medicaid assistance or qualify for other Medicare assistance programs. 

Anyone else who meets these income & resource limits can apply for the Medicare Extra Help program: 

  • Single person – You are eligible if your income is under $1,976/month and have under $17,600 in resources
  • Married couple – You are eligible if your income is under $2,664/month and have under $35,130 in resources

If you meet these requirements and don’t already have Medicare prescription assistance, you can call the Iowa SHIIP-SMP program and ask for help applying for Extra Help. We have counselors who can assist you in English or in Spanish.  You can also apply for the Extra Help program through the Social Security Administration at www.ssa.gov/medicare/part-d-extra-help

Medicare Savings Programs 

There are also Medicare Savings Programs, and if you qualify, the State of Iowa can cover your extra Medicare Part A and Part B costs. You can be eligible for both the Extra Help program and a Medicare Savings Program.   

SLMB β€“ This program will cover your monthly Medicare Part B premium if you meet these requirements as of April 1, 2025: 

  • Single person – You are eligible if your income is under $1,781/month and have under $9,660 in resources
  • Married couple – You are eligible if your income is under $2,400/month and have under $14,470 in resources

QMB β€“ This program will cover your Medicare Part A & B deductibles, premiums, and copays if you meet these requirements as of April 1, 2025: 

  • Single person – You are eligible if your income is under $1,325/month and have under $9,660 in resources
  • Married couple – You are eligible if your income is under $1,783/month and have under $14,470  in resources

If you meet these requirements and don’t already have assistance through a Medicare Savings Program, you can call the Iowa SHIIP-SMP program and ask for help applying.  We have counselors who can assist you in English or in Spanish.  You can also apply through Iowa Health & Human Services online at https://hhsservices.iowa.gov/apspssp/ssp.portal

Sometimes, when you have Medicare and Extra Help or a Medicare Savings Program, you might find out that your assistance ended. If you still qualify (based on income & resource limits above), you might just need to reapply.

For More Information:

  • Visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227) for more information about Medicare.
  • For local help understanding your Medicare coverage and eligibility, call SHIIP-SMP at: 1-800-351-4664.