Medicaid › Help paying Medicare costs

Can Medicaid help pay my Medicare costs?

For anyone on Medicare whose budget is tight. By the end you’ll know which programs can pay your costs, the 2026 limits and how to apply.

What does it mean to have both Medicare and Medicaid?

People with both are called dual eligibles. CMS reports nearly 12.5 million people were enrolled in both programs during fiscal year 2025. There are two kinds:

• Full: you get full Medicaid coverage, and often help with Medicare costs too. CMS counts 72% of people with both in this group.
• Partial: Medicaid helps only with Medicare premiums and, in most cases, your deductibles, coinsurance and copays (called cost sharing), through a Medicare Savings Program. CMS counts 28% in this group.

Which Medicare Savings Program fits me?

A Medicare Savings Program (MSP) is a state program that pays some of your Medicare costs. There are four. The limits below are for 2026. “Savings” means what Medicare calls countable resources, such as money in the bank.

• For SLMB and QI, you must already have Part A and Part B.
• QI must be renewed every year. It is first come, first served, and people who had QI the year before get priority. You can’t get QI if you qualify for other Medicaid.
• QDWI is for people with a disability who went back to work and lost their disability benefits and premium-free Part A.
• Income limits are a little higher in Alaska and Hawaii.
• The 2027 limits aren’t out yet. They follow the federal poverty guidelines, which usually come out in January.

What if I think I have too much?

Apply anyway. Medicare.gov says you may still qualify in your state even if your income or savings are higher than these limits. According to KFF, as of March 2026, 18 states (counting Washington, DC) had rules more generous than the federal minimums, and some had dropped the savings test for these programs entirely.

Can a doctor bill me if I’m in QMB?

Not for Medicare cost sharing. CMS says federal law bars all Original Medicare and Medicare Advantage providers, not just those that take Medicaid, from billing people in QMB for Part A and Part B deductibles, coinsurance and copays. That holds even if Medicaid doesn’t pay the provider in full. A provider who bills you anyway is breaking its agreement with Medicare.

How does Extra Help lower my drug costs?

Extra Help lowers what you pay for Medicare drug coverage (Part D). You get it automatically if you have full Medicaid, get help paying your Part B premium through an MSP, or get SSI (Supplemental Security Income).

Otherwise, the 2026 limits are $23,940 a year in income for one person or $32,460 for a couple, and $18,090 in savings for one person or $36,100 for a couple. The savings limits include $1,500 each for burial costs.

In 2026, people with full Medicaid and income at or below the poverty line pay no more than $1.60 for generics and $4.90 for brand-name drugs. Those who live in a nursing home, or get care at home through Medicaid, pay $0. Many drug plans also have a $0 premium for people with Extra Help.

For 2027, the savings limits are $17,210 for one person and $34,340 for a couple ($18,710 and $37,340 with the burial allowance). CMS says the 2027 income limits will come out in early 2027.

Are there Medicare plans just for people with both?

Yes. A dual eligible special needs plan (D-SNP) is a kind of Medicare Advantage plan built for people who have both Medicare and Medicaid. Some are “integrated,” meaning your Medicare and Medicaid coverage line up in one plan. They aren’t offered everywhere.

Since January 1, 2025, federal rules (42 CFR 423.38) give you extra chances to change plans:

• Once a month, if you have Medicaid, an MSP or Extra Help, you can switch to Original Medicare with a stand-alone drug plan, or switch from one stand-alone drug plan to another. This can’t be used to join or switch regular Medicare Advantage plans. It may not apply if your drug plan has limited you under its at-risk drug program.
• Once a month, if you have full Medicaid, you can join an integrated D-SNP, where one is offered, so your Medicare and Medicaid plans line up.

Before you switch, check that the new plan covers your doctors and drugs.

Where can I get free help?

• SHIP: free, unbiased Medicare counselors in your state. Find yours at shiphelp.org or call 877-839-2675.
• 1-800-MEDICARE: 1-800-633-4227 (TTY 1-877-486-2048), 24 hours a day, 7 days a week, except some federal holidays.

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Benefits Insider is an independent publisher, not a government agency. This page is general information, not legal or financial advice for your situation. For a decision on your case, contact your state Medicaid office or 1-800-MEDICARE.