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Understanding Medicaid, Medicare Savings Programs, and Extra Help

Navigating government health assistance programs can be overwhelming, especially when you’re eligible for Medicare. In this article, we’ll clearly explain the differences and connections between three major programs that help people with low income and resources:

  • Medicaid

  • Medicare Savings Programs (MSP)

  • Extra Help (Low-Income Subsidy)

We’ll walk you through how each one works, what they cover, who qualifies, and how they can work together without conflict to provide full coverage.

What Is Medicaid?

Medicaid is a joint federal and state program that provides health coverage to people with limited income and assets. Medicaid can cover a wide range of services, including:

  • Hospital and outpatient care

  • Home and community-based services (HCBS)

  • Long-term care (nursing home)

  • Medical transportation

  • Dental and vision services (varies by state)

Important: Once someone is enrolled in Medicare, Medicaid stops covering prescription drugs. At that point, individuals need a Medicare Part D plan to cover their prescriptions, and if they have limited income, Extra Help can lower those costs.

Medicaid Income & Asset Limits (2025)

Eligibility rules vary by state and Medicaid program type. As an example, for Nursing Home Medicaid and most HCBS Waiver programs in 2025:

  • Income limit (individual): up to $2,901/month

  • Asset limit (individual): up to $2,000

See your state-specific limits here:
 https://www.medicaidplanningassistance.org/medicaid-eligibility-income-chart/

What Are Medicare Savings Programs (MSPs)?

Medicare Savings Programs help low-income individuals pay Medicare-related costs. There are four main types:

1. QMB (Qualified Medicare Beneficiary)

  • Covers: Part A and Part B premiums, deductibles, copays, and coinsurance

  • 2025 Income Limits:

    • Individual: $1,325/month

    • Married couple: $1,783/month

  • Asset Limits:

    • Individual: $9,660

    • Couple: $14,470

2. SLMB (Specified Low-Income Medicare Beneficiary)

  • Covers: Part B premium

  • 2025 Income Limits:

    • Individual: $1,585/month

    • Couple: $2,135/month

3. QI (Qualifying Individual)

  • Covers: Part B premium (priority given to those not already on Medicaid)

  • 2025 Income Limits:

    • Individual: $1,781/month

    • Couple: $2,400/month

Full MSP details:
 https://www.medicare.gov/basics/costs/help/medicare-savings-programs

If you’re eligible for an MSP, you’re automatically eligible for Extra Help with prescription drug costs.

What Is Extra Help (Low-Income Subsidy)?

Extra Help is a federal program that assists with the cost of Medicare Part D prescription drug coverage. It helps:

  • Pay Part D premiums

  • Reduce the deductible

  • Lower prescription copays

  • Eliminate late enrollment penalties

Extra Help Income & Asset Limits (2025)

  • Income Limit:

    • Individual: up to $23,475/year

    • Couple: up to $31,725/year

  • Asset Limit:

    • Individual: up to $17,600

    • Couple: up to $35,130

Apply or check eligibility here:
 https://www.medicare.gov/basics/costs/help/drug-costs

You do not need to have Medicaid or an MSP to qualify for Extra Help. You can apply separately.

How These Programs Work Together

These three programs can work together without conflict, each covering different pieces of your health care needs:

Program What It Covers
Medicaid Medical services, long-term care, cost-sharing assistance
Medicare Savings Program Part A & B premiums, deductibles, coinsurance (depending on program type)
Extra Help + Part D Lowers costs of prescription drugs (Part D premiums, deductibles, and copays)

You can be enrolled in:

  • Only Extra Help, even if you don’t qualify for Medicaid or MSP

  • Medicaid + MSP + Extra Help, if you qualify by income and assets

  • MSP + Extra Help, without full Medicaid

These programs complement each other and offer a safety net that can dramatically reduce out-of-pocket health care costs.

Final Thoughts

If you’re over 65 or have a disability and limited income, you’re likely eligible for one or more of these programs. Each program plays a specific role:

  • Medicaid helps with services

  • MSP helps with Medicare premiums

  • Extra Help makes prescriptions more affordable

Need help figuring out what you qualify for? Contact our agency at 616-600-8444 and we’ll guide you step-by-step — from checking eligibility for Medicare and government programs to enrollment into Medicare plans, all at no cost to you.

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