Medicare Savings Programs and Extra Help in Washington
Medicare premiums, deductibles, coinsurance, and prescription costs can strain a fixed income. Two different programs may help:
- Medicare Savings Programs (MSPs) are administered by Washington and can help with Medicare Part A or Part B premiums and, at some levels, Medicare cost sharing.
- Extra Help is a federal program that lowers Medicare Part D prescription-drug costs.
A person may qualify for one, both, or Medicaid/Apple Health in addition to Medicare. Do not assume income or savings are too high without completing a current screening.
Why these programs matter
Help can include:
- Payment of the Part B premium
- Payment of a Part A premium for someone who does not receive premium-free Part A
- Protection from certain Medicare deductibles, coinsurance, and copayments
- Lower Part D premium and deductible
- Lower prescription copayments
- No Part D late-enrollment penalty while receiving Extra Help
- More opportunities to change Medicare Advantage or Part D coverage
- Automatic Extra Help with certain MSP or Medicaid eligibility
The exact help depends on the program category and current eligibility.
Medicare Savings Program categories
Washington determines which MSP category applies.
Qualified Medicare Beneficiary (QMB)
QMB can help pay:
- Part A premium, if owed
- Part B premium
- Medicare deductibles
- Medicare coinsurance
- Medicare copayments for Medicare-covered services
A provider generally cannot bill a QMB beneficiary for Medicare-covered deductibles, coinsurance, or copayments, even if the provider does not accept Medicaid. The beneficiary may still owe for services Medicare does not cover and for applicable prescription costs.
Keep proof of QMB status and contact the plan, provider, or SHIBA if improper billing continues.
Specified Low-Income Medicare Beneficiary (SLMB)
SLMB helps pay the Part B premium. A person must have Part A and Part B.
SLMB eligibility also provides Extra Help with Part D costs.
Qualifying Individual (QI)
QI helps pay the Part B premium. A person must have Part A and Part B.
QI eligibility also provides Extra Help. QI funding is limited and applications are generally handled in priority order, so renewal and timely application matter.
Qualified Disabled and Working Individual (QDWI)
QDWI may help pay the Part A premium for certain people with disabilities who returned to work and lost premium-free Part A.
This category has different eligibility rules from the other MSPs.
Washington's current income screening
The Washington Health Care Authority's current Medicare Savings Program flyer lists these monthly income screening amounts:
| Program | Individual | Married couple |
|---|---|---|
| QMB | Up to $1,463 | Up to $1,984 |
| SLMB | Up to $1,596 | Up to $2,165 |
| QI-1 | Up to $1,835 | Up to $2,490 |
These amounts can change and do not by themselves determine eligibility. Washington applies program rules about household, countable income, disregards, and other factors. The agency's current flyer and decision control.
If income is close to or above a displayed figure, apply or request a screening rather than self-denying.
What is Extra Help?
Extra Help, also called the Part D Low-Income Subsidy, helps eligible people with Medicare prescription-drug plan costs.
In 2026, Medicare states that Extra Help can provide:
- A $0 plan premium for an eligible benchmark plan
- A $0 Part D deductible
- Copayments of no more than $5.10 for each covered generic drug
- Copayments of no more than $12.65 for each covered brand-name drug
- $0 for each covered drug after total drug costs reach the 2026 threshold described by Medicare
- No Part D late-enrollment penalty while receiving Extra Help
Plan formularies, pharmacy networks, and covered drugs still matter. Extra Help reduces costs; it does not make every drug covered by every plan.
2026 Extra Help income and resource limits
Medicare's 2026 general limits are:
| Household situation | Annual income limit | Resource limit |
|---|---|---|
| Individual | $23,940 | $18,090 |
| Married couple | $32,460 | $36,100 |
These are general limits for the 48 contiguous states and Washington, D.C. Special rules can allow eligibility with higher income in some situations, including when a person works or supports dependents. Income and resource counting rules have exclusions.
Do not count or exclude assets based on guesswork. Social Security determines Extra Help under federal rules.
What resources count for Extra Help?
Social Security may ask about:
- Bank accounts
- Stocks and bonds
- Mutual funds
- IRAs and other investment accounts
- Real estate other than the primary residence
- Cash or other countable resources
Items generally excluded can include the primary home, one vehicle, household goods, personal possessions, burial plots, and certain burial funds or life insurance amounts under program rules.
The rules can change. Answer the application accurately and let Social Security determine what counts.
Automatic Extra Help
A person generally receives Extra Help automatically when receiving:
- Full Medicaid
- Help from a state Medicare Savings Program paying the Part B premium
- Supplemental Security Income (SSI)
Medicare sends notices explaining automatic eligibility and plan enrollment.
Automatic enrollment in a drug plan does not mean the assigned plan is the best match for the person's prescriptions. Review the formulary and pharmacies and use available change rights if another plan fits better.
How MSP and Extra Help work together
QMB, SLMB, or QI eligibility generally brings automatic Extra Help.
This makes an MSP application valuable even when the immediate goal is only to reduce the Part B premium.
Applying for Extra Help through Social Security can also initiate a Medicare Savings Program referral to the state unless the applicant declines that referral. Follow up with Washington because an Extra Help application is not always a completed Washington MSP determination.
Extra Help still requires Part D coverage
Extra Help pays through Medicare Part D. A person needs a Medicare-approved plan with prescription coverage:
- A stand-alone Part D plan with Original Medicare, or
- A Medicare Advantage plan that includes Part D
If an eligible person has no plan, Medicare may enroll the person in one. Review any yellow, green, purple, or other Medicare notices and confirm the coverage date.
Choose the drug plan using medications
Even with Extra Help, plans differ in:
- Formulary
- Pharmacy network
- Preferred pharmacy status
- Prior authorization
- Step therapy
- Quantity limits
- Specialty-pharmacy requirements
- Coverage of specific doses or formulations
Prepare:
- Exact drug name
- Strength
- Dose
- Frequency
- Quantity
- Pharmacy
Compare the exact list in Medicare Plan Compare.
Applying for Extra Help
Apply through Social Security:
- Online through the official Extra Help application
- By phone
- By requesting or completing Form SSA-1020
- With assistance from Social Security or SHIBA
Helpful records can include:
- Bank statements
- Tax return
- IRA and retirement account balances
- Pension information
- Veterans benefits
- Annuities
- Railroad Retirement benefits
- Income information for the applicant and spouse
Do not send financial records through an ordinary email or unsecured contact form.
Social Security sends a written decision. Keep it.
Applying for a Washington Medicare Savings Program
Apply through the Washington State Health Care Authority using the current MSP application or approved application channel.
The current form is Application for Medicare Savings Programs (HCA 13-691). Confirm that the current version is being used.
Information may include:
- Identity and Washington residence
- Medicare coverage
- Household and marital status
- Income
- Other insurance
- Authorized representative, if any
- Information required by current Washington eligibility rules
Keep copies and proof of submission.
If you need help applying
Washington SHIBA provides free, unbiased, and confidential Medicare counseling. SHIBA can:
- Screen for possible MSP and Extra Help eligibility
- Explain applications and notices
- Help compare Part D plans
- Identify other cost programs
- Help address QMB billing
- Refer to the correct state or federal agency
The Washington OIC Insurance Consumer Hotline can connect callers with local SHIBA help.
What happens after approval?
MSP
Watch for:
- Washington eligibility notice
- Effective date
- Part B premium payment
- Reimbursement of a premium already withheld, when applicable
- Medicaid or ProviderOne information
- QMB protection
- Renewal requests
It can take time for Social Security and Medicare premium records to reflect the state payment. Do not stop paying a bill unless the responsible agency confirms the change.
Extra Help
Watch for:
- Social Security or Medicare notice
- Extra Help level
- Drug plan enrollment
- Premium amount
- Prescription copayments
- Plan-effective date
- Special Enrollment Period information
Show proof to the drug plan if the pharmacy is charging the wrong amount.
Best Available Evidence
If someone qualifies for Extra Help or Medicaid but the plan or pharmacy does not show it, Medicare has a process commonly called Best Available Evidence.
Contact the plan and provide accepted proof, which can include state eligibility documentation under current Medicare rules. Tell the plan how soon medication will run out.
Call 1-800-MEDICARE if the problem is not resolved.
QMB billing protection
A QMB beneficiary generally cannot be billed for Medicare-covered deductibles, coinsurance, or copayments.
If a bill arrives:
- Confirm QMB effective dates.
- Compare the bill with the Medicare Summary Notice or plan Explanation of Benefits.
- Give the provider proof of QMB.
- Ask the provider to bill the state correctly.
- Contact the plan, Washington HCA, SHIBA, or 1-800-MEDICARE if needed.
- Keep a call log and copies.
QMB does not eliminate charges for non-covered services, prescriptions, or care outside applicable rules.
Renewal and redetermination
Eligibility can be reviewed periodically. Respond to notices by the deadline.
Report changes as required, including:
- Address
- Marital status
- Household
- Income
- Resources when applicable
- Other insurance
- Medicaid status
Do not assume a program continues indefinitely because the Part B premium is still being paid.
If eligibility ends
A loss of Medicaid, MSP, or Extra Help can change:
- Part B premium withholding
- Drug copayments
- Drug plan premium
- Plan enrollment
- Special Enrollment Period rights
- Eligibility for a Dual Eligible Special Needs Plan
- Billing protections
Read the termination notice and appeal instructions immediately. Verify the date and compare replacement coverage before current help ends.
Appeals
Both state and federal eligibility decisions include appeal rights.
Keep:
- Decision notice
- Application
- Submitted documents
- Proof of submission
- Call notes
- Deadline
- Any evidence the decision missed
Follow the notice. An insurance agent cannot decide an eligibility appeal.
Other assistance to check
A person seeking MSP or Extra Help may also need screening for:
- Full Apple Health/Medicaid
- Supplemental Security Income
- SNAP food assistance
- Low-income energy assistance
- Property-tax relief
- Pharmaceutical assistance
- Hospital financial assistance
- Transportation or community programs
- Long-term care services
- Housing assistance
Eligibility rules differ. SHIBA or local benefit counselors can help identify referrals.
Common misconceptions
“I own a home, so I cannot qualify.”
The primary home generally is not counted as a resource for Extra Help. Washington MSP rules must be applied by the state.
“My income is a little above the chart, so applying is pointless.”
Deductions, disregards, household rules, and special circumstances can affect eligibility. Apply or get screened.
“Extra Help is a drug plan.”
Extra Help is a subsidy. The person still needs a Part D plan.
“All Part D plans cost the same with Extra Help.”
Formularies, pharmacies, restrictions, and premiums above the benchmark can differ.
“QMB means every health service is free.”
QMB protects cost sharing for Medicare-covered services under program rules. Non-covered services and prescriptions can still have costs.
“The programs renew automatically forever.”
Eligibility can be reviewed. Open every notice.
A practical application checklist
- Medicare card
- Social Security and state notices
- Proof of Washington address
- Income statements
- Bank and investment statements
- Retirement account balances
- Pension and benefit information
- Current insurance
- Medication list
- Authorized representative documents
- Copies of prior applications
Use official secure channels.
Your next step
Complete two separate checks:
- Apply or screen for the Washington Medicare Savings Program through the Health Care Authority.
- Apply for Extra Help through Social Security.
Then review the Part D plan using the person's actual medications and pharmacies.
Health Insurance Options LLC is a licensed independent insurance agency. We may help explain Medicare coverage but do not determine MSP, Medicaid, or Extra Help eligibility. Currently, we represent 8 organizations offering 75 Medicare products in the area. Contact Medicare.gov, 1-800-MEDICARE, Washington HCA, or Washington SHIBA for authoritative program information. We are not affiliated with or endorsed by the U.S. government or Medicare.
Official sources
- Medicare Savings Programs — Medicare.gov; checked Jul 30, 2026
- Help with Medicare drug costs — Medicare.gov; checked Jul 30, 2026
- Washington Medicare Savings Program — Washington State Health Care Authority; checked Jul 30, 2026
- Washington SHIBA (SHIP) — Washington State Office of the Insurance Commissioner; checked Jul 30, 2026
- Apply for Medicare Part D Extra Help — Social Security Administration; checked Aug 10, 2026