Medicare Subsidies
These figures are for rough screening only. They may change, and we do not guarantee their accuracy. Always confirm eligibility with Social Security, your state Medicaid agency, or a SHIIP counselor before applying.
Medicare Savings Programs & Dual Status
2026 Federal Baseline Screening Guide
Initial Triage Only: Identify possible eligibility and coordination flags—not for final eligibility decisions.
| Status / Program | Single Monthly Income ≤ |
Couple Monthly Income ≤ |
Assets (Liquid Resources) |
|---|---|---|---|
| FBDE (Full Dual)¹ Nursing Home / HCBS Waiver. |
$2,982* | State Rules Apply | $2,000 |
| QMB Pays premiums & cost-sharing. |
$1,350 | $1,824 | $9,950 |
| SLMB / QI Pays Part B Premium only. |
$1,816 | $2,455 | $9,950 |
Baseline Key Definitions:
- ¹State Variability: MSP and Waiver rules vary by state. Many states have eliminated asset tests or use higher standards.
- Miller Trust: Required if income exceeds $2,982 but the resident still needs Medicaid.
- $20 General Disregard: Monthly income not counted by SSA (already included in limits).
Action Note: If a resident appears near a threshold, coordination review is appropriate.
Low-Income Subsidy (Extra Help)
2026 U.S. Federal Eligibility Standards
Initial Triage Only: Identify possible eligibility and coordination flags—not for final eligibility decisions.
| LIS Category / Status | Single Monthly Income ≤ |
Couple Monthly Income ≤ |
Assets (Liquid Resources) |
|---|---|---|---|
| Level 1: Institutional / HCBS Nursing Home / Waiver residents. |
Qualify Automatically via Medicaid | $0 Drug Copays | |
| Level 2: Full-Benefit Duals Income ≤ 100% FPL. |
$1,350 | $1,824 | $16,590* |
| Level 3: Expanded Extra Help Income ≤ 150% FPL. |
$2,015 | $2,725 | $16,590* |
Federal Coordination Definitions:
- Liquid Resources: Savings, stocks, IRAs. Does not include home or one vehicle. *Couple Asset Limit: $33,100 ($36,100 w/ burial).
- Automatic Qualification: SSI recipients and those in an MSP are automatically granted Extra Help.
Action Note: If a resident appears near a threshold, coordination review is appropriate.
2026 Maximum Pharmacy Copays
Prescription Cost-Sharing Standards
Maximum costs for covered Part D drugs before the $2,100 annual out-of-pocket cap is met.
| LIS Status Level | Generic / Preferred | Brand / Non-Preferred |
|---|---|---|
| Level 1: Institutional / HCBS Residents in Nursing Homes or on Waivers. |
$0.00 | $0.00 |
| Level 2: Full-Benefit Duals Income ≤ 100% Federal Poverty Level. |
$1.60 | $4.90 |
| Level 3: Extra Help / MSP Income ≤ 150% Federal Poverty Level. |
$5.10 | $12.65 |
Important Legal Disclosure
Disclaimer: This material is provided for educational and screening purposes only. Figures shown are based on 2026 federal baseline references and may not reflect specific state-level Medicaid, MSP, or waiver rules.
Final eligibility, enrollment, and benefit determinations are made solely by the Social Security Administration (SSA), the Centers for Medicare & Medicaid Services (CMS), and respective state Medicaid agencies.
This resource is for professional coordination assistance and does not constitute an official offer of benefits or a guarantee of program qualification. We are not affiliated with, or endorsed by, any government agency. For official state-specific limits, please consult your local Department of Human Services or SHIP office.
