Sandra almost didn’t apply. She figured her Social Security check put her just over the line for any assistance, so she never bothered filling out the form. When a friend finally talked her into checking, she qualified for a program that now covers her Part B premium entirely. Stories like hers are common: licensed Medicare agents who field questions from beneficiaries every day say the pattern is consistent. People quietly stop taking their medications, or fall behind on premiums, without ever finding out help was sitting there the whole time.
Fewer than half of Medicare beneficiaries eligible for Extra Help, the federal subsidy that can bring prescription drug premiums down to zero, actually sign up for it, according to the Social Security Administration. It’s one of several programs designed specifically to keep Medicare affordable for people on fixed incomes, and it’s also one of the most underused corners of the entire system.
The gap isn’t really about eligibility. It’s about awareness.
Three programs, one blind spot
Ask agents what to do when a client says they can’t afford their Medicare premiums, and the answers cluster around the same handful of programs: Medicare Savings Programs, Extra Help, and Medicaid, each targeting a different piece of the cost puzzle.
John Hawk, a broker licensed in New Jersey, New York, Pennsylvania and South Carolina, laid out the mechanics plainly. Medicare Savings Programs are state-run and can cover Part A and Part B premiums, and in some cases deductibles and coinsurance too. Asset limits for 2026 sit at $9,950 for individuals and $14,910 for couples, though Hawk noted several states don’t apply an asset test at all. Qualifying automatically enrolls a beneficiary in Extra Help, the companion program for prescription drug costs, which Hawk estimated is worth roughly $5,700 a year in savings, with copays capped at a few dollars per prescription.
Meghan Blankenship, a broker licensed in Florida, Maryland and Ohio, said the first instinct for many people is to assume they make too much money to qualify, often incorrectly. “You don’t have to drop coverage. There are safety nets designed specifically for this situation,” Blankenship said, pointing beneficiaries toward Medicaid, Medicare Savings Programs, Extra Help, and free counseling through a State Health Insurance Assistance Program, or SHIP.
What the income cutoffs actually look like
The thresholds are higher than many people assume, which is part of why so many eligible beneficiaries never apply. Michael Andrews, a Connecticut-based broker, described his state’s Medicare Savings Program using round numbers most people can hold in their head. “If you’re single and your income is about $3,200 a month or less, and yes, that is gross income, including all of your Social Security and any distributions you’re receiving from a 401(k), then if that total amount is below $3,200, we can help you get on the savings program,” Andrews said. Married couples get a higher threshold. There’s no cost to apply, and the program can cover Part B premiums and sometimes copays.
Evan Agona, licensed in Ohio, Florida, Kentucky and six other states, said the mistake he sees most often isn’t a missed deadline. It’s people never applying because they assume the answer will be no. “Additionally, it may be as simple as meeting with a Medicare Broker to review your plan annually and switch to a plan that better suits your budget,” Agona said, describing plan reviews as free and sometimes overlooked entirely by beneficiaries who’ve had the same coverage for years without checking whether something cheaper now fits their needs.
Dual eligibility and the programs stacked on top
For beneficiaries at the lowest end of the income scale, agents describe a further layer: qualifying for both Medicare and Medicaid at once, often called dual eligibility. Terri Reagin, a broker licensed in Oklahoma, Arkansas, Colorado and six other states, walked through the sequence for a client who calls unable to pay a Part B premium. “The first thing I would do if I could not afford my Medicare Part B premiums is contact my local Department of Human Services and apply for Medicaid, because if you’re approved for Medicaid, they will actually pay your Part B premium,” Reagin said. “You can also apply for what’s called a low-income subsidy, and that can pay either all or part of your Medicare premium.”
Steven Bleicher, an Arizona broker, pointed to a further option for beneficiaries who clear the Medicaid threshold: a Special Needs Plan, a category of Medicare Advantage plan built specifically for people who qualify for both programs. “If approved, depending on your aging in to Medicare, you can apply for a ‘SNP’ Advantage plan, where there are no premiums per month and no out-of-pocket expenses for medical and hospital treatment or prescription drugs,” Bleicher said.
Several agents also mentioned a narrower fix for people who don’t qualify for full assistance but are still feeling squeezed: a Medicare Advantage plan with a Part B “giveback,” which returns some or all of the Part B premium directly, often reflected as a slightly larger Social Security deposit each month. It’s not a substitute for Medicare Savings Programs or Extra Help, agents caution, but it’s one more lever for the beneficiaries who fall just above the income cutoffs.
The one action that actually matters
The advice across dozens of agent responses converges on a single point: apply anyway. Otisha Newton, licensed in Arizona, Alabama, Arkansas and 18 other states, put it in list form: a Medicare Savings Program for Part A and B costs, Extra Help through Social Security for drug costs, Medicaid for beneficiaries with very limited income, and a call to a local SHIP office for free, unbiased guidance on all of it. Ann Sanfelippo, licensed across Florida, Alabama, Arizona and 14 other states, added the warning that matters most for anyone tempted to just let a bill lapse: “It’s important not to stop paying premiums, because that can lead to losing coverage and penalties later.”
The programs exist because Medicare’s baseline costs were never designed to be affordable for everyone at every income level. The agents who spend their days walking beneficiaries through applications make the same point in slightly different words each time. The money is there, the eligibility bar is often lower than people assume, and the biggest reason someone misses out usually isn’t the paperwork. It’s never finding out the paperwork existed.
