Extra Help vs QMB: Side-by-Side Comparison
| Feature | Extra Help (LIS) | QMB |
|---|---|---|
| What it covers | Medicare Part D (prescription drugs) | Medicare Part A & B premiums, deductibles, copays |
| Income limit (single) | ~$2,025/mo (150% FPL) | $1,350/mo (100% FPL) |
| Asset limit (single) | ~$17,220 (2026) | $9,660 (many states higher) |
| Administered by | Social Security Administration (SSA) | State Medicaid agency |
| How to apply | Online at SSA.gov or call 1-800-772-1213 | Through your state Medicaid agency |
| Auto-enrollment | Auto-enrolled if on Medicaid, QMB, SLMB, or QI | Must apply separately through state |
| Part D copays | $5.10 generic / $12.65 brand (2026) | Does not cover Part D |
| Part B premium | Does not cover Part B premium | Covered under QMB (and SLMB/QI) |
| Can you have both? | Yes — you can and should have both if you qualify | |
Can I Have Both Extra Help and QMB?
Yes — and if you qualify for both, you should apply for both. They cover completely different costs:
- QMB pays your Part B premium ($185.00/month) and all Medicare cost-sharing
- Extra Help pays your Part D drug plan premium and reduces drug copays to $5.10 for generics and $12.65 for brand-name drugs
- Together, they can save you thousands of dollars per year
QMB enrollment automatically qualifies you for Extra Help. If you are enrolled in QMB, SLMB, or QI, you are automatically enrolled in Extra Help — you do not need to apply separately. However, if your income is between 100–150% FPL, you may qualify for Extra Help but not QMB — in that case, apply for Extra Help through Social Security separately.
Which Program Should I Apply For?
Income below $1,350/mo (single)
Apply for QMB through your state Medicaid agency. QMB enrollment will automatically qualify you for Extra Help too.
Income $1,351–$2,025/mo (single)
You may not qualify for QMB but can apply for Extra Help through SSA.gov. Also check SLMB and QI eligibility for Part B premium help.
On Medicaid
If you have full Medicaid coverage, you are automatically enrolled in Extra Help. Check with your state about QMB enrollment for additional cost savings.