Medicare 2026

Medicare Savings Programs in 2026: What the 2025 Law Paused Until 2034, and What Still Applies

Medicare Savings Programs (MSPs) help people with limited income and resources pay for Medicare. Depending on which program a person qualifies for, the state can pay their Part B premium, their Part A premium, and sometimes their Medicare deductibles, coinsurance and copayments. People apply through their state, and Medicare.gov encourages applying even if you aren't sure you'll qualify, because states can use broader limits than the federal minimums.

A 2025 budget law paused a big chunk of a 2023 federal rule that was meant to make MSP enrollment simpler. Here's what that means for you as you plan for 2026 and 2027.

What a Medicare Savings Program can do

There are four MSPs, and the state decides which one you qualify for based on your income and resources. The Qualified Medicare Beneficiary (QMB) program is the most comprehensive — it can cover Part A and Part B premiums plus deductibles, coinsurance and copayments. For 2026, the federal QMB limits are $1,350 a month in income and $9,950 in resources for an individual. Many states use higher limits, so Medicare.gov's advice is simple: apply anyway. People in the Qualifying Individual (QI) program must reapply each year to keep their benefits.

A separate but related program, Extra Help, lowers Part D drug costs. Federal law treats an Extra Help application as an MSP application too — Social Security sends the information to your state to start the MSP process unless you decline.

The 2023 rule that was supposed to streamline enrollment

In September 2023, CMS finalized a rule called "Streamlining Medicaid; Medicare Savings Program Eligibility Determination and Enrollment." It took effect November 17, 2023, and gave states compliance dates between 2024 and 2026 for different pieces. Among other things, it would have required states to:

• count family size the same way Extra Help does when checking income,
• accept less documentation for things like dividend and interest income, non-liquid resources, burial funds and life insurance, and
• start QMB coverage as early as the month Part A begins for certain people in states that pay Part A premiums through a "group payer" arrangement.

What section 71101 of the 2025 law paused

Section 71101 of Public Law 119-21 bars the Department of Health and Human Services, from July 4, 2025, through September 30, 2034, from implementing, administering or enforcing the rule's changes to five listed federal regulation sections. CMS has described these as the pieces whose compliance dates fell after July 4, 2025. While the pause is in effect, CMS says it will generally return to the regulations that were in place as of November 16, 2023, for those sections.

Practically, that means the simplifications listed above — the family-size alignment, lighter documentation requirements, and earlier QMB start dates in group-payer states — are on hold. States can still choose to go further than federal rules require, but they are no longer required to adopt those specific changes.

What is NOT paused

A few important pieces continue:

• Automatic QMB enrollment for most Medicare-eligible people who receive SSI. This part of the 2023 rule took effect October 1, 2024, and remains in force.
• The federal law that makes an Extra Help application count as an MSP application. Social Security's operations manual says the information used for the Extra Help decision is forwarded to the state to begin the MSP process unless the person opts out.

A companion pause on Medicaid renewals

Section 71102 of the same law also pauses, until September 30, 2034, parts of a 2024 CMS rule on Medicaid applications and renewals. Among the paused pieces: provisions that aligned renewal rules for people whose eligibility is not based on modified adjusted gross income — such as people 65 and older — with the rules for other enrollees, that gave people at least 15 days to respond to a request for information, and that provided a 90-day reconsideration period after a denial for not returning requested information. If your state asks for paperwork, respond quickly and keep copies.

If you have Medicaid or Extra Help, you have more flexibility

Since 2025, people with Medicaid or Extra Help have a monthly Special Enrollment Period to move to Original Medicare with a stand-alone Part D plan, or to switch stand-alone Part D plans. Full-benefit dual-eligible individuals can also join an integrated Dual Eligible Special Needs Plan (D-SNP) in any month. This gives you room to adjust coverage during the year if your needs change.

Looking ahead to 2027

The Part D out-of-pocket cap rises to $2,400 in 2027 (up from $2,100 in 2026). The maximum Part D deductible a plan may charge in 2027 is $700, and the Part D base beneficiary premium — used to calculate the late-enrollment penalty — is $41.33. Actual plan premiums vary.

The Social Security Administration announced a 3.6 percent cost-of-living adjustment for benefits payable beginning January 2027. The 2027 Part B standard premium and deductible, and the 2027 IRMAA income brackets, have not been announced yet; CMS typically releases them in the fall.

Annual Enrollment runs October 15 – December 7, 2026, with changes effective January 1, 2027. When comparing Medicare Advantage against Original Medicare paired with a Medigap policy and a stand-alone Part D plan, weigh the trade-offs — networks, out-of-pocket structures, extra benefits, portability — against your own situation. There is no single right answer.

Where to go next

Apply for an MSP through your state's Medicaid agency, and apply for Extra Help through Social Security. For general Medicare questions, visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048.