Under the Extra Help program, the federal government subsidizes premiums, deductibles and cost sharing for Part D prescription drug benefits. The assistance varies according to income level — up to $20,385 for individuals and $27,465 for couples this year. The asset limit is $14,010 for individuals and $27,950 for couples.

Enrollment levels in the two programs vary significantly among the states, according to a recent study by K.F.F. For example, in 2019, 33 percent of Medicare enrollees in the District of Columbia were enrolled in its Medicare Savings Program, compared with 19 percent of beneficiaries in New York State, 22 percent in California, and 23 percent in Mississippi. In North Dakota, just 7 percent were enrolled.

Paradoxically, the programs are most needed — and most used — in both the highest- and lowest-income states in the country, says Jan Mutchler, a professor of gerontology at the University of Massachusetts Boston. “One group of people who have trouble meeting their health care expenses live along the coasts, where many people actually do have money for retirement but the costs are very high,” she said. “The other group lives in places where incomes are very low.”

But the need for help exists everywhere. In 2020, 45 percent of men and 54 percent of women living alone lacked the resources to pay for their basic living needs, according to the university’s Elder Index, which measures the typical cost of living for older people for every county in the United States. For couples, who usually benefit from two Social Security checks and are more likely to have other income, the comparable figure was 24 percent.

K.F.F.’s research shows that the programs disproportionately serve beneficiaries in communities of color, those under 65 with disabilities and women, who tend to have lower incomes and levels of savings.

In California, the high cost of living in many parts of the state creates a need for assistance with Medicare costs, even for retirees with higher incomes, said Christina Dimas-Kahn, who leads the board of California Health Advocates, a Medicare advocacy and education nonprofit organization that supports the state’s free State Health Insurance Assistance Program. “We have a hidden poor population here — they’re called middle-income seniors, and everyone’s forgotten about them.”

The San Francisco area, where Ms. Dimas-Kahn lives, offers an instructive example. The cost of meeting basic living expenses in San Mateo County this year for a single elder who rents an apartment is $48,936, or $4,087 a month — 64 percent higher than the California average, according to the U.C.L.A. Center for Health Policy Research.

K.F.F. estimates that only 50 percent to 65 percent of the Medicare beneficiaries with incomes low enough to qualify for the Medicare assistance program are enrolled, and 55 percent to 70 percent of those eligible for Extra Help are signed up.

This content was originally published here.