Medicare Savings Programs in 2026: QMB, SLMB, QI, and QDWI Eligibility, Benefits, and How to Apply

*9 min read · Last updated June 02, 2026*

In this article

– What the four Medicare Savings Programs actually are – Who qualifies: 2026 income and asset limits by tier – What each program pays – How to apply through your state Medicaid office – Common reasons applications get denied – FAQ

A 68-year-old widow in Phoenix pays $185 per month for her Medicare Part B premium and $1,676 every time she is hospitalized for her Part A deductible. She may qualify for a program that eliminates both charges entirely. Most QMB enrollees find out about the program from a social worker, not from Medicare.gov.

What the four Medicare Savings Programs actually are

Medicare Savings Programs (MSPs) are state-administered programs funded jointly by federal and state governments. They pay some or all of Medicare’s out-of-pocket costs for beneficiaries whose income falls below certain thresholds. There are four programs, each covering a different set of costs.

QMB (Qualified Medicare Beneficiary): The most comprehensive tier. QMB pays your Medicare Part A premium (if you owe one), your Part B premium, your Part A and Part B deductibles, and your Part A and Part B coinsurance and copayments. In plain terms: if a doctor or hospital accepts Medicare, QMB means your share of the bill is zero. QMB beneficiaries are also protected from balance billing by any provider who accepts Medicare.

SLMB (Specified Low-Income Medicare Beneficiary): Covers your Part B premium only. SLMB does not cover deductibles, coinsurance, or copayments. The Part B premium in 2026 is $185/month for most beneficiaries — so SLMB still represents $2,220 in annual savings, money that stays in your pocket instead of going to Medicare.

QI (Qualifying Individual): Also covers your Part B premium only, at the same $185/month rate. QI operates under a federal funding cap, and states process applications first-come-first-served. Most states exhaust their QI allocation before the end of the year. Applications reset each January and do not carry over. If you qualify for QI, apply in January — do not wait.

QDWI (Qualified Disabled and Working Individuals): Pays the Part A premium for working people with disabilities who lost premium-free Medicare after returning to work. The Part A premium can run up to $518/month — that is over $6,000 a year that QDWI eliminates for eligible individuals. Income limits are higher than the other three programs. Relatively few beneficiaries use QDWI, but it is the only program that covers Part A premium costs for working disabled individuals.

All four programs are administered through your state Medicaid office. You apply there, not through Medicare.gov or the Social Security Administration.

Who qualifies: 2026 income and asset limits by tier

Eligibility is based on your monthly income and your countable assets. Federal rules set a floor, but states can and do raise these limits.

2026 federal income limits (monthly):

These thresholds correspond to approximately 100% FPL (QMB), 120% FPL (SLMB), 135% FPL (QI), and 200% FPL (QDWI). FPL stands for Federal Poverty Level — the government’s annual income benchmark used to determine eligibility for dozens of assistance programs. For 2026, the federal poverty level is $15,960 for an individual and $21,450 for a couple — meaning the QMB limit of $1,275/month is roughly what someone receives on an average Social Security retirement benefit.

What counts as income: Social Security benefits, pension payments, wages, interest income, and rental income all count. Certain income is excluded: the first $20 of most income per month, the first $65 of earned income plus half of earnings above that, food assistance, and irregular or infrequent income under $30 per quarter.

Here is why the $20 exclusion matters. If your gross Social Security is $1,290/month and you count the full amount, you appear to be above QMB’s $1,275 limit. Subtract the $20 exclusion and your countable income is $1,270 — which qualifies. Do not count your gross income and assume you are out. Always apply the exclusions first.

Asset limits (federal, 2026):

Countable assets include checking accounts, savings accounts, CDs, stocks, bonds, and cash value of life insurance above $1,500. Excluded assets include your primary home (regardless of value), one vehicle, household goods and personal effects, burial funds up to $1,500, and most retirement accounts in certain states.

The 12 states with better limits: California, New York, Oregon, Washington, Arizona, Massachusetts, Connecticut, New Jersey, New Hampshire, Minnesota, Illinois, and Vermont have eliminated the asset test entirely for QMB, SLMB, or QI — or have set significantly higher asset or income thresholds than federal minimums. If you live in one of these states and assumed you would not qualify due to assets, call your state Medicaid office before concluding you are ineligible. Assuming the federal limit applies when your state has removed it entirely is one of the most common reasons people walk away from a benefit they actually have coming.

What each program pays

QMB covers: – Part A premium: $0 if you have 40 work quarters (most people). $285/month if 30-39 quarters. $518/month if fewer than 30 quarters. QMB eliminates this entirely. – Part B premium: $185/month standard rate in 2026. – Part A deductible: $1,676 per benefit period in 2026. – Part B deductible: $240 annual in 2026. – Part A coinsurance: $419/day for hospital days 61-90. – Part B coinsurance: typically 20% of Medicare-approved amount. – QMB no-balance-billing protection: providers who accept Medicare may not bill QMB beneficiaries for any cost-sharing. This applies to all Medicare-covered services. If a provider sends you a bill, you do not owe it. Report the violation to 1-800-MEDICARE — the provider faces civil money penalties for improper billing.

SLMB covers: – Part B premium only: $185/month.

QI covers: – Part B premium only: $185/month. Unlike SLMB, QI is a federal block grant with finite annual appropriations. Priority goes to prior-year QI enrollees who reapply first.

QDWI covers: – Part A premium for qualified working disabled individuals: up to $518/month.

How to apply through your state Medicaid office

Step 1: Confirm you are enrolled in Medicare. You must have Medicare Part A and Part B to be eligible for any MSP except QDWI.

Step 2: Gather your documents. Standard documents required at every state Medicaid office: – Proof of Medicare (Medicare card or My Medicare letter) – Proof of identity (driver’s license, state ID, or passport) – Proof of income: last month’s Social Security award letter, pension statements, or employer pay stub – Proof of assets: last 3 months of bank statements for all accounts – Proof of residency (utility bill, lease, or bank statement with your current address)

Step 3: Contact your state Medicaid office. Options vary by state. Most states accept applications by mail, in person, or online. Some process applications through local Area Agencies on Aging. Find your state’s Medicaid office through Medicaid.gov or call 1-800-MEDICARE for a referral.

Step 4: Submit your application. The worker will calculate your countable income and assets using the current month. If you are applying in December, your income snapshot is December, not the full year. Retroactive enrollment is available in most states. QMB, SLMB, and QI can be backdated to the first of the month you applied — meaning benefits start from your application date, not the date you were approved.

Step 5: Wait for determination. Most states process MSP applications within 45 days. If approved, your state Medicaid office notifies your Medicare plan. For QI, approval is subject to available funding.

Common reasons applications get denied

Incorrect income count. This mistake causes people to give up on applying when they actually qualify. If your gross Social Security is $1,290/month, do not count it as $1,290. The standard general income exclusion removes $20 from most income sources before the limit test. Subtract it and your countable income is $1,270 — which falls under QMB’s $1,275 threshold. Always apply the exclusions before concluding you are over-income.

Asset calculation errors. Two versions of this mistake come up constantly. First: listing the full face value of a whole life insurance policy without applying the $1,500 cash-value exclusion. Second: listing an IRA as a countable asset when your state excludes it. State rules on asset exclusions vary significantly. Review your state’s specific asset test rules before assuming you exceed the limit. One phone call to the Medicaid office can tell you what your state excludes.

QI first-come-first-served exhaustion. States run out of QI funding late in the year. If you apply in October and your state has already exhausted its QI allocation, you will be denied — even if you are income-eligible. Apply in January when allocations reset.

Failure to reapply for QI annually. QI approval does not carry forward automatically. Returning enrollees who do not reapply by December 31 lose coverage on January 1. Most states send a renewal notice, but it is your responsibility to return it — not the Medicaid office’s responsibility to chase you.

Application submitted to the wrong agency. Social Security offices can accept MSP applications in some states, but processing happens at the state Medicaid office. If your application sits in the wrong queue, your effective enrollment date gets delayed. Submit directly to your state Medicaid office to avoid the routing problem.

MSP enrollment often combines with other federal cost-reduction programs. If you qualify for QMB, you almost certainly qualify for Extra Help with Part D costs. Review government programs that help with health insurance premiums for related assistance. Beneficiaries who qualify for Medicaid alongside Medicare may also benefit from understanding how Medicaid expansion impacts your coverage options. For primary care access when cost-sharing remains a barrier, free and low-cost health clinics serve Medicare beneficiaries on a sliding-fee basis.

FAQ

Do I qualify for QMB if my income is just over the $1,275/month limit? Possibly, because the $1,275 figure applies to your countable income after deductions, not your gross income. The standard general income exclusion removes $20/month from most income sources before the limit test. Earned income exclusions also apply. If your gross income is $1,300/month and you subtract the $20 exclusion, your countable income is $1,280, still above the QMB limit. At $1,295 gross, countable income becomes $1,275, which meets the threshold exactly. Apply and let the state worker calculate. Do not self-screen out.

Can a provider bill me for services if I have QMB? No. Federal law prohibits any Medicare-enrolled provider from billing QMB beneficiaries for Medicare cost-sharing. If a provider bills you, you do not have to pay. Report the violation to 1-800-MEDICARE. The provider faces civil money penalties for improper billing. Keep a copy of any bill you receive as documentation when you report.

How long does Medicare Savings Program approval take? Most states process MSP applications within 45 days. Some states complete approvals in 2 to 3 weeks when documentation is complete at the time of application. The fastest path is submitting in person at your local Medicaid office with all required documents. This eliminates the back-and-forth from missing paperwork.

What documents do I need to apply? Bring your Medicare card, a current photo ID, your most recent Social Security award letter (or last pay stub if you have earned income), 3 months of bank statements for all accounts, and a document showing your current home address. States may ask for additional documentation depending on your household situation. If you receive a pension, bring the pension statement. If you have a life insurance policy, have the cash surrender value on hand.

Does getting QMB or SLMB affect my Medicare coverage in any other way? No. Your Medicare plan and coverage choices remain unchanged. MSP is a payer on top of Medicare, not a replacement for it. You keep your current Medicare Advantage or Original Medicare plan. The only change is that the state Medicaid program pays the premiums and cost-sharing you would otherwise owe. Extra Help for Part D drug costs automatically accompanies QMB, SLMB, and QI enrollment in most states, lowering or eliminates your drug plan premium and reduces cost-sharing on covered prescriptions.