Medicare Savings Programs: Income Limits, QMB, SLMB and How to Apply

What Are Medicare Savings Programs?

Medicare Savings Programs (MSPs) are Medicaid-administered programs that help people with limited income pay their Medicare costs. There are four separate programs, each with different eligibility limits and different benefits. Together they help millions of beneficiaries avoid having to choose between medicine, food, and rent.

Enrollment in QMB, SLMB, or QI does not just help with Medicare premiums. It also automatically qualifies you for the Part D Extra Help (Low-Income Subsidy) program, which slashes prescription drug costs.

The four programs are:

• QMB (Qualified Medicare Beneficiary), the most generous
• SLMB (Specified Low-Income Medicare Beneficiary)
• QI (Qualifying Individual)
• QDWI (Qualified Disabled and Working Individual)

Each is run by your state Medicaid agency using federal minimum standards. Some states are more generous than the federal baseline, so it is always worth applying even if you think you might be over the limit.

2026 Income and Asset Limits for Each Program

The 2026 monthly income limits below already include the standard $20 general income disregard used in MSP calculations. Alaska and Hawaii have higher limits.

In Alaska the QMB income limit rises to $1,683 single and $2,275 married, and in Hawaii it is $1,550 single and $2,095 married. SLMB, QI, and QDWI limits are similarly higher in those two states.

What Each Program Pays For

The four programs cover very different things. QMB is by far the most comprehensive.

QMB: The full package

QMB pays your Medicare Part A premium if you don't have premium-free Part A, plus the Part B premium ($202.90/month in 2026), all Part A and Part B deductibles, and all Part A and Part B coinsurance and copayments. That includes the $1,736 Part A hospital deductible per benefit period, the $283 Part B deductible, the 20% Part B coinsurance, hospital coinsurance of $434 per day (days 61-90), and skilled nursing facility coinsurance of $217 per day (days 21-100).

Just as important, federal law prohibits Medicare providers from billing QMB enrollees for Medicare deductibles, coinsurance, or copayments for covered Part A and B services. That protection applies whether or not the provider accepts Medicaid.

SLMB and QI: Part B premium only

SLMB and QI both pay just the Part B premium of $202.90 per month, saving roughly $2,435 per year. They do not cover deductibles or coinsurance. QI is only available for people who do not otherwise qualify for Medicaid.

QDWI: Part A premium only

QDWI is a niche program for people under 65 with disabilities who returned to work and lost their premium-free Part A. It pays the Part A premium (up to $565/month in 2026) but nothing else.

How QMB Can Replace the Need for Medigap

The whole point of a Medigap policy is to cover the deductibles, coinsurance, and copays that Original Medicare leaves behind. QMB does exactly the same thing at no cost to you.

People with QMB are excused by law from paying Medicare cost-sharing, providers are prohibited from charging them, and all cost-sharing related to Parts A and B is excused. The state is responsible for these payments.

If you qualify for QMB, buying a Medigap plan on top of it would be paying for something the state is already covering. That said, if your income might push you above the QMB threshold soon (a common situation with cost-of-living Social Security raises), it is worth reading about Medicare Supplement costs so you understand what you might need if you lose eligibility.

For SLMB and QI enrollees, Medigap may still make sense because those programs don't cover deductibles or coinsurance. Compare a Medigap plan chart to see what a Plan G or Plan N would add on top of your MSP, and review the gaps a Medigap plan fills that an SLMB or QI benefit does not.

Interaction With Extra Help for Part D

MSPs and Extra Help (also called the Low-Income Subsidy, or LIS) are separate programs, but they are tightly linked.

You'll get Extra Help automatically if you have full-benefit Medicaid, help from your state paying your Part B premiums through a Medicare Savings Program, or Supplemental Security Income (SSI) payments from Social Security.

In 2026, under Extra Help your Part D plan premium is $0, plan deductible is $0, and you pay up to $5.10 for each generic drug and $12.65 for each brand-name drug. Once your total drug costs reach $2,100, you pay $0 for each covered drug. If you also get full Medicaid coverage and are in QMB, you'll pay no more than $4.90 for each covered drug.

If you already have a standalone Part D plan, understanding how Medigap and Part D work together can help you decide whether to keep your current plan or switch to a benchmark plan that Extra Help fully covers.

MSP vs. Full Medicaid: The Key Difference

An MSP is not the same as full Medicaid. This confusion trips up a lot of families.

If you are fully dual-eligible, you qualify for both Medicare and the full range of Medicaid benefits in your state. This means comprehensive coverage with little or no out-of-pocket costs, including services Medicare does not cover such as long-term care, dental, vision, and transportation.

Many people qualify for both. In fact, about three-quarters of the roughly 12.5 million dually eligible beneficiaries in the U.S. receive full Medicaid benefits in addition to an MSP. Learn more about how Original Medicare works by reviewing Part A and Part B coverage so you understand exactly what an MSP is filling in.

How to Apply Through Your State Medicaid Agency

MSPs are administered by the state, so the exact form and mailing address vary. But the basic steps are the same everywhere.

Step 1: Contact your state Medicaid agency

You can apply through your state Medicaid office (sometimes called the Department of Social Services, Human Services, or Health and Human Services). Your local State Health Insurance Assistance Program (SHIP) can also help you fill out the application at no cost.

Step 2: Choose how to apply

Most states allow all of these:

• Online through the state benefits portal
• By mail using a paper MSP/Medicaid application
• By phone with an eligibility worker
• By fax
• In person at a county social services office

Step 3: Gather your documents

You will typically need:

• Your Medicare card (front and back)
• Proof of income: Social Security award letter, pay stubs, pension statements
• Proof of assets: bank statements, life insurance policies with cash value, retirement account statements
• Proof of residence: lease, utility bill, or state ID
• Photo ID and, for non-citizens, proof of eligible immigration status

Step 4: Wait for a decision

Your Medicaid agency reviews your application and checks your income and assets against your state's MSP limits. You should get a response about your eligibility within 45 days. If you do not, follow up in writing.

States With Expanded MSP Eligibility

Several states have moved beyond the federal minimum standards, either by raising income limits, dropping the asset test, or both. Connecticut, Maine, Massachusetts, and New York have chosen to remove the MSP asset test and/or increase MSP income limits.

For example, in New York the 2026 QMB monthly income limit is roughly $1,856 single and $2,509 married (138% of FPL), well above the federal $1,350/$1,824. If you live in one of these states or in a state with community-rated Medigap pricing, it's worth checking both your MSP eligibility and how Medigap plans work by state before deciding on your coverage strategy. Beneficiaries under 65 due to disability should also review Medigap options by state for under-65 enrollees, since MSP eligibility often intersects with these state rules.

Common Myths About Asset Limits

Myth 1: My house counts as an asset. The home you live in is not counted as an asset for MSP purposes, no matter how much it is worth.

Myth 2: I can't own a car. One vehicle used for primary transportation is exempt.

Myth 3: My retirement account disqualifies me. Rules vary by state, but many states exclude retirement accounts that are in payout status, and some don't count them at all.

Myth 4: My burial fund counts. A modest burial fund and burial plot are usually excluded.

Myth 5: If I'm even a dollar over, I'm out of luck. Some states have no asset test. Others have "spend-down" rules that let you qualify by paying certain medical expenses.

Frequently Asked Questions

Can I have a Medigap plan and QMB at the same time?

Technically yes, but it is almost always a waste of money. QMB covers all Medicare cost-sharing that Medigap is designed to cover, so paying a Medigap premium on top of QMB duplicates coverage. Most experts recommend dropping the Medigap policy once QMB is approved, though you may want to briefly keep it until you receive written QMB confirmation.

What if I lose my QMB eligibility because my income goes up?

If your income rises above the QMB limit, the state will notify you. You may drop down to SLMB or QI, which still pay your Part B premium. If you lose all MSP eligibility, you have a guaranteed-issue right to buy certain Medigap plans within 63 days. Learn more about the Medigap Open Enrollment Period and related guaranteed-issue situations.

Does QMB cover Medicare Advantage cost-sharing?

Yes. The QMB balance-billing protection applies whether you are in Original Medicare or a Medicare Advantage plan. Your MA plan providers cannot bill you for copays, coinsurance, or deductibles for Medicare-covered services if you are enrolled in QMB. If you're weighing your options, our Medigap vs. Medicare Advantage guide walks through the trade-offs.

Will applying for an MSP affect my Social Security benefits?

No. MSP eligibility is a separate determination from Social Security retirement or disability benefits. Applying does not reduce, delay, or otherwise impact your Social Security check. In fact, if you already receive SSI, you are usually auto-enrolled in an MSP.

How often do I have to re-apply?

Most states require an annual redetermination, though some do it every six months or every two years. You will get a renewal notice by mail. Report income changes promptly to avoid an overpayment that you would have to pay back later.