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 program (also called the Low-Income Subsidy), which slashes prescription drug costs and eliminates the Part D late enrollment penalty.

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. Several states expand eligibility beyond federal minimums in 2026, 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 income 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 for days 61-90 and $868 per day for lifetime reserve days, and skilled nursing facility coinsurance of $217 per day (days 21-100). You can review these amounts in more detail alongside the gaps a Medigap plan fills.

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 Part A and Part B is covered. 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 in 2026 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.

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 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 (on a benchmark plan), your 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 for the rest of the year. If you also have full Medicaid coverage and are in QMB with income at or below 100% of FPL, you'll pay just $1.60 for generics and $4.90 for brand-name drugs. If you are institutionalized or receive home and community-based services, all covered drugs are $0.

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. Learn more about how Medicare and Medicaid work together if you think you might qualify for both.

Many people qualify for both. About three-quarters of the roughly 12 million dually eligible beneficiaries in the U.S. receive full Medicaid benefits in addition to an MSP.

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.

Important context: CMS finalized a 2023 rule that would have streamlined MSP enrollment (including auto-enrollment from LIS data and self-attestation of resources) with most provisions originally scheduled to take effect April 1, 2026. However, Section 71101 of the July 4, 2025 enacted budget law imposes a moratorium on implementation, administration, or enforcement of the specified MSP rule provisions until after September 30, 2034. The rule itself remains on the books, but its major streamlining requirements cannot be enforced against states before October 1, 2034 unless Congress changes course. One provision that took effect before the moratorium remains in force: starting October 1, 2024, states are required to auto-enroll certain SSI recipients into QMB.

In short, most 2026 streamlining that beneficiaries were expecting is now paused, but SSI-based QMB auto-enrollment continues and many states are voluntarily adopting simpler processes.

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 (BenefitsCal in CA, COMPASS in PA, ConneCT in CT, MassHealth online in MA)
• 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: your 2026 Social Security benefit statement (SSA-1099 or January COLA letter), pay stubs, pension statements
• Proof of assets: recent 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.

Thirteen states plus DC have eliminated the MSP asset test entirely, so you qualify on income alone: Alabama, Arizona, Connecticut, Delaware, DC, Louisiana, Maine, Massachusetts, Mississippi, New Mexico, New York, Oregon, Vermont, and Washington.

States that use higher-than-federal income limits include Connecticut, Delaware, DC, Illinois, Indiana, Maine, Massachusetts, Mississippi, New York, and Washington, plus Alaska and Hawaii, which use higher federal figures. Connecticut's QMB income limit runs well above the federal $1,350/$1,824, and DC's is higher still.

California kept its higher income rules but reinstated an asset limit effective January 1, 2026. For MSPs, DHCS says the asset limits are $130,000 for an individual and $65,000 for each additional household member up to 10. DHCS also states that there were no asset/property limits for MSPs from January 1, 2024 through December 31, 2025. Even with that reinstated test, California's asset ceiling is more than 13 times the federal limit. Minnesota has also raised its asset limits above the federal minimums without eliminating them entirely.

If you live in one of these states or in a state with community-rated Medigap pricing, it is 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. Thirteen states plus DC have no asset test at all. 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 of $202.90. 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. If you already receive SSI, you may already be auto-enrolled in QMB under the October 2024 rule that survived the 2025 moratorium on the broader MSP streamlining regulation.

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.