Medicare Savings Programs Explained: QMB, SLMB, and QI — Who Pays Your Part B Premium

If you have Medicare and a low income, your state may pay some of your Medicare costs for you. Four state plans do this work. They are called Medicare Savings Programs. The best known are QMB, SLMB, and QI. A fourth plan, QDWI, helps some people who work and have a disability. This guide explains what each plan pays, who can get it, and how to apply. Our Paying for Care section holds more guides on ways to lower your health costs.

What these programs are

Medicare Savings Programs are run by each state. They sit inside the state Medicaid office. They do not replace Medicare. They pay some of the costs that Medicare leaves to you.

The main cost they pay is the Part B premium. That premium is $202.90 per month (Ledger A1). If a program pays it for you, that sum stays in your check each month. Over a year, that is real help on a tight budget.

Each program has an income limit and a resource limit. Income is the money you get each month. Resources are things you own that the state counts, like bank accounts and stocks. Your home and your car do not count. The next parts of this guide give the limit for each program.

One more fact helps many readers. If you get into QMB, SLMB, or QI, you also get Extra Help with drug costs. You do not need a second form for that. Our guides on Extra Help live in this same Paying for Care group of pages.

QMB: the widest help

QMB stands for Qualified Medicare Beneficiary. It pays more than the other programs. It pays the Part A premium if you owe one. It pays the Part B premium. It also pays your Medicare deductibles, coinsurance, and copays (Ledger J1).

The QMB income limit is $1,350 per month for one person and $1,824 per month for a couple (Ledger J1). The resource limit is $9,950 for one person and $14,910 for a couple (Ledger J1).

There is one more QMB rule that protects you. Doctors and hospitals that take Medicare cannot bill you for the Medicare deductibles, coinsurance, and copays that QMB covers. If a bill like that shows up, call the office and say you are in QMB. A small Medicaid copay may still apply in some cases.

SLMB: Part B premium only

SLMB stands for Specified Low-Income Medicare Beneficiary. It pays one thing: your Part B premium (Ledger J2). It does not pay deductibles. It does not pay coinsurance or copays.

The SLMB income limit is $1,616 per month for one person and $2,184 per month for a couple (Ledger J2). The resource limit is $9,950 for one person and $14,910 for a couple (Ledger J2).

SLMB fits people whose income is too high for QMB but still low. The premium help alone can free up cash for rent, food, or drugs each month.

QI: premium help with limited funds

QI stands for Qualifying Individual. Like SLMB, it pays the Part B premium only (Ledger J3). It does not pay other Medicare costs.

The QI income limit is $1,816 per month for one person and $2,455 per month for a couple (Ledger J3). The resource limit is $9,950 for one person and $14,910 for a couple (Ledger J3).

QI has one catch the other programs do not. Its funds are limited. States take people in the order they apply, and the money can run out for the year. If you think you fit QI, apply early. Do not wait for a letter or a deadline notice.

QDWI: help for people who work

QDWI stands for Qualified Disabled and Working Individual. It is the one program here built for people who work. It serves people with a disability who lost free Part A when they went back to work. QDWI pays the Part A premium only (Ledger J4).

The QDWI income limit is $5,405 per month for one person and $7,299 per month for a couple (Ledger J4). The resource limit is lower than the other programs: $4,000 for one person and $6,000 for a couple (Ledger J4).

If you work and pay a Part A premium each month, ask your state office about QDWI by name. Many people have never heard of it, and offices may not raise it first.

What counts as income and resources

States count most cash you get each month as income. They count money in checking and savings accounts as resources. They count stocks and bonds too. Retirement accounts can count as well.

Some things do not count as resources:

The limits in this guide are the federal limits most states use. Limits are higher in Alaska and Hawaii. Your state may count things in a slightly different way, so the state office has the last word on your case.

• Your home.
• One car.
• A burial plot.
• Furniture and things you use at home.
• Your own personal items.

Who pays for what

• Medicare pays its share of your covered care under Part A and Part B, as it does for anyone with Medicare.
• Medicaid, through your state, pays your Part B premium if you are in QMB, SLMB, or QI (Ledger J1, J2, J3).
• Medicaid, through your state, also pays your Part A premium, deductibles, coinsurance, and copays if you are in QMB (Ledger J1).
• Medicaid, through your state, pays your Part A premium if you are in QDWI (Ledger J4).
• Private pay is you. You still pay the costs no program covers, like care Medicare does not cover at all.
• Social Security is where the Part B premium comes out of your check now. When a program takes over that premium, your check goes up by that sum.

Sample situation

James is 70 and lives alone. His income is low, but it sits just above the QMB limit. Each month, the Part B premium of $202.90 comes out of his check (Ledger A1), and that loss is hard on his budget. A counselor at his senior center tells him about SLMB. His income is under the SLMB limit of $1,616 per month for one person (Ledger J2). He applies at his state Medicaid office with his bank records and his Medicare card. The state approves him for SLMB. The state now pays his Part B premium, and his check grows by that sum each month. James still pays his own copays when he sees a doctor, since SLMB pays the premium only. He tells his sister to apply too, even though she thinks she earns too much. He has learned that the state, not a guess, makes the call.

How to apply

You apply through your state Medicaid office. You do not apply through Medicare. Most states let you apply by mail, by phone, online, or in person.

Keep copies of what you send. Write down the date you applied and the name of the person who helped you. If QI is your program, that date can matter, since funds go to people in the order they apply.

• Gather your Medicare card, proof of income, and bank records before you start.
• Ask the office to check you for all four programs, not just one.
• Apply even if you think you are over the limit. States decide who gets in. Some states use higher limits than the ones in this guide. Some states have no resource test at all.
• If you are turned down, ask what fact drove the choice. Rules and incomes change, and you can apply again.
• If you need free help, ask for a State Health Insurance Assistance Program counselor. They do not sell anything.

Sources

• https://www.medicare.gov/basics/costs/help/medicare-savings-programs
• https://www.medicare.gov/basics/costs