Alabama Medicare Savings Programs 2026: QMB, SLMB & QI

Alabama's Medicare Savings Programs pay the Medicare Part B premium, and for the lowest-income tier the Part A and Part B deductibles, coinsurance and copays, for beneficiaries with limited income. Alabama is one of the states that apply no asset test to these programs, so only your monthly income decides whether you qualify.

What Are Medicare Savings Programs?

Medicare Savings Programs are Medicaid-administered benefits that pay some or all of a low-income Medicare beneficiary's Medicare premiums and cost-sharing. QMB, SLMB, and QI are defined by federal income tiers tied to the Federal Poverty Level, which is why the 2026 federal income limits are the same in every state except Alaska and Hawaii.1

In Alabama, all three programs are administered by the Alabama Medicaid Agency, which calls them the Medicare Buy-In. The Agency sets policy and processes eligibility.

One feature makes Alabama's version more generous than the federal standard: Alabama applies no resource or asset test to these programs, so only income counts. The income limits themselves are the standard federal tiers, and like every state's they are set using the Supplemental Security Income (SSI)-related methodology, which applies a $20 general income disregard to your unearned income (such as Social Security) before comparing it to the limit. The income figures below already reflect that $20 disregard.1

QMB: Qualified Medicare Beneficiary

QMB is the most comprehensive tier. It covers:

• The Medicare Part A premium, for anyone who does not have premium-free Part A (most beneficiaries do, after 40 or more quarters of work)
• The Medicare Part B premium, which is $202.90 per month in 2026
• The Part A inpatient hospital deductible, which is $1,736 per benefit period in 2026
• The Part B annual deductible, which is $283 in 2026
• Part A and Part B coinsurance and copays on Medicare-covered items and services2

2026 Alabama QMB income limits: at or below $1,350/month for a single person, or at or below $1,824/month for a couple. These figures reflect 100% of the Federal Poverty Level with the $20 general income disregard applied. Alabama applies no resource limit.1

For a single Alabama senior on Social Security, QMB wipes out the Part B premium ($202.90 a month; 12 × $202.90 = $2,434.80 over a full year), the $283 Part B deductible, and the $1,736 Part A hospital deductible, plus the Part A and Part B copays and coinsurance on Medicare-covered services.2 Every QMB enrollee is also automatically deemed eligible for full Part D Extra Help.

SLMB: Specified Low-Income Medicare Beneficiary

SLMB covers one benefit: the Medicare Part B premium. At the 2026 standard rate of $202.90 a month, that works out to 12 × $202.90 = $2,434.80 over a full year.2

2026 Alabama SLMB income limits: more than the QMB limit and up to $1,616/month for a single person, or up to $2,184/month for a couple. Alabama applies no resource limit.1

SLMB does not cover deductibles or copays. But for a beneficiary with relatively few medical claims, eliminating the Part B premium is the dominant cost saving. SLMB enrollment also triggers automatic Part D Extra Help, which caps covered drug copays at no more than $5.10 for generics and $12.65 for brand-name drugs in 2026.3

QI: Qualifying Individual

QI pays the Part B premium only, the same as SLMB, but applies at a higher income band: more than the SLMB limit and up to $1,816/month for a single person, or up to $2,455/month for a couple (2026 figures with the $20 disregard applied). Alabama applies no resource limit.1

Three structural differences set QI apart from QMB and SLMB:

1. First-come, first-served. QI is paid out of a capped annual federal allocation to each state and granted first-come, first-served, with preference for people who received QI help in the last month of the previous year. Qualifying on income does not guarantee a slot.1
2. You must reapply every year. QI has to be reapplied for annually; being selected one year does not entitle you to help the next. Miss the reapplication and the Part B premium payment stops.1
3. Mutually exclusive with other Medicaid eligibility. The statute defines the QI group as people who are "not otherwise eligible for medical assistance under the State plan," so the bar is broader than full Medicaid alone: qualifying for any other Medicaid eligibility group rules out QI. Someone who qualifies for both a Medicare Savings Program and full Medicaid is a QMB Plus or an SLMB Plus, never a QI.4

Like SLMB, QI enrollment triggers automatic Part D Extra Help.

The QMB Billing Prohibition

Federal law (Social Security Act § 1902(n)(3)(B), 42 U.S.C. § 1396a(n)(3)(B)) prohibits all Medicare providers and suppliers, including pharmacies, from billing a QMB enrollee for Medicare Part A or Part B cost-sharing: deductibles, coinsurance, and copayments on Medicare-covered items and services.5 CMS states that QMB enrollees "have no legal obligation to pay Part A or Part B deductibles, coinsurance, or copayments for any Medicare-covered items and services."6 The protection reaches both Original Medicare and Medicare Advantage providers, and it holds even when Alabama Medicaid pays nothing toward that cost-sharing.6,5

If you are a QMB enrollee and receive a bill for a Part A or Part B deductible, coinsurance, or copay from a Medicare provider, do not pay it. The provider cannot legally collect it. Instead:

• Tell the provider you are enrolled in QMB and cite the federal prohibition.
• Show the provider both your Medicare card and your Medicaid card (or QMB Program card), or a Medicare Summary Notice that says you're in the QMB Program and shouldn't be billed.5
• If the billing continues, call 1-800-MEDICARE (1-800-633-4227), the official CMS beneficiary line. Medicare will confirm your QMB status and can ask the provider to stop billing you and to refund any payments you've already made.7,5
• If you've already paid a bill for Medicare-covered services, you have the right to a refund.5
• Contact Alabama SHIP (the State Health Insurance Assistance Program) for free help disputing the bill.8

Part D Extra Help / Low-Income Subsidy

Every QMB, SLMB, and QI enrollee in Alabama is automatically deemed eligible for full Part D Extra Help (the Low-Income Subsidy). No separate application is required.1

Under the 2026 Part D benefit rules, full Extra Help caps your out-of-pocket cost at $5.10 per generic prescription and $12.65 per brand-name drug, and once your out-of-pocket drug spending reaches $2,100 for the year, you pay $0 for covered drugs the rest of the year.3

Because the deeming is automatic, the Centers for Medicare & Medicaid Services (CMS) notifies you that you do not need to apply for Extra Help yourself. Extra Help covers your Part D premium only up to your region's benchmark amount, so if you pick a more expensive drug plan you pay the difference.3

Alabama Medicare Savings Programs: 2026 Income Limits at a Glance

Every row of the table below carries automatic Part D Extra Help alongside the premium help, because federal rules deem QMB, SLMB, and QI full-subsidy eligible.1

These income limits reflect 100% of the Federal Poverty Level for QMB, 100 to 120% for SLMB, and 120 to 135% for QI, each with the $20 general income disregard applied. Alabama does not apply a resource limit to any of the three.1 For a married applicant, the couple column applies when both spouses are on Medicare. If only one spouse has Medicare, the applying spouse's own income must stay within the single limit, and the two incomes combined within the couple limit.1 They are also not a self-screening cutoff: SSA instructs staff to encourage people to apply even when income appears somewhat higher than the state limits, so an Alabamian a little over these amounts should apply and let the agency decide.1

Alabama Does Not Count Your Assets

The federal Medicare Savings Program resource standard for 2026 is $9,950 for an individual and $14,910 for a couple. Alabama does not apply it. The Alabama Medicaid Agency states plainly that the resource limits do not apply to its Medicare-related programs, so your bank accounts, savings, a paid-off home, and a vehicle do not count against you.1

That matters because many Alabama seniors rule themselves out of these programs on the assumption that a house or a modest nest egg disqualifies them. In Alabama, it does not. Only your monthly income is measured, and only after the general income disregard is applied.

How the Income Disregards Work

The most common reason eligible Alabama seniors skip these programs: they look at their gross income, see a figure above the threshold, and stop. The SSI-related methodology counts income differently.

The $20 general income disregard excludes $20 a month from unearned income (Social Security, pensions, VA compensation) before your income is compared to the limit.1 This is already built into the published limits above.

If you or your spouse still work, a second disregard cuts your countable income further. Medicare Savings Program eligibility is measured with the SSI counting rules, which the federal QMB definition at Section 1905(p)(1) of the Social Security Act incorporates by reference. Under those rules, SSI does not count the first $65 of earned income in a month, and it does not count one-half of the remaining earned income in the month. Wages are therefore always counted at less than half their gross amount.9 Federal law also lets a state disregard additional amounts or types of income, which effectively raises its limits above the federal ones, so the Alabama Medicaid Agency's own rules are the final word on what counts.1

Run the actual disregard math, or ask a counselor to run it, before concluding you do not qualify.

Where to Get Help in Alabama

How to Apply for Alabama Medicare Savings Programs

Determination Timeline and Effective Dates

Medicare Savings Program applications are not disability determinations, so 42 CFR § 435.912(c)(3) gives the Alabama Medicaid Agency a ceiling of 45 days from the application date to notify you of its decision. That is an outer limit on the agency, not a promise of a decision on day 45, and the rule allows longer in unusual circumstances, such as when the applicant delays taking a required step.11

• QMB: under Social Security Act § 1902(e)(8), a QMB determination applies to services furnished after the end of the month in which it is made, so QMB coverage runs forward from the month after Alabama approves the application. Apply as early as possible.
• SLMB and QI: that QMB rule names only QMB. How far back SLMB or QI coverage can start is a question for the Alabama Medicaid Agency, so ask when you apply.12

Learn More

Find personalized help applying for Alabama Medicare Savings Programs at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.