DC Medicare Savings Programs 2026: QMB Income Limits

DC Medicare Savings Programs rank among the country's most generous: the Qualified Medicare Beneficiary (QMB) income limit reaches 300% of poverty, $4,010 a month for one person in 2026. The District runs a single QMB tier that pays Medicare Part A and Part B premiums plus Medicare deductibles and coinsurance for lower-income District residents.1

In This Guide

• What Medicare Savings Programs Are
• Why DC Runs a Single QMB Tier
• Who Qualifies for DC Medicare Savings Programs
• What QMB Covers
• The QMB Balance-Billing Protection
• Automatic Part D Extra Help
• DC Medicare Savings Programs Income Limits at a Glance
• How to Apply for DC Medicare Savings Programs
• Frequently Asked Questions
• Learn More

What Medicare Savings Programs Are

Medicare Savings Programs are Medicaid-administered benefits that pay some or all of a low-income Medicare beneficiary's premiums and cost-sharing. Nationally there are four, each defined by income relative to the Federal Poverty Level (FPL).2

Under the federal standard, QMB is the narrowest of the income tiers. It reaches only to 100% FPL, about $1,350 a month for an individual and $1,824 for a couple in 2026, with SLMB and QI sitting just above it up to 135% FPL.2 The District departs sharply from that template, which is why its program works differently from most states'.

Why DC Runs a Single QMB Tier

The District of Columbia does not layer QMB, SLMB, and QI as three separate income bands. It runs one Medicare Savings Program, QMB, and sets its income ceiling at 300% FPL.1 That ceiling sits far above the federal SLMB and QI thresholds, which top out around 135% FPL.2

The practical effect is that DC's single QMB program absorbs the population other states route into SLMB or QI. A District resident whose income would place them in the SLMB or QI range elsewhere instead qualifies for full QMB in DC, which pays more, the premiums plus deductibles and coinsurance rather than the Part B premium alone.1 DHCF does not publish separate DC income limits for SLMB or QI; its published Medicare Savings Program eligibility is stated as the single QMB standard at 300% FPL.1

Who Qualifies for DC Medicare Savings Programs

To qualify for QMB in the District in 2026, you must be entitled to Medicare Part A or Part B (or both), be a District resident, be a U.S. citizen or have eligible immigration status, and have monthly income at or below the QMB limit, which for 2026 is $4,010 a month for one person and $5,430 for a couple (already including the standard $20 income disregard).1 The at-a-glance table below breaks the limits down by household size.

Income is the financial test DHCF names in its published QMB eligibility criteria; the District's criteria list income at or below 300% FPL rather than a resource or asset limit.1 That contrasts with the federal MSP framework, which applies a resource test of $9,950 for one person and $14,910 for a couple in 2026.2 For the District's broader Medicaid financial rules, see DC Medicaid eligibility and income limits.

What QMB Covers

QMB is secondary insurance that picks up what Medicare leaves for the beneficiary to pay. For a District QMB enrollee, DC Medicaid pays:1

• The Medicare Part A premium (most beneficiaries already have premium-free Part A after 40 work quarters)1
• The Medicare Part B premium, which is $202.90 a month at the standard rate in 20263
• Medicare deductibles on covered services, including the $1,736 Part A inpatient hospital deductible and the $283 Part B annual deductible in 20263
• Medicare coinsurance, including the 20% Part B coinsurance on most outpatient services3

Put together, QMB removes the single largest fixed cost most beneficiaries face, the Part B premium of $202.90 a month, and eliminates the deductibles and coinsurance that would otherwise apply on every Medicare-covered service.3

The QMB Balance-Billing Protection

Federal law bars Medicare providers from billing a QMB enrollee for Part A and Part B deductibles, coinsurance, or copayments, under any circumstances.2 The prohibition holds whether or not the provider participates with DC Medicaid.

If you are a QMB enrollee and a provider bills you for cost-sharing on a Medicare-covered service, do not pay it. Instead:

• Tell the provider you are a QMB enrollee and that federal law prohibits the charge.
• Show your DC Medicaid eligibility notice or your Medicare card with the QMB indicator.
• Call 1-800-MEDICARE to report improper billing.

Automatic Part D Extra Help

Enrolling in QMB in the District automatically qualifies you for the Part D Extra Help benefit, also called the Low-Income Subsidy.1 No separate application is required, because MSP enrollment deems you eligible for the full subsidy.2

Under the 2026 Part D benefit, full Extra Help eliminates the annual Part D deductible and caps prescription copays:4,5

• In 2026, full Part D Extra Help caps generic-drug copays at no more than $5.10 per prescription5
• In 2026, full Part D Extra Help caps brand-name covered-drug copays at no more than $12.65 per prescription5
• Under 2026 full Extra Help, drug copays drop to $0 once your out-of-pocket costs reach the $2,100 catastrophic threshold for the year5

DC Medicare Savings Programs Income Limits at a Glance

The figures above are the District's published 2026 QMB limits and already include the $20 monthly income disregard; they update each year with the Federal Poverty Level.1 Confirm the current figures with DC Medicaid before you rely on them.

How to Apply for DC Medicare Savings Programs

DC Medicaid is administered by DHCF, and the District's Department of Human Services Economic Security Administration (ESA) runs the phone and in-person application channels. The District does not require an in-person interview for Medicaid.6 You can apply through any of these channels:

• Online at districtdirect.dc.gov, where you can submit applications, renewals, changes, and verifications.6
• By phone through the ESA Public Benefits Call Center at (202) 727-5355.6
• By mail to the Department of Human Services, Economic Security Administration, Case Record Management Unit, P.O. Box 91560, Washington, DC 20090.6
• In person at any ESA Service Center.6

Documents to Gather Before You Apply

• Your Medicare card (showing your Medicare Beneficiary Identifier)
• Social Security card or proof of your Social Security number
• Your most recent Social Security benefit award or cost-of-living-adjustment letter
• Proof of any other monthly income, such as a pension or annuity statement
• Proof of District residency, such as a utility bill, lease, or mortgage statement

Learn More

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.