Indiana Medicare Savings Programs 2026: QMB, SLMB & QI

Indiana Medicare Savings Programs can eliminate your Medicare Part B premium, cover Medicare deductibles and copays, and automatically qualify you for Part D Extra Help.

What Are Indiana Medicare Savings Programs?

A Medicare Savings Program (MSP) is a Medicaid benefit that pays some or all of a low-income Medicare beneficiary's Medicare premiums and cost-sharing. The Indiana Family and Social Services Administration (FSSA), through its Office of Medicaid Policy and Planning (OMPP), administers all three MSPs statewide. Eligibility determinations are handled by the Division of Family Resources (DFR).

There are three programs, tiered by income. Every Hoosier on Medicare with limited income should know whether they qualify: the dollar value can exceed $4,000 per year in saved premiums, deductibles, and copays.

The MSPs use the SSI-related ABD income methodology, not the MAGI methodology used for ACA coverage. SSI income counting rules apply, including a $20 per month general income disregard that is already built into the published income ceilings below. Indiana updates its Medicaid income standards on March 1 each year, not January 1, so the figures in this guide reflect the March 1, 2026 update.

Qualified Medicare Beneficiary (QMB)

QMB is the most comprehensive Indiana Medicare Savings Program. It pays:

• The Part A premium (if any)
• The 2026 Part B standard premium of $202.90 per month
• The Part A inpatient hospital deductible ($1,736 per benefit period in 2026)
• The Part B annual deductible ($283 in 2026)
• All Medicare Part A and Part B coinsurance and copays

2026 Indiana QMB income limits (with $20 general income disregard):

These reflect 100% of the Federal Poverty Level plus the $20 general income disregard. The Indiana fact file notes an ABD/non-LTSS individual income standard of approximately $1,330/month before the disregard, consistent with the federal 100% FPL figure; the $1,350 ceiling incorporates the $20 SSI disregard that FSSA applies in the QMB calculation.

QMB coverage begins the month after FSSA determines eligibility. There is no retroactive QMB under federal law (42 USC § 1396a(e)(8)). Apply as soon as you think you may qualify.

Specified Low-Income Medicare Beneficiary (SLMB)

SLMB pays the Part B premium only: $202.90 per month in 2026, or $2,434.80 per year.

2026 Indiana SLMB income limits (with $20 general income disregard):

SLMB covers income between 100% and 120% FPL. Up to three months of retroactive coverage is available under 42 CFR § 435.915 if the applicant met all eligibility criteria during those months. File as early as possible to protect the retroactive window.

Qualifying Individual (QI)

QI also pays the Part B premium only, for income between 120% and 135% FPL.

2026 Indiana QI income limits (with $20 general income disregard):

QI is funded through a federal capped allotment at 100% FMAP, allocated first-come, first-served with preference for prior-year enrollees. Indiana has not exhausted its QI allotment in recent years, so income-eligible applicants have generally been approved.

Important: QI is mutually exclusive with full Medicaid by statute (42 USC § 1396u-3(c)(1)). An Indiana PathWays for Aging member or any other full-Medicaid enrollee cannot receive QI. They would instead qualify as QMB-Plus or SLMB-Plus.

QI also allows up to three months of retroactive coverage under 42 CFR § 435.915.

Full Indiana MSP Comparison

Resource limit (all three programs): $9,950 individual / $14,910 couple in 2026. The primary residence of any value, one vehicle, household goods, and burial funds up to $1,500 are excluded from countable resources.

The QMB Billing Prohibition

Federal law (42 USC § 1396a(n)(3)(B)) prohibits any Medicare provider from billing a QMB-enrolled beneficiary for Medicare cost-sharing. This applies to:

• Original Medicare and Medicare Advantage providers
• Providers who do not participate with Indiana Medicaid
• Hospitals, physicians, ambulance services, durable medical equipment suppliers, and skilled nursing facilities

If you are a QMB and receive a bill for a Medicare deductible, coinsurance, or copay, do not pay it. Tell the provider you are a QMB and that federal law prohibits the charge. If the provider refuses to drop the bill, call 1-800-MEDICARE (1-800-633-4227) or contact Indiana's SHIP program, the Indiana State Department of Health's Senior Health Insurance Information Program (SHIP), at 1-800-452-4800.

CMS guidance (MLN Matters Article SE1128) and CMS final rule 81 Fed. Reg. 80170 (Nov. 15, 2016) extended these protections explicitly to Medicare Advantage providers.

Part D Extra Help (Automatic for All MSP Enrollees)

Under the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (42 USC § 1395w-114), every QMB, SLMB, and QI enrollee is automatically deemed eligible for full Part D Low-Income Subsidy. No separate application to the Social Security Administration is required.

In 2026, full Part D Extra Help provides:

Auto-deeming flows from FSSA/OMPP's monthly data file to CMS. If an enrollee is not already in a Part D plan, CMS will auto-assign a benchmark plan. The enrollee can switch to any other Part D plan during open enrollment without losing Extra Help status.

The Income Disregards That Matter

Many Hoosiers look at their gross Social Security benefit, see it is above the QMB limit, and never apply. Two disregards regularly pull people back under the ceiling:

The $20 general income disregard. Under SSI methodology (20 CFR § 416.1124(c)(12)), $20 per month per household is excluded from unearned income before the FPL test. The ceiling figures in the tables above already reflect this $20. It is one disregard per household, not per person.

The $65 + ½ earned-income disregard. Under 20 CFR § 416.1112(c)(4)-(5), the first $65 of earned income is excluded, then half the remaining earned income is excluded. A part-time worker earning $700 per month has countable earned income of ($700 - $65) ÷ 2 = $317.50, not $700.

For applicants with both Social Security and part-time wages, running the actual disregard math rather than the gross amounts often means qualifying where a quick glance at gross income would suggest otherwise.

How to Apply for Indiana Medicare Savings Programs

FSSA handles MSP applications through DFR. The primary channels are:

FSSA Benefits Portal (online): Apply at fssabenefits.in.gov. Indiana's primary online benefits portal accepts MSP applications, document uploads, and status tracking.

DFR phone: Call 1-800-403-0864 to apply by phone or ask questions about the process.

Local DFR office: Walk-in applications are accepted at local DFR county offices. A caseworker will assist with the ABD application.

Social Security Administration: Applying for Part D Extra Help at SSA on Form SSA-1020 automatically generates an MSP application referral to FSSA under 42 USC § 1320b-14. The SSA filing date is protected for retroactive coverage purposes.

Documents to bring:

• Medicare card or Medicare claim number (MBI)
• Social Security card and proof of age
• Proof of Indiana residency (utility bill, lease, or bank statement)
• Most recent SSA award or COLA letter
• Recent bank and investment statements
• Pension or annuity statements

Note on income standard update timing: Indiana updates ABD/MSP income standards on March 1, not January 1. The figures in this guide reflect the March 1, 2026 update. If you applied between January 1 and February 28, 2026, slightly different figures applied.

Processing timeline: Non-disability ABD applications carry a 45-day clock under 42 CFR § 435.912(c)(3). FSSA must send a written decision explaining the determination and the right to appeal.

Indiana SHIP: The Indiana SHIP program (through the Indiana State Department of Health) offers free, unbiased counseling on MSPs and other Medicare questions. Call 1-800-452-4800.

Worked Example: Single Hoosier Applying for SLMB

The figures below are hypothetical and shown only to illustrate how the income calculation works. They are not a real case and not a prediction of your own result.

A retired Hoosier, age 71, living in Hamilton County, receives $1,480 per month in Social Security and a small pension of $100 per month. His savings total $6,800. He owns his home and one car.

Income test:

• Gross unearned income: $1,480 + $100 = $1,580
• Less $20 general income disregard: $1,560 countable
• 2026 QMB individual limit: $1,350 -- above QMB.
• 2026 SLMB individual limit: $1,616 -- below SLMB.
• Result: qualifies for SLMB.

Resource test:

• Savings: $6,800 (counted)
• Home and vehicle: excluded
• Total counted resources: $6,800
• 2026 resource limit: $9,950
• Result: below the limit.

Outcome: SLMB pays his $202.90 Part B premium each month, $2,434.80 per year. He is auto-deemed for full Part D Extra Help. He can apply for up to three months of retroactive SLMB coverage if he was eligible in the prior months.

Learn More

• Indiana Medicaid Eligibility and Income Limits
• How to Apply for Indiana Medicaid
• Medicaid Personal Needs Allowance Explained

Find personalized help applying for Indiana 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.