Missouri's Medicare Savings Programs pay Medicare premiums and cost-sharing for residents with limited income, and every enrollee automatically qualifies for Part D Extra Help. Administered by the Missouri Department of Social Services through MO HealthNet, Missouri's Medicaid program, the three programs are QMB, SLMB, and QI.
What Are Missouri Medicare Savings Programs?
Missouri's Medicare Savings Programs are part of MO HealthNet, the state's Medicaid program administered by the Missouri Department of Social Services (DSS), Family Support Division. Federal law (42 USC § 1396a(a)(10)(E)) requires every state to run QMB, SLMB, and QI. Missouri administers all three using the federal income and resource standards.
The programs exist because Medicare itself leaves substantial cost exposure. The 2026 Part B standard premium is $202.90 per month. The Part A inpatient hospital deductible is $1,736 per benefit period, the Part B annual deductible is $283, and coinsurance accrues on every Medicare-covered service. For a Missouri resident who qualifies, the Missouri Medicare Savings Programs pay those costs directly.
Income is counted under the SSI-related ABD methodology (42 CFR Part 435), not the MAGI rules that apply to marketplace coverage. Two disregards apply before the income test:
- $20 general income exclusion per household per month, taken from unearned income (Social Security, pensions, VA compensation) first.
- $65 + half of remaining earned income for applicants who work.
The published income ceilings already incorporate the $20 disregard. Missouri residents whose gross Social Security benefit is within $20 of the ceiling should apply and let DSS run the calculation with the disregard.
QMB: Qualified Medicare Beneficiary
QMB is the most comprehensive Missouri Medicare Savings Program. It pays both Part A and Part B premiums and covers all Medicare cost-sharing, including deductibles, coinsurance, and copays.
| Individual | Couple | |
|---|---|---|
| Monthly income limit | approximately $1,350 | approximately $1,824 |
| FPL band | at or below 100% FPL | at or below 100% FPL |
| Part B premium paid | $202.90/month | $202.90/month per enrollee |
| Part A deductible paid | $1,736 per benefit period | $1,736 per benefit period |
| Part B deductible paid | $283/year | $283/year |
| Coinsurance and copays | Covered | Covered |
| Resource limit | $9,950 | $14,910 |
Missouri does not set state-specific QMB income limits above the federal floor. The figures above are the federal QMB ceilings (100% FPL plus the $20 disregard) per SSA POMS HI 00815.023.
The QMB Billing Prohibition
Federal law (42 USC § 1396a(n)(3)(B)) prohibits any Medicare provider, whether Original Medicare or Medicare Advantage, from billing a QMB enrollee for any Medicare cost-sharing. This ban applies to providers who participate in MO HealthNet and those who do not.
If a provider bills you for a Medicare deductible, coinsurance, or copay while you are enrolled in QMB:
- Do not pay it. Tell the provider you are a QMB enrollee.
- Show your MO HealthNet QMB eligibility letter or Medicaid card.
- Call 1-800-MEDICARE (1-800-633-4227) to report the billing violation.
- Contact Missouri SHIP at 1-800-390-3330 for help disputing the bill.
The provider must recall the bill from collections and refund any amount already collected.
SLMB: Specified Low-Income Medicare Beneficiary
SLMB pays the Part B premium only. At $202.90 per month in 2026, that is $2,434.80 per year returned to the enrollee's Social Security deposit.
| Individual | Couple | |
|---|---|---|
| Monthly income limit | approximately $1,616 | approximately $2,184 |
| FPL band | 100% to 120% FPL | 100% to 120% FPL |
| Benefit | Part B premium ($202.90/month) | Part B premium per enrollee |
| Resource limit | $9,950 | $14,910 |
SLMB enrollees are automatically deemed eligible for full Part D Extra Help. No separate SSA application is needed. In 2026, that means $0 Part D premium on a benchmark plan, $0 deductible, and $5.10 generic / $12.65 brand-name drug copays.
SLMB also allows up to three months of retroactive coverage under 42 CFR § 435.915. If you were eligible in the three months before filing, DSS can back-date coverage and SSA will issue a lump-sum reimbursement of premiums deducted during those months.
QI: Qualifying Individual
QI pays the Part B premium only, for Missouri residents with income between approximately 120% and 135% FPL.
| Individual | Couple | |
|---|---|---|
| Monthly income limit | approximately $1,816 | approximately $2,455 |
| FPL band | 120% to 135% FPL | 120% to 135% FPL |
| Benefit | Part B premium ($202.90/month) | Part B premium per enrollee |
| Resource limit | $9,950 | $14,910 |
Two QI-specific considerations:
- Capped annual allotment. Missouri receives a fixed federal QI allocation each year and allocates enrollment on a first-come, first-served basis, with priority for prior-year enrollees. Missouri has not exhausted its allotment in recent years, but QI is not a statutory entitlement.
- Mutually exclusive with full MO HealthNet. Federal law (42 USC § 1396u-3(c)(1)) bars QI enrollment for anyone eligible for full Medicaid. If you already receive full MO HealthNet benefits, you would instead qualify for QMB-Plus or SLMB-Plus, combining cost-sharing protection with full MO HealthNet coverage.
Full Comparison: Missouri Medicare Savings Programs
| Program | Income band (individual) | Income band (couple) | What it pays | Resource limit |
|---|---|---|---|---|
| QMB | up to ~$1,350/month | up to ~$1,824/month | Part A + Part B premiums, all deductibles, coinsurance, copays | $9,950 / $14,910 |
| SLMB | ~$1,350 to ~$1,616/month | ~$1,824 to ~$2,184/month | Part B premium only | $9,950 / $14,910 |
| QI | ~$1,616 to ~$1,816/month | ~$2,184 to ~$2,455/month | Part B premium only | $9,950 / $14,910 |
All three Missouri Medicare Savings Programs share the same resource limit and all three trigger automatic Part D Extra Help enrollment.
What Counts as a Resource in Missouri?
The SSI-related resource rules apply. Counted resources include cash, bank accounts, stocks, bonds, non-retirement investment accounts, a second home, and a second vehicle.
Excluded resources include:
- Primary home of any value (Missouri's $752,000 home equity cap applies to nursing-home Medicaid, not to MSP).
- One vehicle of any value.
- Household goods and personal effects.
- Burial spaces and burial funds up to $1,500 per person.
- Life insurance with combined face value at or below $1,500 per person.
Note: Missouri's MO HealthNet nursing-home program uses a higher single-applicant resource limit of $6,068.80 (effective July 1, 2025). That limit does not apply to MSPs, which use the federal $9,950 / $14,910 standard.
Part D Extra Help
Enrollment in any Missouri Medicare Savings Program automatically qualifies you for full Part D Extra Help (Low-Income Subsidy) under 42 USC § 1395w-114. DSS transmits enrollment data to CMS monthly; CMS updates your Part D record. No separate application is required.
In 2026, full Part D Extra Help provides:
- $0 premium on any benchmark Part D plan.
- $0 Part D deductible.
- $5.10 copay per generic prescription.
- $12.65 copay per brand-name prescription.
- $0 copays after $2,100 in true annual out-of-pocket drug costs.
For a Missouri senior on several medications, this benefit can reduce annual drug costs by $1,500 to $3,000 or more, on top of the Part B premium savings.
If your income exceeds the MSP limits but is at or below 150% FPL, you can apply directly for Extra Help using Form SSA-1020 at any Social Security office or online at SSA.gov. SSA forwards the application to DSS as an automatic MSP referral.
How to Apply for Missouri Medicare Savings Programs
DSS accepts MSP applications through the myDSS online portal and by phone.
Primary application channels:
- myDSS online portal at mydss.mo.gov. Create an account and submit the application with supporting documents online.
- Phone: call DSS at 1-855-373-9994 (Mon–Fri during business hours).
- In person at any local Family Support Division office in Missouri.
- Through SSA: applying for Part D Extra Help on Form SSA-1020 generates an automatic MSP application referral to DSS. The SSA application date is the protected filing date.
Documents to have ready:
- Medicare card or Medicare Beneficiary Identifier (MBI)
- Social Security number and date of birth (applicant and spouse, if applicable)
- Most recent SSA COLA letter showing current monthly benefit amount
- Pension or annuity statements (if applicable)
- Recent bank statements (all accounts)
- Proof of Missouri residency (utility bill, lease, or mortgage statement)
Processing time: DSS must determine eligibility within 45 days for non-disability applications and 90 days if a disability determination is needed.
Retroactive coverage: SLMB and QI allow up to three months of retroactive coverage if you met the eligibility criteria during those months. QMB coverage begins the month after the eligibility determination, with no retroactive period allowed.
Annual renewal: DSS attempts to renew MSP coverage annually using existing electronic data. If it cannot confirm eligibility through those sources, it sends a renewal packet. Return it promptly to avoid a gap in coverage. If MSP ends, Medicare resumes deducting the Part B premium from your Social Security check the following month.
Frequently Asked Questions
Any Missouri Medicare beneficiary with monthly income at or below approximately 100% of the Federal Poverty Level (after the $20 general income disregard) and countable resources under $9,950 (individual) or $14,910 (couple). The primary home and one vehicle are excluded from the resource count.
Yes. Missouri administers the Missouri Medicare Savings Programs using the federal income and resource standards. The income ceilings reflect the federal FPL-based bands plus the $20 general income disregard.
Yes. If you qualify for both, you receive QMB-Plus status, which combines all QMB cost-sharing protections with full MO HealthNet Medicaid benefits. The only exclusion is QI, which cannot be combined with any full Medicaid coverage.
No. Enrollment in any Missouri MSP automatically generates Part D Extra Help through MO HealthNet's monthly data file to CMS.
Do not pay it. Federal law prohibits Medicare providers from billing QMB enrollees for cost-sharing. Call 1-800-MEDICARE and Missouri SHIP at 1-800-390-3330 to report the violation and get help.
Missouri's MO HealthNet nursing-home program uses a $6,068.80 single-applicant resource limit. That higher limit does not apply to MSPs. Medicare Savings Programs use the federal $9,950 individual / $14,910 couple standard regardless of Missouri's separate nursing-home rules.
Apply for a Missouri Medicare Savings Program through myDSS at mydss.mo.gov or call DSS at 1-855-373-9994. Free help is available from Missouri SHIP at 1-800-390-3330.
Learn More
- Missouri Medicaid Eligibility and Income Limits
- How to Apply for Missouri Medicaid
- Medicaid Personal Needs Allowance Explained
Find personalized help applying for Missouri 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.