New Jersey Medicare Savings Programs 2026: QMB, SLMB & QI

If you have Medicare and a limited income, New Jersey's Medicare Savings Programs can erase the $202.90 monthly Part B premium.1

The broadest tier, QMB, also wipes out your Medicare deductibles and copays. All three programs run through NJ FamilyCare, the state's Medicaid program, and enrolling in any one of them automatically opens the door to Part D drug-cost help.

What Are Medicare Savings Programs?

Medicare Savings Programs are Medicaid-administered benefits that pay some or all of a low-income Medicare beneficiary's premiums and cost-sharing. QMB, SLMB, and QI are mandatory eligibility groups under federal law, so New Jersey is required to offer all three.2

In New Jersey, the programs are administered by the Division of Medical Assistance and Health Services (DMAHS) through NJ FamilyCare, the umbrella name for the state's Medicaid and CHIP coverage. Applications for seniors and adults with disabilities go through the same NJ FamilyCare process as other non-MAGI Medicaid categories, and they use the asset-tested, Supplemental Security Income (SSI)-related income rules rather than the MAGI rules that govern marketplace coverage. A resource (asset) test does apply.

QMB: Who Qualifies and What It Pays

QMB is the broadest tier. To qualify in 2026, a single New Jersey resident's countable monthly income must be at or below $1,350 ($1,824 for a couple), with countable resources at or below $9,950 ($14,910 for a couple).2

QMB covers:

• The full Medicare Part B premium, $202.90 a month in 2026
• The Medicare Part B deductible, $283 in 2026
• The Medicare Part A hospital deductible, $1,736 per benefit period in 20261
• The Part A premium, which most people already receive at no cost after 40 quarters of work
• All Medicare coinsurance and copays on covered services

The Part B premium alone is worth about $2,435 a year ($202.90 a month over 12 months), before you count the deductibles and coinsurance QMB also erases. Every QMB enrollee is also automatically qualified for full Part D Extra Help.1

SLMB: Help With the Part B Premium

SLMB covers one thing: the Medicare Part B premium. A single New Jersey resident qualifies with monthly income above the QMB limit and at or below $1,616 ($2,184 for a couple), and the resource limit is the same $9,950 and $14,910.2

At the 2026 rate, that single benefit is worth about $2,435 a year ($202.90 a month). SLMB does not touch deductibles or copays, but for someone with few medical bills, wiping out the Part B premium is the savings that matters most. SLMB also confers automatic Part D Extra Help.1

QI: The Part B Premium at a Higher Income

QI pays the Part B premium too, but at a higher income band: above the SLMB limit and up to $1,816 a month for a single person ($2,455 for a couple), with the same $9,950 and $14,910 resource limits.2

Two things set QI apart from QMB and SLMB. First, it is funded by a capped federal allotment, so New Jersey enrolls applicants first-come, first-served, with preference for prior-year enrollees, and cannot guarantee a spot the way it must for QMB and SLMB. Second, you cannot hold QI and full New Jersey Medicaid at the same time; anyone who qualifies for a full-benefit NJ FamilyCare category receives Medicare cost-sharing help through QMB-Plus or SLMB-Plus instead, which add full Medicaid on top of the cost-sharing protection. Like SLMB, QI enrollment triggers automatic Part D Extra Help.2

New Jersey 2026 Income Limits at a Glance

These bands reflect 100% of the Federal Poverty Level for QMB, 100 to 120% for SLMB, and 120 to 135% for QI, with the standard monthly income disregard already built in. The resource limit for all three is $9,950 for a single person and $14,910 for a couple.2

What Counts as a Resource in New Jersey

New Jersey's $9,950 and $14,910 resource test counts less than many people expect, because the biggest assets are excluded.2

Excluded (do not count):

• Your primary residence, regardless of its value
• One vehicle, regardless of make or value
• Household goods and personal effects
• Prepaid burial arrangements

Counted:

• Checking and savings account balances
• Stocks, bonds, certificates of deposit, and mutual funds
• A second home or a second vehicle
• Non-exempt cash-value life insurance

Many New Jersey seniors rule themselves out because they think of their house as an asset. It is not. Someone who owns a paid-off home can still qualify for QMB, as long as their bank balances and other countable assets stay under the limit.

New Jersey PAAD and Senior Gold: Beyond the MSP Limits

If your income runs above the Medicare Savings Program limits, two New Jersey state programs can still help with prescription costs.

PAAD (Pharmaceutical Assistance to the Aged and Disabled) helps with Part D drug costs for residents age 65 or older, or under 65 with a qualifying disability, whose income is above the Medicare Savings Program limits. PAAD enrollees pay a reduced copay per prescription instead of full Part D cost-sharing. The income ceilings are set by the state and are higher than the Medicare Savings Program limits.

Senior Gold is a supplemental prescription program for New Jersey residents age 65 or older with income above the PAAD limit. It provides a flat-rate subsidy per prescription and works alongside Part D as a secondary benefit.

Both are administered by the New Jersey Division of Aging Services, separately from your Medicare Savings Program. Qualifying for one does not disqualify you from the other. Call the PAAD and Senior Gold line at 1-800-792-9745 to confirm the current income thresholds before deciding you earn too much to get help.

Billed for a Copay While on QMB? Don't Pay It

Federal law bars every Medicare provider from billing a QMB enrollee for Medicare deductibles, coinsurance, or copays, under any circumstances. This holds whether you have Original Medicare or a Medicare Advantage plan, and whether or not the provider takes NJ FamilyCare.2

If a hospital, doctor, or other provider sends you a cost-sharing bill:

• Tell them you are a QMB enrollee and that federal law prohibits the charge.
• Show your NJ FamilyCare eligibility notice or your Medicare card.
• Call 1-800-MEDICARE (1-800-633-4227) to file a complaint.
• Contact New Jersey's State Health Insurance Assistance Program (SHIP) at 1-800-792-8820 for free help disputing the bill.

New Jersey SHIP, run by the state Division of Aging Services, gives free, unbiased Medicare counseling through trained volunteers in all 21 counties, with no sales pressure and no tie to any insurer. A provider who wrongly billed a QMB must recall the bill and refund anything already collected.3

MSP Automatically Opens Part D Extra Help

Enrolling in QMB, SLMB, or QI automatically qualifies you for the full Part D Extra Help, also called the Low-Income Subsidy, with no separate application.2

In 2026, full Extra Help caps covered generic drugs at $5.10 and covered brand-name drugs at $12.65, and drops your cost to $0 once your out-of-pocket drug spending reaches $2,100 for the year. On a benchmark plan, the Part D premium and deductible are both $0.4

DMAHS forwards the deeming information to Medicare each month. If you are not already in a Part D plan, Medicare assigns you to a benchmark plan with no monthly premium, and you can switch to another plan during the annual open enrollment period without losing your Extra Help status.

How New Jersey Counts Your Income

A common reason New Jersey seniors skip these programs: they look at their gross Social Security check, see it above the limit, and stop. The SSI-related methodology sets aside part of your income before comparing it to the ceiling.

New Jersey's 100% Federal Poverty Level figure for 2026 is $1,330 a month for a single person ($1,804 for a couple).5 The QMB ceiling lands slightly higher, at $1,350 ($1,824), because the SSI rules set aside the first $20 of monthly income before counting it. A single person with $1,370 in Social Security has $1,350 in countable income, right at the QMB line.2

If you work, the SSI rules leave out even more of your earnings, so your gross wages overstate what actually counts. The practical lesson: run your real numbers, or ask NJ SHIP to run them, before deciding you earn too much to qualify.

How to Apply for a New Jersey Medicare Savings Program

By law, DMAHS must decide most Medicare Savings Program applications within 45 days, or within 90 days when eligibility rests on a disability.6 QMB coverage begins the first day of the month after approval and cannot be backdated, so apply as early as you can. SLMB and QI can be granted for up to three retroactive months if you were eligible during that window.

You can also apply for Part D Extra Help at the Social Security Administration (SSA); when you do, SSA forwards a referral to New Jersey so your Medicare Savings Program application starts from the same date.

Learn More

Find personalized help applying for New Jersey 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.