North Dakota Medicare Savings Programs 2026: QMB, SLMB & QI

In North Dakota, three Medicare Savings Programs help people on Medicare with limited income pay their Medicare Part B premium, which is $202.90 a month in 2026. The highest tier, the Qualified Medicare Beneficiary (QMB) program, goes further and also covers Medicare deductibles and copays. North Dakota uses the standard federal income limits for all three, so a single applicant with monthly income at or below about $1,816 can usually qualify for one of them.1,2

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. Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), and Qualifying Individual (QI) are mandatory Medicaid eligibility groups, so every state, including North Dakota, must cover them, though QI enrollment is limited by a capped federal allotment described below.2

North Dakota Health and Human Services (ND HHS) administers all three programs, with eligibility processed through county Human Service Zones across the state. North Dakota is a Section 209(b) state, meaning it can apply some financial methodologies independently from Supplemental Security Income (SSI) rules.4 For Medicare Savings Programs, though, North Dakota publishes the standard federal income limits, set from the Federal Poverty Level (FPL), so the 209(b) election does not tighten MSP eligibility here.2

Medicare Savings Programs use the Supplemental Security Income (SSI) counting rules. The published limits already build the $20 general income disregard on top of the underlying Federal Poverty Level figure, so measure your monthly income against the bands in this guide rather than subtracting that $20 a second time.3,2

If you or your spouse still work, the SSI rules discount earnings before they are counted: after any unused part of the $20 general exclusion, the first $65 of monthly earned income does not count, and neither does half of what remains. A working applicant whose gross pay looks too high can still land inside a program band once that discount is applied, so do not rule yourself out on gross wages alone.5

QMB: Qualified Medicare Beneficiary

QMB is the most comprehensive tier. It covers:

• The Medicare Part A premium, if you owe one (most people pay no Part A premium because they or a spouse paid Medicare taxes long enough while working, generally at least 10 years)1
• The Medicare Part B premium, $202.90 a month in 20261
• The Part A inpatient hospital deductible, $1,736 per benefit period in 20261
• The Part B annual deductible, $283 in 20261
• All Medicare coinsurance and copays on Medicare-covered services

2026 North Dakota QMB income limits: at or below $1,350 a month for a single person, or $1,824 a month for a couple. These reflect 100% of the Federal Poverty Level with the $20 general income disregard applied.2

Resource limit: $9,950 for one person, $14,910 for a couple, plus an additional $1,500 in designated burial funds allowed on top of each of those limits.2 ND HHS does not count the value of your home, one car, home furnishings, or other personal items.4

For a single North Dakota senior, QMB eliminates the $202.90 monthly Part B premium and, on top of that, erases the $283 Part B deductible, the $1,736 Part A hospital deductible, and every Medicare copay on a covered service.1 QMB does not cover Part D drug copays, but every QMB enrollee is also automatically deemed eligible for full Part D Extra Help, which holds those copays to no more than $12.65 per covered drug in 2026.3

SLMB: Specified Low-Income Medicare Beneficiary

SLMB covers one thing: the Medicare Part B premium, which is $202.90 a month in 2026.1

2026 North Dakota SLMB income limits: over $1,350 up to $1,616 a month for a single person, and over $1,824 up to $2,184 a month for a couple. The resource limit is the same as QMB: $9,950 single, $14,910 couple, plus the same $1,500 burial-fund allowance on top.2 You need both Part A and Part B to qualify for SLMB, and the same goes for QI.3

Unlike QMB, SLMB does not pay deductibles or copays. But for a beneficiary with few medical claims, the Part B premium is usually the largest fixed Medicare cost, and SLMB removes it cleanly.

SLMB also confers automatic Part D Extra Help, which caps covered drugs at $5.10 per generic and $12.65 per brand-name prescription in 20266 and eliminates the annual Part D deductible entirely.7 You pay $0 for a plan's basic Part D coverage as long as that basic premium is at or below your region's low-income benchmark.7

QI: Qualifying Individual

QI covers the Part B premium only, the same as SLMB, but at a higher income band: over $1,616 up to $1,816 a month for a single person, and over $2,184 up to $2,455 a month for a couple (2026 North Dakota figures).2

Two things set QI apart from QMB and SLMB:

1. First-come, first-served. QI is funded through a capped annual federal allotment to each state. Slots go first-come, first-served, with preference for people who had QI in the last month of the previous year.3 QI pays only to the extent the state has slots left in that allotment, so an applicant who meets every QI rule can still be turned away, and that denial says nothing about their Medicaid eligibility.8
2. Not available alongside other Medicaid. Federal law limits QI to people who are not otherwise eligible for Medicaid, so if you qualify for full Medicaid you cannot be on QI.8 You would instead be a QMB Plus or SLMB Plus enrollee, or, if you meet neither program's rules, another full-benefit dual-eligible category. QMB Plus keeps QMB's protection from Medicare cost-sharing; SLMB Plus pays the Part B premium alongside full Medicaid, and whether it also covers Medicare cost-sharing varies by state. That does not leave an SLMB Plus enrollee unprotected: a provider who takes Medicaid can charge no more than the state plan allows for services both programs cover, and every Medicare provider must accept the Medicare-allowed amount as payment in full for Part B services.9

Like SLMB, QI enrollment triggers automatic Part D Extra Help. You also have to reapply for QI every year; being selected one year does not entitle you to it the next.3

The QMB Billing Prohibition

Federal law prohibits any Medicare provider from billing a QMB enrollee for Medicare cost-sharing, and Social Security Act section 1902(n)(3)(B) says the beneficiary has no legal liability to pay the provider for it.10 This applies to Original Medicare and Medicare Advantage providers alike, whether or not they participate with North Dakota Medicaid.3,11

In plain terms: if you are a QMB enrollee and you receive a bill for a deductible, coinsurance, or copay on a Medicare-covered service, do not pay it. The provider is legally barred from collecting it. The one bill that can still come is a small Medicaid copayment, if one applies.11

If you receive such a bill:

• Tell the provider you are a QMB enrollee and cite the federal balance-billing prohibition.
• Show your Medicare card and your Medicaid or QMB card. With Original Medicare, your Medicare Summary Notice also shows that you are in QMB.11
• If the billing continues, call 1-800-MEDICARE (1-800-633-4227; TTY 1-877-486-2048). Medicare will confirm your QMB status and can ask the provider to stop billing you and refund what you already paid.10
• Contact the North Dakota State Health Insurance Assistance Program (SHIP) at 1-888-575-6611 for free help.12

CMS tells a provider that has billed a QMB to recall the bill, including any bill turned over to collections, and to refund any cost-sharing money already collected.11

Part D Extra Help / Low-Income Subsidy

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

Under the 2026 Part D Extra Help rules, a full-subsidy enrollee gets:

• A $0 premium for a plan's basic Part D coverage, so long as that basic premium is at or below your region's low-income benchmark (an enhanced plan's extra-benefit share is still yours to pay)7
• A $0 annual deductible, instead of the up to $615 a Part D plan may charge someone without Extra Help in 20267
• No more than $5.10 for each generic prescription and $12.65 for each brand-name prescription; people who also have full Medicaid pay $1.60 and $4.90 if their income is at or below the poverty line, and $0 if they live in a nursing home or get home and community-based services6
• $0 for covered drugs once your out-of-pocket drug costs reach $2,100 for the year6

For a senior who fills several prescriptions a month, those copay caps add up, on top of the Part B premium that SLMB or QI already covers.

Because the deeming comes from your MSP enrollment, Medicare tells you that you do not need to file a separate Extra Help application.6 The premium subsidy is capped at your region's low-income benchmark: pick a plan that costs more than the benchmark and you pay the difference yourself. CMS sets that benchmark separately for each Part D region, so which plans stay at $0 depends on where you live.7

North Dakota Medicare Savings Programs: 2026 Income Limits at a Glance

These bands reflect 100% FPL (QMB), 100 to 120% FPL (SLMB), and 120 to 135% FPL (QI), with the $20 general income disregard applied. The resource limit for all three is $9,950 (single) / $14,910 (couple), with another $1,500 in designated burial funds allowed on top of each.2 Those are the federal standards rather than absolute cutoffs, and SSA instructs staff to encourage people whose income or resources look somewhat higher to apply anyway.3,2

What Counts as a Resource, and What Doesn't

The $9,950 (single) / $14,910 (couple) resource test2 is applied under the SSI resource-counting rules, and several major asset categories sit outside it.5

Excluded (do not count):

• Your primary residence. ND HHS does not count its value.
• One car
• Home furnishings, household goods, and other personal items
• An irrevocable burial plan4
• Money kept separate from your other funds and clearly designated for burial expenses, but only up to $1,500 per person (you and your spouse each). Mix it with other money and none of it is excluded. That $1,500 is reduced by the face value of any life insurance whose cash value was already excluded, and by amounts held in an irrevocable burial arrangement.5

Counted:

• Checking and savings account balances
• Stocks, bonds, certificates of deposit, and mutual funds
• A second vehicle or a second home
• The countable cash value of certain life insurance policies4

If you have been assuming your home works against the limit, it does not.4 A QMB applicant who owns a mortgage-free home can still qualify, as long as countable assets such as bank balances stay within the $9,950 single limit.2

How to Apply for North Dakota Medicare Savings Programs

Effective Dates and Retroactive Coverage

• QMB: coverage begins the first day of the month after approval. Social Security Act § 1902(e)(8) makes a QMB determination apply only to services furnished after the end of the month the determination is made, so QMB coverage runs forward only. Every month you wait is a month of cost-sharing protection you cannot get back.15
• SLMB and QI: the § 1902(e)(8) rule names only QMB. The federal sources we rely on set no effective-date or look-back rule for SLMB or QI, so ask ND HHS when you apply what date your SLMB or QI coverage will start and whether it can reach back before your application month.15

North Dakota as a 209(b) State

North Dakota is one of only eight states that operate under Section 209(b), which lets a state apply at least one Medicaid eligibility standard more restrictive than SSI. A 209(b) state may not go stricter than the standards it had in effect on January 1, 1972, and it has to let applicants spend down excess income on incurred medical expenses.4 For Medicare Savings Programs, though, the 209(b) election does not change eligibility: North Dakota publishes the standard federal QMB, SLMB, and QI income bands rather than stricter state-set ones.2

For long-term care Medicaid, by contrast, North Dakota's 209(b) status matters: the state applies its own asset limits ($3,000 for a single applicant, $6,000 for a couple) and a medically needy spend-down rather than a simple income cap. If you are also looking at long-term care Medicaid in North Dakota, those rules are covered in North Dakota Medicaid eligibility and income limits.4

Where to Get Help in North Dakota

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.