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

North Dakota Medicare Savings Programs pay Medicare premiums and cost-sharing for income-eligible seniors and people with disabilities enrolled in Medicare. The top tier, QMB, eliminates the Part B premium and all Medicare cost-sharing in a single program.

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. QMB, SLMB, and QI are mandatory eligibility groups under Title XIX of the Social Security Act, meaning every state, including North Dakota, must cover them.

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 retains authority to apply certain financial methodologies independently from SSI rules; for MSPs, however, federal law mandates use of the FPL-based income thresholds, so the 209(b) election does not tighten MSP eligibility relative to other states.

MSPs use the SSI-related income methodology, which includes two key disregards that lower countable income: a $20/month general income disregard applied to unearned income first, and a $65 plus half of remaining earned income disregard for working applicants. The income bands below reflect the $20 disregard already applied.

QMB: Qualified Medicare Beneficiary

QMB is the most comprehensive tier. It covers:

• The Medicare Part A premium (if any; most beneficiaries have premium-free Part A after 40 or more work quarters)
• The Medicare Part B premium ($185.00/month standard rate in 2026 per CMS)
• The Part A inpatient hospital deductible ($1,736 in 2026)
• The Part B annual deductible ($257 in 2026)
• All Medicare coinsurance and copays on every Medicare-covered service

2026 North Dakota QMB income limits: at or below $1,350/month for a single person, or at or below $1,823/month for a couple. These figures reflect 100% of the Federal Poverty Level with the $20 general income disregard applied.

Resource limit: $9,950 for one person, $14,910 for a couple. The primary home and one vehicle are excluded entirely from the resource count.

For a single North Dakota senior on Social Security, QMB can be worth more than $3,000 a year in saved premiums, deductibles, and copays. Every QMB enrollee is automatically deemed eligible for full Part D Extra Help.

SLMB: Specified Low-Income Medicare Beneficiary

SLMB covers one thing: the Medicare Part B premium. At the 2026 standard premium rate, that benefit is worth $2,220.00 per year.

2026 North Dakota SLMB income limits: $1,351 to $1,616/month for a single person, $1,824 to $2,186/month for a couple.

Resource limit: same as QMB: $9,950 single, $14,910 couple.

Unlike QMB, SLMB does not pay deductibles or copays. For a beneficiary with relatively few medical claims, the Part B premium elimination is the dominant out-of-pocket cost, and SLMB delivers it cleanly.

SLMB also confers automatic Part D Extra Help, which can cut drug costs to $5.10/generic and $12.65/brand-name copays with a $0 deductible and $0 premium on a benchmark Part D plan.

QI: Qualifying Individual

QI covers the Part B premium only, the same as SLMB, at a higher income band: $1,617 to $1,816/month for a single person, $2,187 to $2,457/month for a couple (2026 North Dakota figures).

Two structural differences from QMB and SLMB:

1. First-come, first-served. QI is funded through a capped federal allotment. North Dakota allocates enrollment on a first-come, first-served basis, with a preference for prior-year QI enrollees. Unlike QMB and SLMB, which are entitlements, QI has no guarantee of enrollment once the annual allotment is exhausted.
2. Mutually exclusive with full Medicaid. If you qualify for any full-benefit Medicaid category, you cannot be on QI. You would instead qualify for QMB-Plus or SLMB-Plus, which combine MSP cost-sharing protection with full Medicaid coverage.

Like SLMB, QI enrollment triggers automatic Part D Extra Help.

The QMB Billing Prohibition

Federal law, specifically 42 USC § 1396a(n)(3)(B), prohibits any Medicare provider from billing a QMB enrollee for Medicare cost-sharing. This covers Original Medicare and Medicare Advantage providers alike, whether or not they participate with North Dakota Medicaid.

In plain terms: if you are a QMB enrollee and receive a bill for a deductible, coinsurance, or copay on a Medicare-covered service. Do not pay it. The provider is legally prohibited from collecting it.

If you receive such a bill:

• Tell the provider you are a QMB enrollee and cite federal law.
• Show your ND HHS eligibility notice or Medicare card with the QMB indicator.
• Call 1-800-MEDICARE (1-800-633-4227) to file a complaint.
• Contact the North Dakota State Health Insurance Assistance Program (SHWI) for free counseling assistance.

A provider who has billed a QMB must recall the bill from any collections process and refund any payments already collected.

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, or LIS). No separate application is required.

Under the 2026 Part D benefit structure:

• $0 Part D premium on a benchmark plan
• $0 annual deductible
• $5.10 per generic prescription
• $12.65 per brand-name or preferred multi-source drug
• $0 in copays after the annual out-of-pocket cap

For a senior filling six prescriptions per month, Part D Extra Help can represent $1,500 to $2,500 in annual drug-cost savings on top of the Part B premium benefit from SLMB or QI.

The deeming flows automatically from ND HHS to CMS each month after MSP enrollment. If you are not already in a Part D plan, CMS will auto-assign you to a zero-premium benchmark plan. You can switch to any other Part D plan during the annual open enrollment period without losing LIS status.

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

Income limits reflect 100% FPL (QMB), 100-120% FPL (SLMB), and 120-135% FPL (QI) with the $20 general income disregard applied. Resource limit for all three: $9,950 single / $14,910 couple.

What Counts as a Resource, and What Doesn't

The $9,950/$14,910 resource test excludes several major asset categories:

Excluded (don't count):

• Primary residence, regardless of value or equity
• One vehicle, regardless of make, model, or value
• Household goods and personal effects
• Prepaid burial arrangements and a burial fund up to $1,500 per person

Counted:

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

Many North Dakota seniors rule themselves out of MSP because they think their home counts against the limit. It doesn't. A QMB applicant in a paid-off house worth $300,000 can still qualify as long as their bank balances and other financial assets fall within $9,950.

How to Apply for North Dakota Medicare Savings Programs

North Dakota offers three application pathways:

1. Online via the ND Self Service Portal Apply at apply.nd.gov. This is the primary online portal for Medicaid and related benefit programs administered by ND HHS. Create an account, complete the application, and upload supporting documents.

2. In person at a county Human Service Zone office North Dakota's Human Service Zone offices serve every county. Bring your Medicare card, Social Security award letter, recent bank statements, and proof of North Dakota residency. To find your local Human Service Zone office, contact ND HHS directly.

3. By phone Call ND HHS at 1-800-472-2622. Staff can assist with applications by phone for applicants who cannot access the online portal or visit an office in person.

Through SSA. Applying for Part D Extra Help at your local Social Security office using Form SSA-1020 generates an automatic referral to North Dakota Medicaid. Federal law (42 USC § 1320b-14) requires SSA to forward the application to the state, with your SSA application date serving as the protected filing date.

Documents to Gather Before You Apply

• Medicare card (showing your Medicare Beneficiary Identifier / MBI)
• Social Security card or proof of Social Security number
• Most recent SSA benefit award or COLA letter
• Recent bank and investment account statements
• Pension or annuity statements, if applicable
• Proof of North Dakota residency (utility bill, lease, or mortgage statement)

Effective Dates and Retroactive Coverage

• QMB: coverage begins the first day of the month after approval. Federal law (42 USC § 1396a(e)(8)) prohibits retroactive QMB coverage. Apply as early as possible.
• SLMB and QI: up to three months of retroactive coverage is available under 42 CFR § 435.915 if you were eligible during those months. Your filing date is the protected date, so apply early even if you cannot gather every document immediately.

After approval, ND HHS sends a written eligibility notice. For QMB, a state buy-in notice goes to CMS, which stops withholding the Part B premium from your Social Security check the following month. For SLMB/QI, retroactively withheld premiums are refunded by SSA as a lump sum.

North Dakota as a 209(b) State

North Dakota is one of roughly a dozen states that operate as a Section 209(b) state, giving it authority to apply Medicaid eligibility standards more restrictive than SSI in some program categories. For Medicare Savings Programs specifically, however, federal law mandates the use of FPL-based income thresholds, which means the 209(b) election does not change MSP eligibility. Applicants face the same QMB/SLMB/QI income bands used in non-209(b) states.

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

Learn More

• North Dakota Medicaid Eligibility and Income Limits
• How to Apply for North Dakota Medicaid
• Understanding the Personal Needs Allowance

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.