Ohio Medicare Savings Programs 2026: QMB, SLMB & QI

Ohio Medicare Savings Programs cut or eliminate Medicare premiums and cost-sharing for low-income seniors and people with disabilities enrolled in Medicare. QMB, the broadest tier, wipes out the Part B premium and all cost-sharing in one 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. They are mandatory eligibility groups under Title XIX of the Social Security Act, meaning every state plan must cover QMB, SLMB, and QI.

The Ohio Department of Medicaid (ODM) administers all three programs. Financial eligibility is determined by county-level CDJFS (County Department of Job and Family Services) offices, and applications are processed through the Ohio Benefits portal at benefits.ohio.gov.

Because MSPs use the SSI-related income methodology rather than MAGI rules, they have two meaningful income disregards that reduce what counts: a $20/month general income disregard applied to unearned income first, and a $65 + half of remaining earned income disregard for workers. The income bands below already reflect the $20 disregard.

QMB: Qualified Medicare Beneficiary

QMB is the most comprehensive program. It covers:

• The Medicare Part A premium (most beneficiaries have premium-free Part A from 40+ work quarters)
• The Medicare Part B premium ($202.90/month standard rate in 2026)
• 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 Ohio QMB income limits: at or below $1,350/month for a single person, or at or below $1,824/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 residence and one vehicle are excluded entirely from this count.

For a single Ohio senior on Social Security, QMB can be worth over $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, eliminating the Part B premium is worth approximately $2,220 per year.

2026 Ohio SLMB income limits: $1,351 to $1,616/month for a single person, $1,825 to $2,184/month for a couple.

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

Unlike QMB, SLMB does not pay deductibles or copays. But for a beneficiary with relatively few medical claims, the Part B premium elimination is the dominant savings, 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, but applies at a higher income band: $1,617 to $1,816/month for a single person, $2,185 to $2,455/month for a couple (2026 Ohio figures).

Two structural differences from QMB and SLMB:

1. First-come, first-served. QI is funded through a capped federal allotment. Ohio 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 enrollment is not guaranteed.
2. Mutually exclusive with full Medicaid. Anyone eligible for full-benefit Ohio Medicaid (including the ABD Medicaid pathway) cannot enroll in QI. They would qualify instead 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 Ohio Medicaid.

In plain terms: if you are a QMB enrollee and receive a bill from a hospital, physician, skilled nursing facility, or any other Medicare provider for a deductible, coinsurance, or copay, 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 ODM eligibility notice or Medicare card with QMB indicator.
• Call 1-800-MEDICARE (1-800-633-4227) to file a complaint.
• Contact OSHIIP (Ohio Senior Health Insurance Information Program) at 1-800-686-1578 for free help disputing the bill.

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 Ohio 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 $2,100 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.

The deeming flows automatically from ODM 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.

Ohio 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 is less restrictive than it first appears because several major assets are excluded:

Excluded (don't count):

• Primary residence, regardless of value or equity
• One vehicle, regardless of make, model, or value (Ohio exempts a vehicle with no fair-market-value cap)
• Household goods and personal effects
• Prepaid burial arrangements and burial space items
• A burial fund up to $1,500 per person (plus unlimited irrevocable pre-need burial contracts)

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

Many Ohio seniors rule themselves out of MSP because they think of their home as a resource. It is not. A QMB applicant in a paid-off home can still qualify as long as bank balances and other financial assets fall within the $9,950 limit.

How to Apply for Ohio Medicare Savings Programs

Ohio offers multiple application pathways:

1. Online via Ohio Benefits Apply at benefits.ohio.gov. Ohio Benefits is the state self-service portal for Medicaid and related programs. Complete the online application and upload supporting documents.

2. In person at your county CDJFS office Ohio has 88 CDJFS offices, one in each county. Bring your Medicare card, Social Security award letter, recent bank statements, and proof of Ohio residence.

3. By phone Call the Ohio Medicaid Consumer Hotline at 1-800-324-8680 (Mon-Fri, 8 a.m. to 4 p.m. ET).

Through OSHIIP. OSHIIP (Ohio Senior Health Insurance Information Program, part of ODI) provides free, unbiased Medicare counseling including MSP application assistance. Call 1-800-686-1578 or visit insurance.ohio.gov to find a local OSHIIP counselor.

Through SSA. Applying for Part D Extra Help at a Social Security office using Form SSA-1020 automatically generates a referral to Ohio Medicaid. SSA is required by federal law (42 USC § 1320b-14) 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 Ohio residency (utility bill, lease, or mortgage statement)

Determination Timeline

ODM/CDJFS must process non-disability MSP applications within 45 days under 42 CFR § 435.912. Disability-based applications get 90 days.

Effective Dates and Retroactive Coverage

• QMB: coverage begins the first day of the month after the month ODM approves the application. 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.

After approval, ODM sends a written 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, any previously withheld premiums for retroactive months are refunded by SSA as a lump sum.

How the Income Disregards Work

The most common reason eligible Ohio seniors skip MSP: they look at their gross income, see it above the threshold, and stop. The SSI-related income methodology runs the numbers differently.

$20 general income disregard: Before counting income, $20 per household per month is excluded from unearned income (Social Security, pensions, VA compensation). This is why the QMB single ceiling is $1,350 rather than $1,330.

$65 + half of earned income: For applicants with wages or self-employment income, the first $65 of earned income is excluded and then half of the remainder is excluded. A part-time worker earning $800/month gross has $800 - $65 = $735; half of $735 = $367.50 countable from earned income. Combined with the $20 disregard on unearned income, a person with both a Social Security check and part-time wages often has substantially lower countable income than gross figures suggest.

Run the actual numbers before concluding you don't qualify.

Ohio-Specific Notes

Ohio is a Section 1634 state, meaning SSI recipients automatically receive Medicaid without a separate application. SSI recipients enrolled in Medicaid may already be eligible for MSP protections; their Medicaid enrollment handles the MSP interface automatically.

Ohio uses the same $9,950/$14,910 MSP resource limit that aligns with the federal Part D LIS resource standard.

The ACA QMB carve-out (42 USC § 1396p(b)(1)(B)) means that Medicare cost-sharing payments made through QMB (Part A and Part B premiums, deductibles, and copays) are NOT recoverable under Ohio Medicaid estate recovery. This is a permanent protection enacted January 1, 2010.

For Ohio seniors who also qualify for full ABD Medicaid (the aged, blind, and disabled Medicaid pathway), QMB-Plus or SLMB-Plus may apply automatically. Check with your county CDJFS caseworker about dual-eligibility status.

QDWI note. Ohio also offers the Qualified Disabled and Working Individual (QDWI) program for working people who have lost Social Security disability benefits due to returning to work. QDWI pays the Medicare Part A premium and has a 2026 income limit of $2,680/month single (200% FPL + $20 disregard) with a $4,000 resource limit. QDWI applicants must not be otherwise eligible for full Medicaid.

Learn More

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

Find personalized help applying for Ohio 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.