Ohio Medicare Savings Programs 2026: QMB, SLMB & QI

Ohio's Medicare Savings Programs cut or eliminate Medicare premiums and cost-sharing for low-income seniors and people with disabilities who are enrolled in Medicare. There are three: QMB, SLMB, and QI. QMB, the broadest tier, wipes out the Part B premium and every Medicare deductible and copay in one program, and all three automatically unlock Part D Extra 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 Medicare premiums and cost-sharing. QMB, SLMB, and QI are mandatory eligibility groups under Title XIX of the Social Security Act, so every state plan, Ohio's included, must cover them.1

The Ohio Department of Medicaid (ODM) administers all three programs as its Medicare Premium Assistance Programs. Financial eligibility is determined by county-level County Department of Job and Family Services (CDJFS) offices, and applications are processed through the Ohio Benefits portal at benefits.ohio.gov.1

Because these programs use the SSI-related income methodology rather than MAGI rules, Ohio applies a $20 monthly general income disregard before counting income, and discounts part of any earned income on top of that. The income limits below already reflect the $20 disregard.1

QMB: Qualified Medicare Beneficiary

QMB is the most comprehensive program. It covers:

• The Medicare Part A premium (most beneficiaries already have premium-free Part A from 40 or more work quarters)
• The Medicare Part B premium ($202.90/month standard rate in 2026)
• The Part A inpatient hospital deductible ($1,736 per benefit period in 2026)
• The Part B annual deductible ($283 in 2026)
• All Medicare coinsurance and copays on every Medicare-covered service2

2026 Ohio QMB income limit: at or below $1,350/month for a single person, or $1,824/month for a couple. These are the 100% Federal Poverty Level standards with the $20 general income disregard applied.1

Resource limit: $9,950 for one person, $14,910 for a couple. The primary residence and one vehicle are excluded entirely from the count.1

For a single Ohio senior, QMB eliminates the $202.90 monthly Part B premium, the $283 annual Part B deductible, the $1,736 hospital deductible, and every Medicare copay and coinsurance charge.2 Every QMB enrollee is also automatically deemed eligible for full Part D Extra Help.

SLMB: Specified Low-Income Medicare Beneficiary

SLMB covers one thing: the Medicare Part B premium, which is $202.90 a month in 2026.2 For a beneficiary with relatively few medical claims, wiping out the Part B premium is the dominant saving, and SLMB delivers it cleanly.

2026 Ohio SLMB income limit: up to $1,616/month for a single person, or $2,184/month for a couple. This is the band above the QMB limit up to 120% of the Federal Poverty Level.1

Resource limit: the same as QMB, $9,950 single and $14,910 couple.1

Unlike QMB, SLMB does not pay deductibles or copays. It also confers automatic Part D Extra Help, which cuts drug costs to $5.10 per generic and $12.65 per brand-name prescription, with a $0 deductible and $0 premium on a benchmark Part D plan.3

QI: Qualifying Individual

QI covers the Part B premium only, the same as SLMB, but applies at a higher income band.

2026 Ohio QI income limit: up to $1,816/month for a single person, or $2,455/month for a couple, which is the range from 120% up to 135% of the Federal Poverty Level.1

Two structural differences set QI apart 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 aged, blind, and disabled (ABD) 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.1

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 barred from collecting it.

If you receive such a bill:

• Tell the provider you are a QMB enrollee and cite the federal balance-billing prohibition.
• Show your ODM eligibility notice or your Medicare card with the QMB indicator.
• Call 1-800-MEDICARE (1-800-633-4227) to file a complaint.
• Contact OSHIIP 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 (LIS). No separate application is required.

Under the 2026 Part D benefit, full Extra Help means:

• $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 for covered drugs after out-of-pocket costs reach the $2,100 annual cap3

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), 120% FPL (SLMB), and 135% FPL (QI), each with the $20 general income disregard applied. The resource limit for all three is $9,950 single / $14,910 couple.1,4

What Counts as a Resource, and What Doesn't

The $9,950 single / $14,910 couple resource test is less restrictive than it first appears, because several major assets are excluded entirely.1

Excluded (do not 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, burial space items, and irrevocable pre-need burial contracts

Counted:

• Checking and savings account balances
• Stocks, bonds, certificates of deposit, and 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.1

How to Apply for Ohio Medicare Savings Programs

The Ohio Department of Medicaid administers all three programs, and your county CDJFS office determines financial eligibility.1 Ohio offers several application pathways:

1. Online via Ohio Benefits. Apply at benefits.ohio.gov, the state's 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).

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

5. Through Social Security. Applying for Part D Extra Help at a Social Security Administration (SSA) 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, or MBI)
• Social Security card or proof of your 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 and the 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, so 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 and 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 limit, and stop. Ohio uses the SSI-related income methodology, which does not count every dollar.

The $20 general income disregard. Before Ohio counts income, $20 per month is excluded from unearned income such as Social Security, pensions, and VA compensation. This is why the effective QMB single ceiling works out to $1,350 rather than the gross federal poverty figure of $1,330.1

Earned income is discounted further. For applicants who still work, SSI methodology excludes part of any wages or self-employment income before counting it. A person with both a Social Security check and part-time earnings often has far lower countable income than their gross figures suggest.

Run the actual numbers, or have an OSHIIP counselor run them, before you conclude that you do not qualify.

Ohio-Specific Notes

Ohio is a Section 1634 state, meaning SSI recipients automatically receive Medicaid without a separate application. SSI recipients already enrolled in Medicaid may qualify for MSP protections through that enrollment.

The Affordable Care Act (ACA) QMB carve-out (42 USC § 1396p(b)(1)(B)) means Medicare cost-sharing paid through QMB, including Part A and Part B premiums, deductibles, and copays, is not recoverable under Ohio Medicaid estate recovery. This is a permanent protection in place since January 1, 2010.

For Ohio seniors who also qualify for full ABD Medicaid, QMB-Plus or SLMB-Plus may apply automatically. Ask your county CDJFS caseworker about your dual-eligibility status.

QDWI. Ohio also offers the Qualified Disabled and Working Individual (QDWI) program for people who returned to work, earned above the Substantial Gainful Activity level, and lost premium-free Part A as a result. QDWI pays the Medicare Part A premium and applies at 200% of the Federal Poverty Level, a published 2026 Ohio limit of $2,660/month for a single person, with a $4,000 resource limit.1 Unlike QMB, SLMB, and QI, QDWI does not automatically confer Part D Extra Help, and applicants must not be otherwise eligible for full Medicaid.

Learn More

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.