Oregon Medicare Savings Programs 2026: QMB, SLMB & QI

If Medicare's monthly premium is straining your budget, Oregon's Medicare Savings Programs can wipe it out, and for the lowest incomes cover Medicare's Part A and Part B deductibles and copays too. Better still, Oregon counts none of your savings or property when it decides whether you qualify.1

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. There are four, each tied to a share of the federal poverty level: Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), Qualifying Individual (QI), and Qualified Disabled Working Individual (QDWI).1

Oregon's Medicaid program is the Oregon Health Plan, administered by the Oregon Health Authority.3 The Medicare Savings Programs themselves are run by the Oregon Department of Human Services (ODHS), which decides who qualifies. ODHS requires every applicant to have Medicare Part A.1 Under the federal rules, SLMB and QI also require Medicare Part B.1

The single most important thing to know before you rule yourself out: Oregon does not count your assets. The federal standard caps QMB, SLMB and QI eligibility at $9,950 in resources for one person and $14,910 for a couple. Oregon applies no such limit, so a paid-off home, a full savings account, or a retirement fund does not disqualify you here. Only your monthly income is measured against the limits below.1

QMB: Qualified Medicare Beneficiary

QMB is Oregon's most complete Medicare Savings Program. For a person whose income fits, it can bring nearly every Medicare cost to zero. QMB pays:

• The Medicare Part B premium, which is $202.90 per month in 2026 ($2,434.80 for the year)4
• The Medicare Part A premium, if you pay one (most people pay nothing, because they or a spouse paid Medicare taxes long enough while working, generally at least 10 years)
• The Part A hospital deductible, $1,736 per benefit period in 2026
• The Part B annual deductible, $283 in 2026
• All Part A and Part B coinsurance and copays, including the 20% Part B coinsurance on most outpatient services4

2026 Oregon QMB income limit: at or below $1,330 per month for one person (100% of the federal poverty level) or $1,804 for a couple. Those are the figures ODHS publishes, and they are the poverty level itself, measured before the $20 SSI general income exclusion. SSA's federal figures for the same limit add that $20: $1,350 for one person and $1,824 for a couple, so income between the two is worth an application. Oregon applies no asset limit.1

For an Oregon senior living on Social Security, QMB covers the full $202.90 monthly Part B premium ($2,434.80 a year) plus every Part A and Part B deductible and copay, and the Part A hospital deductible alone is another $1,736 in any year with an inpatient stay.4 QMB does not cover Part D drug-plan copays, but every QMB enrollee is automatically deemed eligible for Extra Help, which holds those copays to no more than $12.65 per covered drug in 2026.1

SLMB: Specified Low-Income Medicare Beneficiary

Oregon SLMB pays your Medicare Part B premium and nothing else. At the 2026 rate, that is worth $202.90 a month, or $2,434.80 over the year, back in your Social Security check.4

2026 Oregon SLMB income limit: at or below $1,596 per month for one person (120% of the federal poverty level) or $2,164 for a couple. As with QMB, those are ODHS's bare poverty-level figures; SSA's federal figures, with the $20 general income exclusion added, are $1,616 and $2,184. Oregon counts no assets.1

SLMB does not pay deductibles or copays, but for a healthy beneficiary who rarely sees a doctor, the Part B premium is usually the largest Medicare cost of the year, and SLMB erases it. SLMB enrollment also triggers automatic Part D Extra Help, which caps prescription copays at $5.10 per generic and $12.65 per brand-name drug, with a $0 Part D deductible.2

QI: Qualifying Individual

QI also pays the Part B premium only, and in Oregon it goes by a different name: ODHS calls it the SMF benefit. Its income limit sits above SLMB: at or below $1,796 per month for one person or $2,435 for a couple in Oregon, with no asset test. Again, those are the figures ODHS publishes; SSA's federal figures, with the $20 general income exclusion added, are $1,816 and $2,455.1

Three features set QI apart from QMB and SLMB:

1. Enrollment is capped. QI is paid from a capped federal allocation each year, granted first-come, first-served, with preference for people who had QI in the last month of the previous year.1 ODHS says it can serve only a set number of people each year for the SMF benefit and must shut down enrollment if it reaches that limit, so apply early in the year.1
2. You can't have any other Oregon Medicaid. ODHS says that if you are eligible for any other Medicaid benefit Oregon offers, you are not eligible for the SMF benefit.1 You may still qualify for help through another Medicare Savings Program.1
3. You must apply every year. Being selected for QI in one year does not entitle you to it the next, so file again each year to stay in the program.1

Like SLMB, QI enrollment automatically qualifies you for Part D Extra Help.

QDWI: For Disabled Workers Who Lost Free Part A

ODHS lists a fourth program, the Qualified Disabled Working Individual (QDWI) program, which helps pay the Medicare Part A premium only. It is for disabled workers who lost Social Security disability benefits because they are working and who aren't eligible for another Medicaid program. Its income limit is the highest of the four, and for one person exactly twice the QMB figure: $2,660 a month for one person or $3,607 for a couple (200% of the federal poverty level), with no asset test in Oregon. If you're in that group and your income is too high for QMB, SLMB and QI, this one may still fit.1

Two differences matter. QDWI does not automatically qualify you for Part D Extra Help.1 And if you want full Medicaid coverage while working, ODHS points to Oregon's separate Employed Persons with Disabilities (EPD) program instead.1

Does Oregon Count Your Home or Savings?

No. This is where Oregon breaks from the federal default. The federal standard for QMB, SLMB and QI is a resource limit of $9,950 for one person and $14,910 for a couple, and states may loosen it. Oregon imposes no asset or resource limit on any of its Medicare Savings Programs.1

That means the following do not affect your eligibility in Oregon at all:

• Your home, whatever it is worth
• Money in checking, savings, or certificates of deposit
• Stocks, bonds, mutual funds, and retirement accounts
• A second vehicle or other property

Only your monthly income is measured against the QMB, SLMB, and QI limits. Many Oregon seniors assume a paid-off home or a modest nest egg rules them out. In Oregon, it does not.1

The QMB Billing Protection

Once you are a QMB enrollee, federal law prohibits Medicare providers and suppliers, including pharmacies, from billing you for Medicare Part A and Part B deductibles, coinsurance, and copays. This protection applies to Original Medicare and Medicare Advantage providers alike, including ones that don't accept Medicaid.5

The one bill that can still come is a small Medicaid copayment, if one applies.5 If you have QMB and receive a bill for a Medicare deductible, coinsurance, or copay, do not pay it. Instead:

• Tell the provider you are a QMB enrollee and that federal law bars the charge.
• Show your Medicare card and your Medicaid or QMB card.5
• Call Medicare's official line, 1-800-MEDICARE (1-800-633-4227), which answers 24 hours a day, 7 days a week, except some federal holidays.6
• Contact Oregon SHIBA (Senior Health Insurance Benefits Assistance) at 1-800-722-4134 for free counseling.7

CMS tells providers to recall any bill for QMB cost-sharing, including one turned over to collections, and to refund anything you already paid.5

Part D Extra Help for Prescription Drugs

Every Oregon QMB, SLMB, and QI enrollee is automatically deemed eligible for full Part D Extra Help, the Low-Income Subsidy that lowers prescription costs. No separate application is required.2

Under the 2026 Extra Help benefit, a full-subsidy enrollee pays:

• $0 for the Part D premium on a benchmark plan
• $0 Part D deductible
• No more than $5.10 for each generic prescription
• No more than $12.65 for each brand-name drug
• $0 for covered drugs once out-of-pocket costs reach the $2,100 annual cap2

The $0 premium covers a plan priced at or below your region's benchmark; pick a pricier plan and you pay the difference. Because QMB, SLMB and QI enrollees are treated as eligible by federal rule, CMS notifies you that you don't need to file a separate Extra Help application.2

Oregon Medicare Savings Programs: 2026 Income Limits at a Glance

The first figure in each cell is what Oregon ODHS publishes for March 2026 through February 2027, the poverty-level percentage itself. The second is SSA's federal figure for the same program, $20 higher because it adds the federal $20/month SSI general income exclusion. Both describe the same limit, so if your income falls between the two, apply. The $20 adjustment does not carry over to QDWI, which is shown as ODHS publishes it. Oregon applies no asset or resource test to any of the four programs. Confirm current figures with Oregon SHIBA or ODHS.1

What If Your Income Is Just Over the Limit?

The most common reason eligible Oregon seniors skip these programs is that they compare their income to the ODHS figure and stop at the first dollar over. Two published sets of figures describe the same QMB, SLMB and QI limits. ODHS lists the bare poverty-level percentages. SSA's federal tables list the same limits with the $20 monthly Supplemental Security Income (SSI) general income exclusion already added, so each SSA figure is exactly $20 above Oregon's.1

That gap matters if your income sits just above an ODHS figure. A single applicant with income above $1,330 and up to $1,350 is over ODHS's published QMB figure but within SSA's, and may still qualify. Neither ODHS nor SSA spells out on those pages which kinds of income Oregon counts or leaves out, so don't screen yourself out on the headline number. SSA tells its own staff to encourage people whose income looks somewhat higher than the limits to apply anyway; ODHS makes the actual decision.1

If your income is anywhere near a limit, apply and let ODHS run the actual calculation rather than assuming you earn too much.

How to Apply for Oregon Medicare Savings Programs

Oregon offers three ways to apply.3

1. Online. Apply through the state's ONE system at one.oregon.gov.3

2. By phone. Call ODHS at 1-800-699-9075.3

3. In person. Visit a local ODHS office or an OHP-certified community partner.3 Bring your Medicare card and the documents listed below.

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
• Your most recent Social Security benefit or cost-of-living notice
• Recent bank and investment statements
• Pension or annuity statements, if you have them
• Proof of Oregon residency, such as a utility bill, lease, or mortgage statement

How Long a Decision Takes

ODHS says it will let you know if you are approved within 45 days of the date you apply.1 Federal rule sets the same outer limit: no more than 45 days, or 90 days for someone who applies for Medicaid on the basis of disability.8 The rule allows longer only in unusual circumstances, for example when an applicant or examining physician delays a required step, or an emergency beyond the agency's control. When the agency does run late it must record why in your case file, and it can't use the time limit as a waiting period or as a reason to deny you.8 Which limit applies turns on the basis you applied under. If you applied on the basis of age rather than disability, your limit is the 45-day one, and a decision still pending on day 46 is late enough to call about.

When Coverage Starts

• QMB covers services from the month after the month ODHS approves you. Federal law (Social Security Act §1902(e)(8)) makes QMB coverage prospective, with no look-back, so apply as early as you can.9
• SLMB and QI start dates are not set by that rule. Ask ODHS how far back your coverage can reach before you assume a start month.9

After approval, Oregon starts paying your Part B premium, and the deduction from your Social Security check stops. The switch runs through a state-to-Medicare data exchange, so you may keep seeing the premium withheld for a month or more. Once the state's payment takes effect, SSA refunds any premiums deducted for months it covers.10

Learn More

Find personalized help applying for Oregon 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.