Pennsylvania Medicare Savings Programs 2026: QMB, SLMB & QI

Pennsylvania 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 Pennsylvania Department of Human Services (DHS) administers all three programs, known in Pennsylvania as part of the "Healthy Horizons" Medical Assistance (MA) program. Financial eligibility is determined by county Assistance Offices (CAOs) across the Commonwealth's 67 counties. Residents apply through the COMPASS portal or in person at their local CAO.

Pennsylvania MSPs are governed by 55 Pa. Code Ch. 140 Subchapter B. Because MSPs use the Supplemental Security Income (SSI)-related income methodology rather than the MAGI rules that govern most Medicaid, a $20 monthly general income disregard is subtracted from unearned income such as Social Security before eligibility is measured, and applicants who work receive an additional earned-income disregard on top of that. The income bands below already reflect the $20 disregard, which is why Pennsylvania's QMB single ceiling is $1,350 rather than the gross 100% federal poverty level figure of $1,330.1

QMB: Qualified Medicare Beneficiary

QMB is the most comprehensive program. It covers:

• The Medicare Part A premium (about 99% of beneficiaries have premium-free Part A from 40 or more work quarters)
• The Medicare Part B premium, which is $202.90 per month at the 2026 standard rate
• 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 Pennsylvania QMB income limits: at or below $1,350 per month for a single person, or at or below $1,824 per month for a couple. These figures reflect 100% of the federal poverty level 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 this count.1

For a single Pennsylvania senior on Social Security, QMB is worth more than $2,700 a year in Part B premiums and deductibles alone ($2,434.80 in annual Part B premiums plus the $283 Part B deductible), and more once Medicare coinsurance and copays are added. Every QMB enrollee is automatically deemed eligible for full Part D Extra Help.2

SLMB: Specified Low-Income Medicare Beneficiary

SLMB covers one thing: the Medicare Part B premium. At the 2026 standard premium rate of $202.90 per month, eliminating the Part B premium is worth about $2,435 per year ($202.90 times 12 months).2

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

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

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 in 2026 caps drug copays at no more than $5.10 per generic and $12.65 per brand-name drug, with a $0 deductible and a $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: $1,617 to $1,816 per month for a single person, $2,185 to $2,455 per month for a couple (2026 Pennsylvania figures).1

Two structural differences from QMB and SLMB:

1. First-come, first-served. QI is funded through a capped federal allotment. Pennsylvania 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 Pennsylvania Medical Assistance (the ABD MA pathway) cannot enroll in QI. They would qualify instead for QMB-Plus or SLMB-Plus, which combine MSP cost-sharing protection with full MA 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 Pennsylvania Medical Assistance.

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 PA DHS eligibility notice or Medicare card with QMB indicator.
• Call 1-800-MEDICARE (1-800-633-4227) to file a complaint.
• Contact APPRISE (Pennsylvania's SHIP program) at 1-800-783-7067 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 Pennsylvania 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, full Extra Help means:

• $0 Part D premium on a benchmark plan
• $0 annual deductible
• No more than $5.10 per generic prescription
• No more than $12.65 per brand-name or preferred multi-source drug
• $0 in copays after out-of-pocket drug costs reach the $2,100 annual catastrophic threshold3

For a senior filling several prescriptions a month, Part D Extra Help can add up to hundreds or even a few thousand dollars in annual drug-cost savings on top of the Part B premium benefit.

The deeming flows automatically from PA DHS 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.

Pennsylvania 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.1

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.1

Excluded (don't count):

• Primary residence, regardless of value or equity
• One vehicle, regardless of value (55 Pa. Code § 178.131)
• Household goods and personal effects
• A prepaid irrevocable burial reserve, within Pennsylvania's limit, plus unlimited burial space items
• Wedding and engagement rings

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 Pennsylvania 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 Pennsylvania Medicare Savings Programs

Pennsylvania offers multiple application pathways:

1. Online via COMPASS Apply at compass.dhs.pa.gov or through the myCOMPASS PA mobile app. COMPASS is the Commonwealth's self-service portal for Medical Assistance and related programs.

2. In person at your county CAO Pennsylvania has 67 county Assistance Offices. Bring your Medicare card, Social Security award letter, recent bank statements, and proof of Pennsylvania residence. To find your local CAO, visit www.dhs.pa.gov.

3. By phone Contact the PA DHS Consumer Service Center at 1-866-550-4355 (Mon-Fri, 8 a.m. to 4:30 p.m. ET). As of June 2025, phone intake is available for Medical Assistance applications.

Through the Social Security Administration. Applying for Part D Extra Help at a Social Security Administration (SSA) office using Form SSA-1020 automatically generates a referral to Pennsylvania Medicaid. SSA is required by federal law (42 USC § 1320b-14) to forward the application to the state.

Through APPRISE. Pennsylvania's APPRISE program (SHIP) provides free, unbiased Medicare counseling including MSP application assistance. Call 1-800-783-7067 to find a local APPRISE counselor.

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 Pennsylvania residency (utility bill, lease, or mortgage statement)

Determination Timeline

PA DHS must process non-disability MSP applications within 30 days (Pennsylvania applies a 30-day standard). Disability-based applications get 90 days.

Effective Dates and Retroactive Coverage

• QMB: coverage begins the first day of the month after the month DHS 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, DHS 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.

How the Income Disregards Work

The most common reason eligible Pennsylvania 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.

The $20 general income disregard: Before counting income, $20 per household each month is excluded from unearned income such as Social Security, pensions, and VA compensation. This is why Pennsylvania's QMB single ceiling is $1,350 rather than the gross 100% federal poverty level figure of $1,330.1

An added disregard for earned income: Applicants who have wages or self-employment income receive a further earned-income disregard under the same SSI-related methodology, so a person with both Social Security and part-time earnings often has substantially lower countable income than their gross pay suggests.

Run the actual numbers before concluding you do not qualify.

Pennsylvania-Specific Notes

Pennsylvania is a 1634 state, meaning SSI recipients automatically receive Medical Assistance without a separate application. SSI recipients already enrolled in MA may be automatically enrolled in QMB-Plus as part of their full-dual status.

Pennsylvania is a Medically Needy state for its ABD Medical Assistance program, with a medically-needy net-income limit of $2,550 on a semi-annual basis. This has no direct effect on MSP income limits, but it means that Pennsylvania seniors with incomes above the ABD categorical level may still access full MA through a spend-down process, and once they do, they become eligible for QMB-Plus or SLMB-Plus rather than standalone MSP.4

The ACA QMB carve-out (42 USC § 1396p(b)(1)(B)) means that Medicare cost-sharing paid through QMB is NOT recoverable under Pennsylvania's estate recovery program. Pennsylvania is a probate-only estate recovery state to begin with, which is more consumer-friendly than most.

For Pennsylvania seniors who also qualify for full ABD Medical Assistance, QMB-Plus or SLMB-Plus may apply automatically. Check with your county CAO about dual-eligibility status.

Learn More

Find personalized help applying for Pennsylvania 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.