South Carolina Medicare Savings Programs 2026: QMB, SLMB & QI

South Carolina Medicare Savings Programs pay Medicare premiums and cost-sharing for income-eligible seniors and people with disabilities enrolled in Medicare. The broadest tier, QMB, wipes out the Part B premium and all Medicare cost-sharing in a single program.

What Are Medicare Savings Programs?

Medicare Savings Programs (MSPs) 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 plan, including South Carolina's, must cover them.1

South Carolina Healthy Connections Medicaid, administered by the South Carolina Department of Health and Human Services (SCDHHS), runs all three programs. Financial eligibility for Medicare Savings Programs uses the Supplemental Security Income (SSI) related income methodology rather than the MAGI rules used for most Medicaid. A $20/month general income disregard is subtracted from countable income before it is compared to each program's limit, so the South Carolina income figures below reflect that $20 disregard already applied.1

QMB: Qualified Medicare Beneficiary

QMB provides the broadest protection. It covers:

• The Medicare Part A premium (most beneficiaries have premium-free Part A after 40 work quarters)
• The Medicare Part B premium, which is $202.90 per month in 2026 per the 2026 CMS Parts A & B premiums fact sheet2
• The Part A inpatient hospital deductible, $1,736 per benefit period in 20262
• The Part B annual deductible, $283 in 20262
• All Medicare coinsurance and copays on every Medicare-covered service

2026 South Carolina QMB income limits: at or below $1,350/month for a single person, or at or below $1,824/month for a couple. These 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 South Carolina enrollee, the Part B premium alone is $2,434.80 a year (12 months at $202.90), and QMB adds the Part A and Part B deductibles plus all coinsurance and copays on top of that.2 Every QMB enrollee is also automatically deemed eligible for full Part D Extra Help.

SLMB: Specified Low-Income Medicare Beneficiary

SLMB covers one benefit: the Medicare Part B premium. At the 2026 standard rate of $202.90 per month, that is worth $2,434.80 per year.2

2026 South Carolina SLMB income limits: $1,351 to $1,616/month for a single person, $1,824 to $2,184/month for a couple.1

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

SLMB does not pay deductibles or copays. For a beneficiary with few Medicare claims in a given year, the Part B premium savings is the biggest expense SLMB addresses.

SLMB also confers automatic Part D Extra Help, which in 2026 caps drug costs at no more than $5.10 per generic and $12.65 per brand-name prescription, 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, at a higher income band than SLMB: $1,617 to $1,816/month for a single person, $2,185 to $2,455/month for a couple (2026 South Carolina figures).1

Two structural differences from QMB and SLMB:

1. First-come, first-served. QI is funded through a capped federal allotment. SCDHHS allocates enrollment first-come, first-served, with a preference for prior-year QI enrollees. QI is not an entitlement: enrollment can close if 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 South Carolina Medicaid.1

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 SCDHHS eligibility notice or Medicare card with the QMB indicator.
• Call 1-800-MEDICARE (1-800-633-4227) to file a complaint.
• Contact South Carolina's I-CARE program (Insurance Counseling Assistance and Referrals for Elders), the state's free Medicare counseling service run by the South Carolina Department on Aging, for one-on-one help.4

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 South Carolina 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 plan3
• $0 annual deductible3
• No more than $5.10 per generic prescription3
• No more than $12.65 per brand-name or preferred multi-source drug3
• $0 for covered drugs once your out-of-pocket spending reaches the 2026 catastrophic threshold of $2,1005

For a senior filling several prescriptions a month who would otherwise pay full retail, capping each generic at $5.10 and each brand-name drug at $12.65 is a substantial saving on top of the premium relief that SLMB or QI already provides.3

The deeming flows automatically from SCDHHS 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.

South Carolina 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:1

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 designated burial fund within the SSI limit

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

A QMB applicant in a paid-off house worth $250,000 can still qualify as long as bank balances and other financial assets fall within $9,950. The home simply doesn't count.1

How to Apply for South Carolina Medicare Savings Programs

South Carolina offers four ways to apply. Any one of them starts your application:1

Online via Healthy Connections. Apply at apply.scdhhs.gov, SCDHHS's online portal for Medicaid and related benefit programs. Create an account, complete the application, and upload supporting documents.

In person at a local SCDHHS county office. Bring your Medicare card, Social Security award letter, recent bank statements, and proof of South Carolina residency. SCDHHS staff can help with paper applications at county offices.

By phone. Call SCDHHS at 1-888-549-0820. Staff can take applications by phone for applicants who cannot access the online portal or visit an office.

Through Social Security. Applying for Part D Extra Help at your Social Security office using Form SSA-1020 generates an automatic referral to South Carolina Medicaid under federal law (42 USC § 1320b-14). Your SSA application date serves 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 South Carolina residency (utility bill, lease, or mortgage statement)

Effective Dates and Retroactive Coverage

• QMB: coverage begins the first day of the month after SCDHHS approves your 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. File early even if you can't gather every document on day one.

After approval, SCDHHS 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; because buy-in is processed through a periodic state-to-CMS data exchange rather than instantly, the deduction may take a month or more to stop, and any premiums withheld in the meantime are credited back.6

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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.