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. Federal rules define four of them by income relative to the Federal Poverty Level. Three of the four, QMB, SLMB, and QI, are the programs this guide covers. The fourth, QDWI, is narrower: it pays the Part A premium for certain working people with disabilities who lost premium-free Part A, and unlike the other three it does not confer Part D Extra Help.1

South Carolina Healthy Connections Medicaid, administered by the South Carolina Department of Health and Human Services (SCDHHS), runs QMB, SLMB, and QI.1 Financial eligibility for Medicare Savings Programs is determined under the Supplemental Security Income (SSI) program's counting rules rather than the MAGI rules used for most Medicaid: the federal QMB definition sets income as determined under SSI's income rules and resources as determined under SSI's resource rules.2 A $20/month general income disregard is subtracted from countable income before it is compared to each program's limit. SCDHHS publishes its 2026 income standards, effective 03/01/2026, before that $20: $1,330 single / $1,804 couple for QMB, $1,596 / $2,164 for SLMB, and $1,796 / $2,435 for QI. SSA's 2026 table states the same standards with the $20 added, exactly $20 higher in each case, and those are the figures this guide uses below.1 One SSI rule protects applicants every January: for someone drawing Social Security, the QMB income test does not count the annual cost-of-living raise during the transition months that run through the month after the new poverty guidelines are published. A January raise does not push you over a limit that has not been updated yet.2

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)3
• The Medicare Part B premium, which is $202.90 per month in 2026 per the 2026 CMS Parts A & B premiums fact sheet3
• The Part A inpatient hospital deductible, $1,736 per benefit period in 20263
• The Part B annual deductible, $283 in 20263
• All Medicare coinsurance and copays on every Medicare-covered service1

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; SCDHHS's own page shows the same standard as $1,330 / $1,804, before the $20.1

Countable resource limit: $9,950 for one person, $14,910 for a couple. SCDHHS's test is on countable resources, not on everything you own.1 The home you live in and one vehicle used for transportation are not counted.4

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.3 Every QMB enrollee is also automatically deemed eligible for full Part D Extra Help.1

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.3

2026 South Carolina SLMB income limits: $1,351 to $1,616/month for a single person, $1,825 to $2,184/month for a couple. SLMB starts where QMB stops: a couple at exactly $1,824 is a QMB, not an SLMB.1

Countable 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.5 Full Extra Help also eliminates the annual Part D deductible entirely6 and pays the premium for a plan's basic coverage in full when that basic premium is at or below your region's low-income benchmark.6

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

Three structural differences from QMB and SLMB:

1. First-come, first-served. QI is paid for out of a capped annual federal allocation to each state and granted first-come, first-served, with preference for people who received QI in the last month of the previous year.1 QI is not an entitlement: CMS says QIs are covered to the extent their state has available slots, so an eligible applicant can still be turned away for want of one.7
2. Mutually exclusive with other Medicaid eligibility. Federal statute defines the QI group as people who are "not otherwise eligible for medical assistance under the State plan," so the bar is broader than full Medicaid alone: qualifying for any other Medicaid eligibility group rules out QI. Someone who qualifies for both an MSP and full Medicaid is a QMB-Plus or an SLMB-Plus, never a QI.7
3. You must reapply every year. Being selected for QI in one year does not entitle you to continued assistance in the next, so file again each year.1

Like SLMB, QI enrollment triggers automatic Part D Extra Help.1

The QMB Billing Prohibition

Federal law prohibits Medicare providers and suppliers, including pharmacies, from billing a QMB enrollee for Medicare cost-sharing: the Part A and Part B deductibles, coinsurance, and copayments on Medicare-covered services. That is what "balance billing a QMB" means, and it is barred.1,8

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. You have no legal obligation to pay it, and you cannot choose to pay it either: CMS says QMBs may not elect to pay Medicare deductibles, coinsurance, and copayments.8

If you receive such a bill:

• Tell the provider you are a QMB enrollee and cite federal law.
• Show your Medicare card and your Medicaid or QMB card, which medicare.gov says to show each time you get care. With Original Medicare, a Medicare Summary Notice also shows you are in the QMB program.8
• If the billing continues, call 1-800-MEDICARE (1-800-633-4227; TTY 1-877-486-2048). Medicare can confirm your QMB status and ask the provider to stop billing you and refund what you already paid.9,10
• Contact South Carolina's State Health Insurance Assistance Program (SHIP) (official page), which GetCareSC.com says is also called I-CARE (Insurance Counseling Assistance and Referrals for Elders).11 It offers free, one-on-one insurance counseling to Medicare beneficiaries, their families, and caregivers, and its counselors assist with Medicare Savings Programs and help resolve billing problems. Reach it by calling the South Carolina Department on Aging at 1-800-868-9095 or through your local Area Agency on Aging.11

CMS tells providers to recall any bill for QMB Medicare cost-sharing, including bills turned over to collections, and to refund any QMB cost-sharing money they collected.8

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.5

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

• $0 premium for a plan's basic coverage if that basic premium is at or below your Part D region's cap, which is the greater of the region's low-income benchmark and its lowest basic plan premium. The subsidy never reaches the part of an enhanced plan's premium that pays for extra benefits, and if you choose a costlier plan you owe the difference between that plan's premium and the benchmark.6
• $0 annual deductible. The 2026 standard rule lets a Part D plan charge a deductible of up to $615; full Extra Help removes it entirely.6
• No more than $5.10 per generic prescription5
• No more than $12.65 per brand-name covered drug5
• $0 for covered drugs once spending on your behalf reaches the 2026 out-of-pocket threshold of $2,100. Certain payments made for you, including payments through Extra Help itself, count toward that $2,100, so you reach the cap on the total counted rather than only on what came out of your own pocket.12

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.5

CMS notifies a deemed enrollee that they do not need to apply for Extra Help.5 Extra Help pays toward a Part D plan, so if you are not in one yet, South Carolina's SHIP counselors can help you compare and enroll in a drug plan at no charge.11

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. SCDHHS publishes the same standards $20 lower, before the disregard, with an effective date of 03/01/2026. Countable resource limit for all three: $9,950 single / $14,910 couple; SCDHHS dates its QMB resource figures 01/01/2026.1 These are the federal standards, not a hard cutoff to screen yourself against: states can effectively raise both the income and the resource limits by disregarding certain income and resources, and Social Security instructs its staff to encourage people to apply even when income or resources look somewhat high. If you are near a line, apply and let SCDHHS run your numbers.1

What Counts as a Resource, and What Doesn't

The $9,950/$14,910 test is less restrictive than it first appears, because it measures countable resources under SSI's rules.2

Excluded (these are examples; SSA's full list of exclusions is longer):4

• The home you live in, and the land it sits on4
• One vehicle, regardless of value, used for transportation4
• Household goods and personal effects4
• Up to $1,500 in funds specifically set aside and clearly designated for your burial expenses, plus a separate $1,500 for a spouse. The money must be kept separate from your other resources; if burial funds are mixed with money not meant for burial, the exclusion applies to none of them.2 That $1,500 is then reduced by any amount in an irrevocable burial arrangement or burial trust, and by the face value of any life insurance whose cash surrender value is already excluded, any burial insurance policy for your own burial expenses, and any life policy on which a funeral provider is the irrevocable beneficiary. Burial insurance reduces it dollar for dollar even though the policy has no cash surrender value, so a $1,200 final-expense policy leaves $300 of burial-fund exclusion, not $1,500.4

Counted:

• Checking and savings account balances
• Stocks, bonds, certificates of deposit, mutual funds
• A second vehicle, or a home you do not live in, unless another exclusion applies: the exclusions above cover one vehicle and the home you live in4
• The cash surrender value of life insurance, when the total face value of all policies on one person is more than $1,500. At $1,500 or less in total face value, the cash surrender value is excluded entirely. Term insurance and burial insurance are not counted in that face-value total.4

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.4

How to Apply for South Carolina Medicare Savings Programs

You apply for all three programs through SCDHHS (Healthy Connections): online, by mail to SCDHHS-Central Mail in Columbia, or at a local county office.1 South Carolina's SHIP offers free counseling and assists with Medicare Savings Programs.11

Online via Healthy Connections. Apply at apply.scdhhs.gov, SCDHHS's online portal.13 Create an account, complete the application, and upload supporting documents.

On paper, by mail, fax, or at a local county office. A paper application can be mailed to SCDHHS Central Mail, faxed, or taken to a local county office.13 Bring your Medicare card, Social Security award letter, recent bank statements, and proof of South Carolina residency.

If SCDHHS says no. South Carolina notices give 30 days to appeal, and the deadline is printed on the notice. You can file an eligibility appeal online at www.scdhhs.gov/appeals, by email to eligappeals@scdhhs.gov, or by phone at 1-888-549-0820, stating what you are appealing and why.14

With free counseling. South Carolina's SHIP counselors assist with Medicare Savings Programs at no charge, and GetCareSC says you can talk to a SHIP counselor at your local Area Agency on Aging to find out if you're eligible for savings programs that help pay Part B premiums. Call the South Carolina Department on Aging at 1-800-868-9095 or contact your local Area Agency on Aging.11

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 runs forward, not backward. Social Security Act §1902(e)(8) (42 USC § 1396a(e)(8)) provides that a QMB determination applies to services furnished after the end of the month in which the determination is first made, so QMB begins with services furnished after your determination month. Apply as early as possible.15
• SLMB and QI: do not count on three months of back coverage. Section 1902(e)(8) names only qualified medicare beneficiaries, and the general Medicaid effective-date rule at 42 CFR § 435.915 does not name SLMB, QI, or Medicare Savings Programs anywhere, so neither source behind this guide states how far back SLMB or QI coverage can reach. That general rule's three-month reach would not be automatic in any case: it requires that you actually received covered services in those months and would have been eligible then, and the state plan fixes the operative date. Ask SCDHHS what your effective date will be, and file early either way.15

After approval, SCDHHS sends a written eligibility notice. For QMB, SLMB, and QI alike, the state then pays your Part B premium under a "state buy-in" agreement, the federal government stops collecting it from you, and the deduction comes off your Social Security check. Buy-in is established through a state-to-CMS data exchange rather than instantly at approval, so you may keep seeing the premium withheld for one or more months. If your premium comes out of a Social Security, RRB, or OPM benefit, that deduction can continue for a month or more, and SSA refunds every month you were covered by buy-in. If instead CMS bills you directly, which it does when you do not receive one of those benefits, keep paying that bill until buy-in is actually in effect: the only exception CMS states to the premium obligation is a state already paying under a buy-in agreement, and unpaid premiums can end your Part B coverage. In the meantime: once buy-in is effective, SSA is required to refund any premiums that were deducted, including any late-enrollment penalties, for every month you are enrolled in buy-in, and that refund is not counted as income under SSI rules.16

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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.