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

South Dakota's Medicare Savings Programs pay the Medicare Part B premium, which is $202.90 a month in 2026, and for the lowest-income tier they pay every Medicare deductible and copay as well. The South Dakota Department of Social Services runs all three programs, QMB, SLMB, and QI, for beneficiaries with limited income and savings.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 Medicare premiums and cost-sharing. There are four in all; this guide covers the three most people apply for, QMB, SLMB, and QI.2

In South Dakota, all three programs are administered by the South Dakota Department of Social Services (DSS). Each income limit below is a percentage of the Federal Poverty Level plus the $20 monthly Supplemental Security Income (SSI) general income exclusion, and DSS states that its 2026 income limits include that $20 disregard. The QMB and SLMB income figures are the federal 2026 standards from the Social Security Administration's table row that covers South Dakota; DSS itself publishes the same resource limit and the same top (QI) income limit.2

QMB: Qualified Medicare Beneficiary

QMB is the most comprehensive tier. It covers:

• The Medicare Part A premium (most beneficiaries have premium-free Part A after 40 or more quarters of work)
• The Medicare Part B premium, which is $202.90 per month in 2026
• The Part A inpatient hospital deductible, which is $1,736 per benefit period in 2026
• The Part B annual deductible, which is $283 in 2026
• All Medicare coinsurance and copays on every Medicare-covered service1

2026 QMB income limits (federal standard used in South Dakota): at or below $1,350/month for a single person, or at or below $1,824/month for a couple. These figures are 100% of the Federal Poverty Level plus the $20 income exclusion. The resource limit is $9,950 single, $14,910 couple.2

For a single South Dakota senior on Social Security, QMB wipes out the Part B premium ($202.90 a month, or $2,434.80 a year), the $283 Part B deductible, and the $1,736 Part A hospital deductible, plus every Medicare copay and coinsurance charge.1 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 a month, that is worth $2,434.80 for the year.1

2026 SLMB income limits (federal standard used in South Dakota): more than the QMB limit and up to $1,616/month for a single person, or up to $2,184/month for a couple. The resource limit is the same as QMB: $9,950 single, $14,910 couple.2

SLMB does not cover deductibles or copays. But for a beneficiary with relatively few medical claims, eliminating the Part B premium is the dominant cost saving. SLMB enrollment also triggers automatic Part D Extra Help, which cuts covered drug copays to $5.10 for generics and $12.65 for brand-name drugs in 2026.3

QI: Qualifying Individual

QI pays the Part B premium only, the same as SLMB, but applies at a higher income band: more than the SLMB limit and up to $1,816/month for a single person, or up to $2,455/month for a couple (2026 figures with the $20 disregard applied). The resource limit is $9,950 single, $14,910 couple.2

Three structural differences set QI apart from QMB and SLMB:

1. First-come, first-served. QI is paid from a capped annual federal allocation to each state, so it is granted first-come, first-served, with preference for people who received QI in the last month of the previous year.2 An applicant who meets the QI rules can still be turned away if the state has no slots left, and that denial says nothing about their Medicaid eligibility.4
2. Mutually exclusive with full Medicaid. Anyone eligible for full Medicaid cannot also be on QI. Someone who qualifies for both full Medicaid and a Medicare Savings Program is a QMB-Plus or SLMB-Plus enrollee instead, which is fuller coverage, not a loss of it.4
3. Reapply every year. Being selected for QI one year does not entitle you to assistance the next, so you have to apply again each year.2

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

The QMB Billing Prohibition

Federal law prohibits Medicare providers and suppliers, including pharmacies, from billing a QMB enrollee for Medicare Part A and Part B cost-sharing: the deductibles, coinsurance, and copays.2 This applies to Original Medicare and Medicare Advantage providers alike, whether or not they accept South Dakota Medicaid, and even if Medicaid doesn't pay them in full. QMB enrollees can't choose to pay those amounts, either. The one bill that can still come is a small Medicaid copayment, if one applies.5

If you are a QMB enrollee and you receive a bill for a deductible, coinsurance, or copay on a Medicare-covered service, do not pay it. The provider cannot legally collect it. Instead:

• Tell the provider you are enrolled in QMB and cite the federal prohibition.
• Show both your Medicare card and your Medicaid or QMB card. With Original Medicare, your Medicare Summary Notice also shows that you're in QMB.5
• Call 1-800-MEDICARE (1-800-633-4227) to file a complaint.6
• Contact SHIINE, South Dakota's State Health Insurance Assistance Program, for free help disputing the bill.

CMS tells providers to recall any bill for QMB Medicare cost-sharing, including bills sent to collections, and to refund any of that cost-sharing they already collected.5

Part D Extra Help / Low-Income Subsidy

Every QMB, SLMB, and QI enrollee in South Dakota is automatically deemed eligible for full Part D Extra Help (the Low-Income Subsidy). No separate application is required.2

In 2026, Extra Help sets your Part D deductible at $0, and your copay is at most $5.10 for a generic and $12.65 for a brand-name drug (some people who also have full Medicaid pay less). Once your out-of-pocket drug spending reaches $2,100 for the year, you pay $0 for covered drugs the rest of the year.3

The Centers for Medicare & Medicaid Services (CMS) notifies people who are deemed eligible that they don't need to apply for Extra Help.3

South Dakota Medicare Savings Programs: 2026 Income Limits at a Glance

These are the federal 2026 limits for every state except Alaska and Hawaii: 100% (QMB), 120% (SLMB), and 135% (QI) of the Federal Poverty Level, each plus the $20 monthly income exclusion. The resource limit for all three is $9,950 single, $14,910 couple.2 These are the federal standards rather than absolute cutoffs: states can effectively raise both the income and the resource limits by disregarding certain income and resources, so someone somewhat over should apply rather than rule themselves out.2

What Counts as a Resource in South Dakota

Unlike some states that have effectively dropped the asset test for these programs, South Dakota applies a resource limit of $9,950 for one person and $14,910 for a couple, and DSS publishes that limit itself. It is not a limit on everything you own.2

Excluded (do not count), per DSS:

• Your home
• One car per couple used for transportation
• Burial plots, and up to $1,500 set aside for burial expenses
• A limited amount in an irrevocable burial trust2

Counted (the examples DSS names):

• Checking and savings accounts
• Certificates of deposit2

Ask DSS how it treats anything else you own, such as investments or a second property.

A QMB applicant who owns a paid-off house can still qualify, provided bank balances and other financial assets stay within the $9,950 single or $14,910 couple limit. The home does not count against you. And if your savings are a little over, apply anyway: federal guidance tells Social Security staff to encourage people whose income or resources look somewhat higher than the limits to apply.2

Where to Get Help in South Dakota

How to Apply for South Dakota Medicare Savings Programs

Effective Dates and Retroactive Coverage

• QMB: coverage applies to services you get after the end of the month in which DSS approves you. Under Social Security Act § 1902(e)(8), QMB runs forward only and can't reach back to earlier bills, so apply as early as possible.9
• SLMB and QI: the federal sources we rely on set no specific retroactive window for these two programs, so ask DSS how far back your coverage can begin.9 For comparison, ordinary Medicaid must cover eligible services from as early as the third month before the month you apply. That is a federal default: a state's window can be shorter under an approved Section 1115 demonstration, and South Dakota's own state plan sets the exact start date.4

Learn More

Find personalized help applying for South Dakota 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.