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. QMB, SLMB, and QI are mandatory eligibility groups under Title XIX of the Social Security Act, so every state Medicaid plan must cover them.2

In South Dakota, all three programs are administered by the South Dakota Department of Social Services (DSS) through its Economic Assistance division. Eligibility uses the Supplemental Security Income (SSI)-related income methodology, which applies a $20 general income disregard to your unearned income (such as Social Security) before it is compared to the limit. The income figures below already reflect that $20 disregard.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 South Dakota QMB income limits: at or below $1,350/month for a single person, or at or below $1,824/month for a couple. These figures reflect 100% of the Federal Poverty Level with the $20 general income disregard applied. 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 South Dakota SLMB income limits: 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

Two structural differences set QI apart from QMB and SLMB:

1. First-come, first-served. QI is funded through a capped federal allotment. DSS 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 carries no enrollment guarantee.
2. Mutually exclusive with full Medicaid. Anyone eligible for full Medicaid cannot also be on QI. Those individuals qualify instead for QMB-Plus or SLMB-Plus, which layer full Medicaid on top of the Medicare Savings Program protections.2

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

The QMB Billing Prohibition

Federal law (42 U.S.C. § 1396a(n)(3)(B)) prohibits any Medicare provider from billing a QMB enrollee for Medicare cost-sharing. This applies to Original Medicare and Medicare Advantage providers alike, whether or not they participate in South Dakota Medicaid. Federal guidance states the bar applies "under any circumstances."2

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 your DSS eligibility notice or your Medicare card with the QMB indicator.
• Call 1-800-MEDICARE (1-800-633-4227) to file a complaint.
• Contact SHIINE, South Dakota's State Health Insurance Assistance Program, for free help disputing the bill.

A provider who has already billed a QMB enrollee must recall the bill from any collections process and refund payments already collected.

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

Under the 2026 Part D benefit rules, full Extra Help caps your out-of-pocket cost at $5.10 per generic prescription and $12.65 per brand-name or preferred multi-source drug, and 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 deeming flows automatically from DSS to the Centers for Medicare & Medicaid Services (CMS) each month after your Medicare Savings Program enrollment. If you are not already in a Part D plan, CMS assigns you to a benchmark plan.

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

These income limits reflect 100% of the Federal Poverty Level for QMB, 100 to 120% for SLMB, and 120 to 135% for QI, each with the $20 general income disregard applied. The resource limit for all three is $9,950 single, $14,910 couple.2

What Counts as a Resource in South Dakota

Unlike a handful of states that drop the asset test for these programs, South Dakota applies a resource limit of $9,950 for one person and $14,910 for a couple. The test excludes several major asset categories.2

Excluded (do not count):

• Your primary residence, regardless of value or equity
• One vehicle, regardless of make, model, or value
• Household goods and personal effects
• A burial plot and up to $1,500 per person set aside for burial expenses2

Counted:

• Checking and savings account balances
• Stocks, bonds, certificates of deposit, and mutual funds
• A second vehicle or a second home
• Non-exempt cash-value life insurance

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.2

Where to Get Help in South Dakota

How to Apply for South Dakota Medicare Savings Programs

Effective Dates and Retroactive Coverage

• QMB: coverage begins the first day of the month after DSS approves your application. Federal law (42 U.S.C. § 1396a(e)(8)) does not allow retroactive QMB coverage, so 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 to protect the retroactive window.

After approval, DSS 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 the following month.

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.