Utah Medicare Savings Programs 2026: QMB, SLMB & QI

A Utah Medicare Savings Program can cover your $202.90 monthly Medicare Part B premium, and its broadest tier, QMB, also erases your Medicare Part A and Part B deductibles and copays. Three programs, QMB, SLMB, and QI, pay different Medicare costs at different income levels, and all three come with automatic Part D Extra Help for your prescriptions.

What Are Medicare Savings Programs?

Medicare Savings Programs are Medicaid-administered benefits that pay some or all of a low-income Medicare beneficiary's premiums and cost-sharing.1 QMB, SLMB, and QI are mandatory Medicaid eligibility groups under section 1902(a)(10)(E) of the Social Security Act, so in the 50 states and the District of Columbia, including Utah, the state Medicaid plan must cover them.2

Utah calls them the Medicare Cost-Sharing Programs, so that is the heading to look for on the state's own site, and it runs all three for people who have Medicare Part A.1

Utah Medicaid is administered by the Utah Department of Health and Human Services (DHHS), and financial eligibility for the savings programs is determined by the Utah Department of Workforce Services (DWS), which takes applications at its offices and through the myCase online portal.3 Utah's income test applies a $20 income deduction, which is the Supplemental Security Income (SSI) general income exclusion, plus an allowance for impairment-related work expenses and a $65-plus-half-of-remaining disregard on earned income; the limits below already reflect the $20 deduction.1

QMB: Qualified Medicare Beneficiary

QMB (Qualified Medicare Beneficiary) is the most comprehensive tier. For a QMB enrollee, Utah Medicaid pays:

• The Medicare Part A premium, if you have one; most people get Part A premium-free because they or a spouse paid Medicare taxes long enough while working
• The Medicare Part B premium, which is $202.90 a month in 2026
• The Part A inpatient hospital deductible, $1,736 per benefit period in 2026
• The Part B annual deductible, $283 in 2026
• Medicare Part A and Part B coinsurance and copays on Medicare-covered items and services4,5

2026 Utah QMB income limits: monthly income at or below $1,350 for a single person or $1,824 for a couple, which is 100% of the Federal Poverty Level plus Utah's $20 income deduction.1

Resource limit: $9,950 in countable assets for one person, $14,910 for a couple. Utah's Medicaid program summary says it doesn't count the home your family lives in, your furniture, or most personal items.1

Because QMB erases the Part B premium, worth $2,434.80 over a full year ($202.90 × 12), along with your Medicare Part A and Part B deductibles, coinsurance, and copays, its value to a single enrollee runs well into the thousands of dollars a year. Every QMB enrollee is also automatically deemed eligible for full Part D Extra Help.4,1

SLMB: Specified Low-Income Medicare Beneficiary

SLMB (Specified Low-Income Medicare Beneficiary) covers one thing: the Medicare Part B premium. At the 2026 standard rate of $202.90 a month, that works out to $202.90 × 12 = $2,434.80 a year SLMB pays on your behalf.4

2026 Utah SLMB income limits: monthly income above the QMB limit and at or below $1,616 for a single person or $2,184 for a couple, which reaches 120% of the Federal Poverty Level.1

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

SLMB does not pay deductibles or copays. For a beneficiary whose Medicare use is modest in a given year, the Part B premium is the largest predictable annual cost, and SLMB removes it.

SLMB also confers automatic Part D Extra Help, which in 2026 caps covered drug costs at $5.10 per generic and $12.65 per brand-name prescription.6,1 Full Extra Help also eliminates the Part D annual deductible7 and covers the basic-coverage part of your plan's premium, so you pay $0 for that basic coverage if it's priced at or below your region's low-income benchmark.7

QI: Qualifying Individual

QI (Qualifying Individual) also covers the Part B premium only, at a higher income band: monthly income above the SLMB limit and at or below $1,816 for a single person or $2,455 for a couple, between 120% and 135% of the Federal Poverty Level.1

Two structural differences set QI apart from QMB and SLMB:

1. First-come, first-served. QI is funded through a capped federal allotment, so it is not an entitlement the way QMB and SLMB are. Utah gets a set amount of federal money each year, selects qualifying individuals in the order in which they apply, and once the year's funds are allocated no new applicant receives benefits.1 The same federal law protects you in three ways: Utah must let every qualifying person apply during the year; once you're selected, you keep QI for the rest of that year as long as you still qualify; and people who had QI in the last month of the previous year get preference for the new year. Selection doesn't carry over automatically into the next year, though, so re-apply early. The QI funding cap doesn't reach QMB or SLMB, and federal law requires Medicaid to be furnished with reasonable promptness to all eligible individuals.8
2. Mutually exclusive with full Medicaid. Federal statute defines the QI group as people who are "not otherwise eligible for medical assistance under the State plan," so qualifying for full Medicaid rules out QI. That isn't a loss of coverage: you'd be a full-benefit dual eligible instead, as QMB-Plus or SLMB-Plus if you also meet those groups' tests, or simply with full Medicaid alongside Medicare if you don't.2

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

The QMB Billing Prohibition

Federal law, specifically 42 U.S.C. § 1396a(n)(3)(B), gives a QMB enrollee no legal liability to pay the provider, which together with the program's excess-charge sanctions prohibits Medicare providers, suppliers, and pharmacies from billing a QMB for Medicare Part A and Part B deductibles, coinsurance, or copayments.9 The protection covers Original Medicare and Medicare Advantage providers alike, not only those that accept Medicaid, and it holds even if the provider doesn't receive full payment from Medicaid.5,10

If you are a QMB enrollee and you receive a bill for a Part A or Part B deductible, coinsurance, or copay on a Medicare-covered service, do not pay it. The provider is legally prohibited from collecting it, and you owe none of that Part A and Part B cost-sharing. The one bill that can still come is a small Medicaid copayment, if one applies.5

If you receive such a bill:

• Tell the provider you're in the QMB program.
• Show both your Medicare card and your Medicaid or QMB card; with Original Medicare, your Medicare Summary Notice also shows you're in QMB.5
• Call 1-800-MEDICARE (1-800-633-4227; TTY 1-877-486-2048), Medicare's official line, for help with the bill.11
• Contact Utah's Senior Health Insurance Program (SHIP) for free one-on-one counseling.12

A provider who improperly bills a QMB enrollee is subject to sanctions and must recall the bill and refund any cost-sharing already collected.10

Part D Extra Help and the Low-Income Subsidy

Every QMB, SLMB, and QI enrollee in Utah is automatically deemed eligible for full Part D Extra Help, also called the Low-Income Subsidy (LIS). No separate application is required.1

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

• $0 for your plan's basic coverage, as long as its basic-coverage premium is at or below your region's low-income benchmark7
• No annual deductible7
• No more than $5.10 for each generic prescription
• No more than $12.65 for each brand-name drug
• $0 for covered drugs once your out-of-pocket spending reaches the $2,100 threshold for 20266

Those copays are ceilings. If you also have full Utah Medicaid, they can be lower: $1.60 and $4.90 at income at or below 100% of the Federal Poverty Level, and $0 if you live in an institution such as a nursing facility or get home and community-based services.6

For a senior filling several prescriptions a month, capping every generic at $5.10 and every brand-name drug at $12.65 removes one of the least predictable costs in retirement, on top of the Part B premium that SLMB or QI already covers.6

Two details are worth knowing before you pick a plan. First, the benchmark is set separately for each Part D region, and if you choose a plan whose premium runs above your region's benchmark, you are responsible for the difference, including any part of an enhanced plan's premium that pays for extra, non-basic benefits.7 Second, you do not have to wait for open enrollment to change plans: starting with the 2025 contract year, people who receive the Low-Income Subsidy have a special enrollment period, at 42 CFR 423.38(c)(4), that lets them switch standalone Part D drug plans once in any month of the year. The one exception: you can't use it while you're identified as a potential at-risk or at-risk beneficiary under a Part D drug management program.13

Utah Medicare Savings Programs: 2026 Income Limits at a Glance

These limits reflect 100% of the Federal Poverty Level for QMB, up to 120% for SLMB, and 120 to 135% for QI, each plus Utah's $20 income deduction. The resource limit for all three is $9,950 for a single person and $14,910 for a couple.1 Both are the federal standard, not an absolute cutoff: states can effectively raise the income and resource limits by disregarding certain income and resources, so someone somewhat over should apply rather than rule themselves out.1

What Counts as a Resource, and What Doesn't

The $9,950 single / $14,910 couple resource test counts only countable assets. Utah's Medicaid program summary is explicit about the big ones it leaves out, and it also cautions that each program has its own rules about counting assets.1

Not counted, per Utah's program summary:

• The home your family lives in
• Furniture and most personal items1

Excluded under Utah's long-term-care Medicaid rules (ask DWS whether they apply to your MSP application):

• One vehicle per household, regardless of its value, that is used for transportation for you, your spouse, or a member of your household
• A pre-need funeral contract that cannot be revoked and cannot be sold; any part of that contract representing burial funds reduces Utah's $1,500 maximum burial fund exclusion3

Counts:

• Cash on hand and bank account balances
• Stocks, bonds, and other items easily turned into cash
• Other property, such as a vacation home or an extra vehicle1

Don't rule yourself out just because you own your home. Utah's Medicaid program summary doesn't count the home a family lives in, though it also says each program has its own asset rules, so ask DWS how your home is treated on your MSP application and measure the rest of your countable assets against the $9,950 single limit.1,3

How to Apply for Utah Medicare Savings Programs

You may apply in person, by mail, by fax, or online, and financial eligibility is determined by the Utah Department of Workforce Services (DWS).3,1

Online through myCase. Apply at jobs.utah.gov/mycase, the Utah DWS portal for Medicaid and related benefits. Create an account, complete the application, and upload your supporting documents.

In person at a local DWS office. You may apply at any Department of Workforce Services office. Bring your Medicare card, Social Security award letter, recent bank statements, and proof of Utah residency. DWS staff will help you complete the application.

By mail or fax. Utah Medicaid accepts a mailed or faxed paper application; the forms and current addresses are on the Utah Medicaid apply page.3

Note that the Social Security Administration does not decide Medicare Savings Program eligibility. State Medicaid agencies do, and SSA's role is screening and referring people to the state. If you apply for Part D Extra Help at SSA, still file your Utah MSP application with DWS through one of the channels above.1

Documents to Gather Before You Apply

• Medicare card (showing your Medicare Beneficiary Identifier, or MBI)
• Social Security card or proof of your Social Security number
• Most recent SSA benefit award or cost-of-living-adjustment letter
• Recent bank and investment account statements
• Pension or annuity statements, if applicable
• Proof of Utah residency (a utility bill, lease, or mortgage statement)

Effective Dates and Retroactive Coverage

• QMB: coverage begins the first day of the month after the month DWS finds you eligible, and Utah does not allow retroactive QMB coverage.1 Social Security Act § 1902(e)(8) applies a QMB determination to services furnished after the end of the month in which the determination is first made, so QMB runs forward from approval, not back. Apply as early as you can.14
• SLMB and QI: that federal QMB rule names only QMB.14 Utah does allow retroactive coverage for SLMB and QI, which its program summary describes as coverage for the three months before the date of application, so ask DWS to include those months when you apply.1

The Part B premium switch isn't immediate. Utah says the state starts paying your Part B premium about three months after you become eligible, and if the premium was coming out of your Social Security check, the check then goes up. Social Security reimburses you for each month of eligibility in which the premium was still deducted.1

Utah-Specific Notes

For long-term-care Medicaid, Utah applies patient-liability rules and runs a separate Spenddown program for people who exceed the income limits for other Medicaid categories. Those are long-term-care rules, and not every Medicaid program allows spenddown; the Medicare Savings Programs have their own income and resource tests, described above.3

If you qualify for full Utah Medicaid as well as Medicare, you are a full-benefit dual eligible: QMB-Plus or SLMB-Plus if you also meet those groups' tests, and in either case full Medicaid supplements your Medicare coverage.2,10 Contact DWS to confirm your status. For more on qualifying for full Utah Medicaid, see Utah Medicaid eligibility and income limits.

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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.