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 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. QMB, SLMB, and QI are mandatory eligibility groups under Title XIX of the Social Security Act, so every state Medicaid plan, including Utah's, must cover them.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 statewide offices and through the myCase online portal. Utah uses the Supplemental Security Income (SSI) income methodology, which applies a $20 general income disregard to unearned income and a $65-plus-half-of-remaining disregard to earned income; the limits below already reflect the $20 disregard.2,1

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, though most beneficiaries already have premium-free Part A after 40 quarters of work
• 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
• All Medicare coinsurance and copays on every Medicare-covered service3

2026 Utah QMB income limits: monthly income at or below $1,350 for a single person or $1,824 for a couple, equal to 100% of the Federal Poverty Level after Utah applies the $20 general income disregard.1

Resource limit: $9,950 for one person, $14,910 for a couple. The primary home and one vehicle are excluded entirely.1

Because QMB erases the Part B premium, worth $2,434.80 over a full year, along with every Medicare deductible and copay, 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.3,1

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 is $2,434.80 a year SLMB pays on your behalf.3

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 holds covered drug costs to $5.10 per generic and $12.65 per brand-name prescription, with no Part D premium or deductible on a benchmark plan.4,1

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 allocates enrollment first-come, first-served, with preference for prior-year QI enrollees.1
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.1

The QMB Billing Prohibition

Federal law, specifically 42 U.S.C. § 1396a(n)(3)(B), prohibits any Medicare provider from billing a QMB enrollee for Medicare cost-sharing. The protection covers Original Medicare and Medicare Advantage providers alike, whether or not they participate in Utah Medicaid.1

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 is legally prohibited from collecting it.

If you receive such a bill:

• Tell the provider you are a QMB enrollee and cite the federal balance-billing prohibition.
• Show your Utah Medicaid eligibility notice or your Medicare card with the QMB indicator.
• Call 1-800-MEDICARE (1-800-633-4227) to file a complaint.
• Contact Utah's State Health Insurance Assistance Program (SHIP) for free help.5

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

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:

• No Part D premium on a benchmark plan
• No annual deductible
• $5.10 for each generic prescription
• $12.65 for each brand-name or preferred multi-source drug
• $0 for covered drugs once your out-of-pocket spending reaches the $2,100 catastrophic cap for 20264

For a senior filling several prescriptions a month, holding every generic to $5.10 and every brand-name drug to $12.65 removes one of the least predictable costs in retirement, on top of the Part B premium that SLMB or QI already covers.4

The deeming flows automatically from Utah Medicaid to CMS each month after MSP enrollment. If you are not already in a Part D plan, CMS auto-assigns you to a zero-premium benchmark plan, and you can switch to any other Part D plan during open enrollment without losing LIS status.

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, with Utah's $20 general income disregard applied. The resource limit for all three is $9,950 for a single person and $14,910 for a couple.1

What Counts as a Resource, and What Doesn't

The $9,950 single / $14,910 couple resource test excludes several major asset categories.1

Excluded (does not count):

• Your 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 modest burial fund

Counts:

• Checking and savings account balances
• Stocks, bonds, certificates of deposit, and mutual funds
• A second vehicle or a second home
• Cash-value life insurance above the standard exclusion

Many Utah seniors assume their home disqualifies them. It does not. A QMB applicant who owns a mortgage-free home can still qualify, as long as countable liquid assets stay within the $9,950 single limit.1

How to Apply for Utah Medicare Savings Programs

Utah offers three ways to apply, and financial eligibility is determined by the Utah Department of Workforce Services (DWS).2

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. Bring your Medicare card, Social Security award letter, recent bank statements, and proof of Utah residency. DWS staff will help you complete the application.

Through the Social Security Administration. Applying for Part D Extra Help at your local Social Security Administration office using Form SSA-1020 generates an automatic referral to Utah Medicaid under federal law (42 U.S.C. § 1320b-14). Your Social Security filing date becomes your protected application date.

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 DWS approves your application. Federal law (42 U.S.C. § 1396a(e)(8)) does not allow retroactive QMB coverage, so apply as early as you can.
• SLMB and QI: up to three months of retroactive coverage is available under 42 CFR § 435.915 if you were eligible during those months.

After approval, Utah Medicaid sends a written eligibility notice. For QMB, a state buy-in notice goes to CMS, which then stops withholding the Part B premium from your Social Security check the following month.

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. None of that applies to the Medicare Savings Programs: MSP eligibility turns solely on the QMB, SLMB, and QI income and resource tests described above.2

If you qualify for full Utah Medicaid as well as Medicare, you are a dual-eligible beneficiary, and you would receive QMB-Plus or SLMB-Plus rather than a standalone MSP, with full Medicaid supplementing your Medicare coverage. 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.