Utah Medicare Savings Programs pay Medicare premiums and cost-sharing for income-eligible seniors and people with disabilities enrolled in Medicare. The broadest tier, QMB, eliminates the Part B premium and all Medicare cost-sharing in a single program.
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 plan, including Utah's, must cover them.
Utah Medicaid is administered by the Utah Department of Health and Human Services (DHHS), with financial eligibility for MSPs determined by the Utah Department of Workforce Services (DWS). DWS processes applications through its statewide offices and the myCase online portal. MSP eligibility uses the SSI-related income methodology, which includes two important disregards: a $20/month general income disregard applied to unearned income, and a $65 plus half of remaining earned income disregard for working applicants. The income figures below reflect the $20 disregard already applied.
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 work quarters)
- The Medicare Part B premium ($185.00/month standard rate in 2026 per CMS)
- The Part A inpatient hospital deductible ($1,736 in 2026)
- The Part B annual deductible ($257 in 2026)
- All Medicare coinsurance and copays on every Medicare-covered service
2026 Utah QMB income limits: at or below $1,350/month for a single person, or at or below $1,823/month for a couple. These reflect 100% of the Federal Poverty Level with the $20 general income disregard applied.
Resource limit: $9,950 for one person, $14,910 for a couple. The primary home and one vehicle are excluded entirely.
For a single Utah senior on Social Security, QMB can be worth more than $3,000 a year in saved premiums, deductibles, and copays. Every QMB enrollee is automatically deemed eligible for full Part D Extra Help.
SLMB: Specified Low-Income Medicare Beneficiary
SLMB covers one thing: the Medicare Part B premium. At the 2026 standard rate, that is $2,220.00 per year.
2026 Utah SLMB income limits: $1,351 to $1,616/month for a single person, $1,824 to $2,186/month for a couple.
Resource limit: same as QMB: $9,950 single, $14,910 couple.
SLMB does not pay deductibles or copays. For a beneficiary whose Medicare utilization is modest in a given year, the Part B premium represents the largest predictable annual cost, and SLMB removes it.
SLMB also confers automatic Part D Extra Help, which can cut drug costs to $5.10/generic and $12.65/brand-name copays with a $0 deductible and $0 premium on a benchmark Part D plan.
QI: Qualifying Individual
QI covers the Part B premium only, at a higher income band: $1,617 to $1,816/month for a single person, $2,187 to $2,457/month for a couple (2026 Utah figures).
Two structural differences from QMB and SLMB:
- First-come, first-served. QI is funded through a capped federal allotment. Utah DWS allocates enrollment first-come, first-served, with preference for prior-year QI enrollees. QI is not an entitlement, unlike QMB and SLMB.
- 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.
The QMB Billing Prohibition
Federal law, specifically 42 USC § 1396a(n)(3)(B), prohibits any Medicare provider from billing a QMB enrollee for Medicare cost-sharing. This covers Original Medicare and Medicare Advantage providers alike, whether or not they participate with Utah Medicaid.
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. The provider is legally prohibited from collecting it.
If you receive such a bill:
- Tell the provider you are a QMB enrollee and cite federal law.
- Show your Utah Medicaid eligibility notice or Medicare card with the QMB indicator.
- Call 1-800-MEDICARE (1-800-633-4227) to file a complaint.
- Contact the Utah SHIP (Senior Health Insurance Information Program) for free assistance.
A provider who has incorrectly billed a QMB 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 Utah is automatically deemed eligible for full Part D Extra Help (also called the Low-Income Subsidy, or LIS). No separate application is required.
Under the 2026 Part D benefit structure:
- $0 Part D premium on a benchmark plan
- $0 annual deductible
- $5.10 per generic prescription
- $12.65 per brand-name or preferred multi-source drug
- $0 in copays after the annual out-of-pocket cap
For a senior filling six prescriptions per month, Part D Extra Help can represent $1,500 to $2,500 in annual drug-cost savings on top of the Part B premium benefit from SLMB or QI.
The deeming flows automatically from Utah Medicaid to CMS monthly after MSP enrollment. If you are not already in a Part D plan, CMS will auto-assign you to a zero-premium benchmark plan. 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
| Program | Single monthly income limit | Couple monthly income limit | What it pays |
|---|---|---|---|
| QMB | $1,350 | $1,823 | Part A + Part B premiums + all cost-sharing |
| SLMB | $1,351-$1,616 | $1,824-$2,186 | Part B premium only |
| QI | $1,617-$1,816 | $2,187-$2,457 | Part B premium only (capped allotment) |
Income limits reflect 100% FPL (QMB), 100-120% FPL (SLMB), and 120-135% FPL (QI) with the $20 general income disregard applied. Resource limit for all three: $9,950 single / $14,910 couple.
What Counts as a Resource, and What Doesn't
The $9,950/$14,910 resource test excludes several major asset categories:
Excluded (don't count):
- 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 burial fund up to $1,500 per person
Counted:
- Checking and savings account balances
- Stocks, bonds, certificates of deposit, mutual funds
- A second vehicle or second home
- Non-exempt cash-value life insurance above the face-value threshold
Many Utah seniors assume their home disqualifies them. It doesn't. A QMB applicant in a paid-off house worth $450,000 can still qualify as long as liquid assets fall within $9,950.
How to Apply for Utah Medicare Savings Programs
Utah offers three application pathways:
1. Online via myCase Apply at jobs.utah.gov/mycase. This is Utah DWS's online portal for Medicaid and related benefit programs. Create an account, complete the application, and upload supporting documents.
2. 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 assist with the application. Use the DWS office locator to find the nearest location.
3. Through SSA Applying for Part D Extra Help at your Social Security office using Form SSA-1020 generates an automatic referral to Utah Medicaid under federal law (42 USC § 1320b-14). Your SSA application date serves as the protected filing date.
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 Utah residency (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 USC § 1396a(e)(8)) prohibits retroactive QMB coverage. Apply early.
- SLMB and QI: up to three months of retroactive coverage is available under 42 CFR § 435.915 if you were eligible during those months. Your filing date is the protected date.
After approval, Utah Medicaid/DWS 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.
Utah-Specific Notes
Utah Medicaid uses a post-eligibility patient-liability model for long-term care rather than a Miller Trust, and it operates a separate Spenddown program for people who exceed income limits for other Medicaid categories. For MSPs, however, these mechanics are irrelevant: MSP eligibility turns solely on the QMB/SLMB/QI income and resource tests described above.
If you qualify for full Utah Medicaid as well as Medicare, you are likely a dual-eligible beneficiary. In that case you would receive QMB-Plus or SLMB-Plus rather than standalone MSP, and the full Medicaid benefit supplements your Medicare coverage. Contact DWS to confirm your dual-eligibility status. For more on qualifying for full Utah Medicaid, see Utah Medicaid eligibility and income limits.
Frequently Asked Questions
A Utah Medicare beneficiary with monthly income at or below $1,350 (single) or $1,823 (couple) and countable resources at or below $9,950/$14,910. The primary home and one car are excluded. QMB pays Part A and Part B premiums plus all Medicare cost-sharing.
No. Federal law prohibits QI enrollment for anyone who qualifies for full Medicaid. If you qualify for full-benefit Utah Medicaid, you would instead be eligible for QMB-Plus or SLMB-Plus.
No. Every Utah QMB, SLMB, and QI enrollee is automatically deemed eligible for full Part D Extra Help. Utah Medicaid transmits the deeming to CMS monthly. If you are not already in a Part D plan, CMS will assign you to a zero-premium benchmark plan.
Don't pay. Federal law prohibits any Medicare provider from billing QMB enrollees for Medicare cost-sharing. Call 1-800-MEDICARE (1-800-633-4227) to file a complaint.
Yes, for up to three months if you were eligible during that window. QMB has no retroactive coverage. File SLMB and QI applications as early as possible to preserve the full retroactive window.
Learn More
- Utah Medicaid Eligibility and Income Limits
- How to Apply for Utah Medicaid
- Understanding the Personal Needs Allowance
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.