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 statewide offices and through the myCase online portal. Utah uses the Supplemental Security Income (SSI) income methodology, which applies a $20 income deduction, 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.3,1

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
• 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 for one person, $14,910 for a couple.1 Utah does not count the home your family lives in, and it excludes one vehicle per household, regardless of its value, that is used for transportation for you, your spouse, or a member of your household.3

Because QMB erases the Part B premium, worth $2,434.80 over a full year, 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 is $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 holds covered drug costs to $5.10 per generic and $12.65 per brand-name prescription.6,1 Full Extra Help also eliminates the Part D annual deductible7 and pays your Part D premium in full if you are enrolled in a plan 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 Being selected in one year does not entitle you to continued assistance in the next year, so re-apply early. An eligible QMB or SLMB applicant, by contrast, cannot be turned away or waitlisted for want of funding.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. You would instead qualify for QMB-Plus or SLMB-Plus, which combine MSP cost-sharing protection with full Medicaid coverage.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 Utah Medicaid does not fully reimburse the provider for that cost-sharing.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 nothing beyond a small Medicaid copayment where one applies.5

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.11
• Contact Utah's State Health Insurance Assistance Program (SHIP) for free help.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:

• No Part D premium, as long as your plan's premium is at or below your region's low-income benchmark7
• No annual deductible7
• $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 20266

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.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.7 Second, you do not have to wait for open enrollment to change plans: since January 1, 2025, 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.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 what Utah treats as a countable asset, and Utah's aged, blind, and disabled rules exclude several major categories.1

Excluded (does not count):

• The home your family lives in
• One vehicle per household, regardless of its value, that is used for transportation for you, your spouse, or a member of your household
• Furniture and most personal items
• A pre-need funeral contract that cannot be revoked and cannot be sold; burial funds themselves are excluded only up to the $1,500 maximum burial fund exclusion3

Counts:

• Checking and savings account balances
• Stocks, bonds, certificates of deposit, and mutual funds
• A second vehicle or a second home

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.1,3

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.

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 DWS approves your application. QMB is prospective-only by statute, because 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 it cannot be granted retroactively. Apply as early as you can.14
• SLMB and QI: these follow the general Medicaid retroactivity rule at 42 CFR § 435.915 and can be effective up to three months before the month you apply, if you met eligibility in those months.14

After approval, Utah Medicaid sends a written eligibility notice. Once the state takes over your Part B premium, the deduction should stop coming out of your Social Security check; ask your DWS eligibility worker to confirm the month that takes effect, because the changeover is not always immediate.

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.3

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.