Vermont Medicare Savings Programs 2026: QMB & QI

Vermont Medicare Savings Programs help people on Medicare with limited income pay their Medicare premiums and cost-sharing.1 Vermont runs three of them, and for two of those, QMB and QI, it is more generous than the federal standard: it counts only your income, not your savings or property. Effective December 31, 2025 Vermont ended the Specified Low-Income Medicare Beneficiary (SLMB) program and moved most former SLMB members into the broader Qualified Medicare Beneficiary (QMB) program with higher income limits.1

What Are Medicare Savings Programs?

Medicare Savings Programs are Medicaid-administered programs that help people with limited income and resources pay Medicare costs: premiums and, for QMB, cost-sharing. Federally there are four: QMB, SLMB, QI, and QDWI.1 Effective December 31, 2025, Vermont ended SLMB as a separate program and moved most former SLMB enrollees into QMB with higher income limits, so today Vermont offers three: QMB, QI, and QDWI.1

Vermont's Medicaid program, called Green Mountain Care, is administered by the Department of Vermont Health Access (DVHA). Vermont's QMB and QI rules are more generous than the federal standard in two ways: the income limits are set higher (up to 202% FPL for QI, well above the federal 135% FPL ceiling1), and for those two programs Vermont counts only income, with no asset or resource test at all. QDWI is the exception, and keeps a resource limit of $4,000 single / $6,000 couple.1

QMB: Qualified Medicare Beneficiary

QMB is the broadest tier, and effective December 31, 2025 it absorbed Vermont's former SLMB program. In 2026, a single Vermonter qualifies for QMB with monthly income at or below $1,995 (150% FPL); the couple limit is $2,707. Vermont applies no asset test, so savings and property do not count.1 QMB covers:

• The Medicare Part A premium, if you don't have premium-free Part A1 (most people get Part A premium-free because they or a spouse paid Medicare taxes long enough while working, generally at least 10 years)3
• The Medicare Part B premium ($202.90 per month standard rate in 2026)3
• The Part A inpatient hospital deductible ($1,736 per benefit period in 2026)3
• The Part B annual deductible ($283 in 2026) and the 20% Part B coinsurance on covered services3
• The remaining Part A and Part B coinsurance and copayments on Medicare-covered items and services. Vermont Medicaid may still charge a small copayment of its own where one applies.4

For a single Vermont senior, QMB is worth about $2,435 a year in the Part B premium alone ($202.90 per month), before the Part A and Part B deductibles, coinsurance, and copayments it also pays on Medicare-covered services.3 QMB does not cover Medicare drug-plan copays, but every QMB enrollee is automatically deemed eligible for full Part D Extra Help, which holds those copays to no more than $12.65 per covered drug in 2026.1

What Happened to SLMB in Vermont?

Vermont no longer runs SLMB (Specified Low-Income Medicare Beneficiary) as a separate program. Effective December 31, 2025, Vermont ended SLMB as a separate enrollment category and automatically moved most former SLMB enrollees into QMB with higher income limits.1

This is good news for the enrollees who were moved. SLMB paid only the Part B premium, while QMB pays the Part B premium, the Part A premium for anyone without premium-free Part A, and Part A and Part B deductibles, coinsurance, and copayments for Medicare-covered items and services.1 Former SLMB enrollees moved into QMB therefore gained broader cost-sharing protection, not just the Part B premium benefit.

DVHA says most SLMB members were moved automatically, not all of them. If you were on SLMB and have not received a DVHA notice putting you in QMB, do not assume the transfer happened. Call Green Mountain Care at 1-800-250-8427 to check, and file a new application if you are not enrolled.1

If you previously had SLMB or expected to qualify for it, you no longer choose between SLMB and QMB. Apply for QMB through DVHA. Because QMB now covers income up to $1,995 per month for a single person (150% FPL), many people who would have landed in SLMB now qualify for the fuller QMB benefit.1

QI: Qualifying Individual

QI helps pay the Part B premium only, at a higher income band than QMB: $1,995 to $2,685 per month for a single person, $2,687 to $3,645 for a couple (150.01% to 202% FPL, 2026 Vermont figures). As with QMB, Vermont counts only income and applies no asset test.1

Two structural differences from QMB:

1. First-come, first-served, and reapplied for every year. QI is paid out of a capped annual federal allocation to each state and granted first-come, first-served, with preference for people who received QI in the last month of the previous year. Being selected in one year does not entitle you to continued assistance the next, so you must apply again each year.1
2. Mutually exclusive with other Medicaid eligibility. Federal statute bars QI status for anyone otherwise eligible for medical assistance under the state plan, which is broader than full-benefit Medicaid alone. In CMS's dual-eligible categories, someone who qualifies for both an MSP and full Medicaid is a QMB Plus or an SLMB Plus, never a QI. Being shut out of QI because you already qualify for full Medicaid is not a loss of coverage: CMS places you in a different, fuller dual-eligible category instead.5

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

The QMB Billing Prohibition

Federal law prohibits Medicare providers and suppliers, including pharmacies, from billing a QMB enrollee for Medicare Part A and Part B deductibles, coinsurance, and copayments on Medicare-covered items and services. The ban binds all Original Medicare and Medicare Advantage providers and suppliers, not only those that accept Medicaid, and it holds even if the provider does not receive full payment from Medicaid.4

If you receive a bill for a Part A or Part B deductible, coinsurance, or copayment on a Medicare-covered service while you are a QMB enrollee, that bill is improper. (A small Vermont Medicaid copayment, where one applies, is a separate charge and is not covered by this protection.) If you receive such a bill:

• Show the provider both your Medicare card and your Medicaid card (or QMB card). With Original Medicare, your Medicare Summary Notice also shows that you are in the QMB program.4
• Call 1-800-MEDICARE (1-800-633-4227), Medicare's official contact line, for help with an Original Medicare question.6
• Contact the Vermont State Health Insurance Assistance Program (SHIP) at 1-800-642-5119 for free help.7

A provider that bills a QMB enrollee this way is violating its Medicare provider agreement, or its obligations under Medicare Part C, and may face sanctions. CMS tells providers to recall any such bill, including one sent to collections, and to refund any QMB cost-sharing already collected.4

Part D Extra Help / Low-Income Subsidy

Every QMB and QI enrollee in Vermont is automatically deemed eligible for full Part D Extra Help (also called the Low-Income Subsidy, or LIS). No separate application is required.1 The partial-subsidy tier was eliminated on January 1, 2024, so everyone who qualifies now gets the full subsidy.8

Under the 2026 Part D benefit structure, full Extra Help eliminates the annual Part D deductible entirely and caps drug copayments.9

• No more than $5.10 per generic prescription8
• No more than $12.65 per brand-name covered drug8
• $0 in drug copays after out-of-pocket drug costs reach the $2,100 out-of-pocket threshold8

If you are not already in a Part D plan when your MSP starts, ask DVHA or Vermont SHIP how your Extra Help is applied and which plans it covers in full.7 QDWI is the one MSP that does not carry this automatic Extra Help deeming.2

Vermont Medicare Savings Programs: 2026 Income Limits at a Glance

The figures above are Vermont's published 2026 limits, exactly as DVHA prints them, and they update with the Federal Poverty Level each year. QMB covers income at or below 150% FPL; QI covers 150.01% to 202% FPL. Neither QMB nor QI has a resource or asset test in Vermont, so savings and property are not counted for those two; QDWI does have one.1

Two things to know about reading this chart. First, DVHA's own QI couple band starts at $2,687, which is below the $2,707 QMB couple limit, so a couple between those two figures appears on both charts. Second, and more important: DVHA advises that if your income is above the limits listed, you should fill out an application anyway. Do not rule yourself out on this table alone.1

Does Vermont Count Your Savings or Property?

Not for QMB or QI. This is where Vermont differs most sharply from the federal standard. The federal standard for QMB, SLMB and QI includes a resource (asset) limit of $9,950 for one person and $14,910 for a couple in 2026, though states may raise it, and some have dropped the test altogether.1 Vermont applies no such test to QMB or QI. It looks only at your income, not at your savings, home, vehicles, or other property.1

Practically, that means a Vermont senior with a paid-off home, a car, and modest retirement savings can qualify for QMB or QI on income alone. The asset rules that disqualify applicants in other states do not apply to those two programs.

Two limits people confuse with this one, and should not:

• QDWI does have a resource limit of $4,000 for one person and $6,000 for a couple. That figure belongs to QDWI only. It is never applied to a QMB or QI applicant.1
• Long-term care Medicaid is a different program with its own asset limit of $2,000 for an individual. See the Vermont-specific notes below.10

How to Apply for Vermont Medicare Savings Programs

You can apply through any of these pathways:

• Through DVHA. Apply online at dvha.vermont.gov or by phone at 1-800-250-8427 (Green Mountain Care).1
• With free in-person help from a certified Assister. DVHA directs applicants who want help with the form to a certified Assister, who can sit down with you and complete it.1
• With free counseling from Vermont SHIP. The Vermont State Health Insurance Assistance Program, run through the Adult Services Division of DAIL, gives free help to Medicare beneficiaries managing their benefits. Call 1-800-642-5119.7

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 cost-of-living-adjustment (COLA) letter
• Proof of any other monthly income (pension or annuity statements, if applicable)
• Proof of Vermont residency (utility bill, lease, or mortgage statement)

Because Vermont applies no asset test to QMB and QI, you do not need to document bank balances or investment accounts for these programs.1

Effective Dates and Retroactive Coverage

• QMB: coverage runs forward only. Under Social Security Act section 1902(e)(8), a QMB determination applies to services furnished after the end of the month in which you are first found eligible, so it does not reach back to earlier months. Apply early.11
• QI: that prospective-only rule names QMB alone, and the federal rules we rely on set no retroactive window for QI either way. Ask DVHA when you apply how far back your QI coverage can start, and file as early as possible.11

Vermont-Specific Notes

For long-term care Medicaid, Vermont runs two paths at once: an institutional income standard of $2,982 per month for an individual, and a medically needy path under which applicants above the protected income level can qualify by incurring enough expenses to bring their income down to that level. Both run through the Choices for Care program.10 That spend-down mechanism, and the $2,000 asset limit that goes with it, apply to long-term care Medicaid, not to MSPs. QMB and QI eligibility in Vermont turns on the income tests described above, with no asset test.10

For Medicare Savings Programs, starting April 1, 2026, a new household-size rule may help applicants who have relatives living with them who depend on the applicant or spouse for at least half of their financial support. For more on Vermont's long-term care rules, see Vermont Medicaid eligibility and income limits.1

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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.