Vermont Medicare Savings Programs 2026: QMB & QI

Vermont Medicare Savings Programs pay Medicare premiums and cost-sharing for income-eligible seniors and people with disabilities. Vermont runs two of them, and it is more generous than the federal standard: it counts only your income, not your savings or property, and effective December 31, 2025 it 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 benefits that pay some or all of a low-income Medicare beneficiary's Medicare premiums and cost-sharing. Federally, QMB, SLMB, and QI are mandatory eligibility groups under Title XIX of the Social Security Act. Effective December 31, 2025, Vermont ended SLMB as a separate program and moved former SLMB enrollees into QMB with higher income limits, so today Vermont runs two MSP tiers, QMB and QI.1

Vermont's Medicaid program, called Green Mountain Care, is administered by the Department of Vermont Health Access (DVHA). Vermont's MSP 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 Vermont counts only income, with no asset or resource test at all. Vermont also disregards about half of income from a current job when it measures eligibility.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 (most beneficiaries have premium-free Part A after 40 work quarters)
• 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
• All remaining Medicare coinsurance and copays on every Medicare-covered service

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 and all coinsurance it also eliminates.3 Every QMB enrollee is automatically deemed eligible for full Part D Extra Help.2

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 former SLMB enrollees into QMB with higher income limits.1

This is good news for affected enrollees. SLMB paid only the Part B premium, while QMB pays the Part A and Part B premiums plus all Medicare deductibles, coinsurance, and copays.3 Former SLMB enrollees moved into QMB therefore gained broader cost-sharing protection, not just the Part B premium benefit.

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 covers 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. QI is funded through a capped federal allotment. Vermont allocates enrollment first-come, first-served, with preference for prior-year QI enrollees. Unlike QMB, QI is not an entitlement.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, which adds full Medicaid coverage on top of the MSP cost-sharing protection.

Like QMB, QI enrollment triggers automatic Part D Extra Help.2

The QMB Billing Prohibition

Federal law, specifically 42 USC section 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, regardless of whether they participate with Vermont Medicaid.1

If you receive a bill for a deductible, coinsurance, or copay on a Medicare-covered service while you are a QMB enrollee, 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 DVHA eligibility notice or Medicare card with the QMB indicator.
• Call 1-800-MEDICARE (1-800-633-4227) to file a complaint.
• Contact the Vermont State Health Insurance Assistance Program (SHIP) for free counseling.

A provider who has incorrectly billed a QMB enrollee must recall the bill and refund any payments already collected.1

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.2

Under the 2026 Part D benefit structure, full Extra Help gives an enrollee a $0 Part D premium on a benchmark plan, a $0 annual deductible, and capped drug copays.2

• No more than $5.10 per generic prescription2
• No more than $12.65 per brand-name covered drug2
• $0 in drug copays after out-of-pocket costs reach the $2,100 catastrophic threshold2

The deeming flows automatically from DVHA to CMS each month after MSP enrollment. If you are not already in a Part D plan, CMS will auto-assign you to a zero-premium benchmark plan.2

Vermont Medicare Savings Programs: 2026 Income Limits at a Glance

The figures above are Vermont's published 2026 limits, which update with the Federal Poverty Level each year. QMB covers income at or below 150% FPL; QI covers 150.01% to 202% FPL. Neither program has a resource or asset test in Vermont, so savings and property are not counted.1 Confirm the current figures with DVHA / Green Mountain Care at 1-800-250-8427 before you rely on them.

Does Vermont Count Your Savings or Property?

No. This is where Vermont differs most sharply from the federal standard. In most states, MSP applicants must pass a resource (asset) test, $9,950 for one person and $14,910 for a couple in 2026.1 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 here. (A separate asset limit does apply to Vermont's long-term care Medicaid, which is a different program; see the Vermont-specific notes below.)4

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). This is the primary route for Vermont MSP.1
• Through Social Security. Applying for Part D Extra Help at the Social Security Administration (SSA) using Form SSA-1020 generates an automatic referral to Vermont Medicaid under federal law (42 USC section 1320b-14). Your Social Security application date serves as the protected filing date.
• With free help from Vermont SHIP. The Vermont State Health Insurance Assistance Program offers free, unbiased counseling to walk you through the application.

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 begins the first day of the month after DVHA approves your application. Federal law (42 USC section 1396a(e)(8)) prohibits retroactive QMB coverage, so apply early.
• QI: up to three months of retroactive coverage is available under 42 CFR section 435.915 if you were eligible during that window. File as early as possible.

After approval, DVHA 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.

Vermont-Specific Notes

Vermont is a medically needy spend-down state for long-term care Medicaid, which means applicants whose income exceeds the protected income level can qualify by spending down excess income on incurred medical costs, a process administered through the Choices for Care program. Vermont also does not require a Miller Trust.4 That spend-down mechanism, and the $2,000 asset limit that goes with it, apply to long-term care Medicaid, not to MSPs. MSP eligibility in Vermont turns solely on the QMB and QI income tests described above, with no asset test.4

Effective April 1, 2026, a household-size rule change may further help applicants who financially support relatives living in the home. 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.