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 three of them, and for the two most people use, 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 benefits that pay some or all of a low-income Medicare beneficiary's Medicare premiums and 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 (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
• 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 and all coinsurance it also eliminates.3 Every QMB enrollee is automatically deemed eligible for full Part D Extra Help.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 A and Part B premiums plus Medicare deductibles, coinsurance, and copayments.3 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 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, and reapplied for every year. 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, and 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. Someone who qualifies for both an MSP and full Medicaid is a QMB Plus or an SLMB Plus, never a QI.5

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

The QMB Billing Prohibition

Federal law prohibits Medicare providers and suppliers from billing a QMB enrollee for Medicare Part A and Part B deductibles, coinsurance, and copayments on Medicare-covered items and services. This covers Original Medicare and Medicare Advantage providers alike, and it holds even where Vermont does not fully reimburse the provider for that cost-sharing.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:

• Tell the provider you are enrolled in the QMB program.4
• Show your DVHA eligibility notice or Medicare card with the QMB indicator.
• Call 1-800-MEDICARE (1-800-633-4227) to report it.6
• Contact the Vermont State Health Insurance Assistance Program (SHIP) at 1-800-642-5119 for free help.7

A provider who improperly bills a QMB enrollee is violating federal law.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 costs reach the $2,100 catastrophic 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. In most states, QMB, SLMB and QI 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 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 $2,000 asset limit. 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). This is the primary route for Vermont MSP, and it is the one that puts a DVHA filing date on your record.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 begins the first day of the month after DVHA approves your application. QMB is prospective-only by statute (Social Security Act section 1902(e)(8)), so it cannot be granted retroactively. Apply early.11
• QI: QI follows the general Medicaid retroactivity rule (42 CFR 435.915), so it can be effective up to three months before the application month if you met eligibility in those months. File as early as possible.11

After approval, DVHA sends a written eligibility notice.

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 spending down excess income on incurred medical costs. 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

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

Learn More

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.