Virginia Medicare Savings Programs 2026: QMB, SLMB & QI

Virginia's Medicare Savings Programs (MSPs) pay your Medicare Part B premium, and for the lowest-income enrollees they wipe out Medicare deductibles and copays too. Everyone who qualifies is also auto-enrolled in Part D Extra Help. The standard Part B premium alone runs $202.90 a month in 2026, so the savings add up quickly.

What Are Virginia Medicare Savings Programs?

A Medicare Savings Program (MSP) is a Medicaid benefit that pays some or all of a low-income Medicare beneficiary's premiums and cost-sharing. The Virginia Department of Medical Assistance Services (DMAS), Virginia's Medicaid agency, administers all three MSPs statewide under Cardinal Care.

There are three programs, each covering a different income band, and together they serve Virginians from the lowest income tier up through 135% of the Federal Poverty Level (FPL).1 The savings are concrete: QMB alone covers the standard Part B premium of $202.90 a month in 2026, before you count the deductibles and coinsurance it also pays.2

The MSPs use the Supplemental Security Income (SSI)-related methodology for the aged, blind, and disabled (ABD), not the Modified Adjusted Gross Income (MAGI) rules used for Marketplace coverage. That means a $20 per month general income disregard is subtracted before your income is compared to the limit, and it is already built into the published ceilings below.1

Virginia is a 209(b) state, which lets it set some Medicaid standards differently from SSI. For the MSPs, however, Virginia applies the federal income and resource standards without deviation.

Qualified Medicare Beneficiary (QMB)

QMB is the most comprehensive MSP. In 2026 it pays:

• The Medicare Part A premium, if you owe one
• The standard Part B premium of $202.90 per month
• The Part A inpatient hospital deductible of $1,736 per benefit period
• The annual Part B deductible of $283
• All Medicare Part A and Part B coinsurance and copays2

2026 Virginia QMB income limits (with the $20 general income disregard applied):1

These figures are 100% of the Federal Poverty Level plus the $20 monthly disregard.1 DMAS excludes $20 of unearned income per household, not per person, before applying the FPL test.

QMB coverage begins the month after DMAS determines you are eligible. There is no retroactive QMB; federal law (42 U.S.C. § 1396a(e)(8)) sets that limit. Apply as soon as you think you might qualify.

Specified Low-Income Medicare Beneficiary (SLMB)

SLMB pays the Part B premium only, which is $202.90 per month in 2026.2 It does not cover deductibles or coinsurance the way QMB does.

2026 Virginia SLMB income limits (with the $20 general income disregard applied):1

SLMB covers income between 100% and 120% FPL.1 Unlike QMB, SLMB allows up to three months of retroactive coverage (42 CFR § 435.915) if you met every requirement during those months, so file as early as you can to protect that window.

Qualifying Individual (QI)

QI also pays the Part B premium only, for income between 120% and 135% FPL.1

2026 Virginia QI income limits (with the $20 general income disregard applied):1

QI runs on a capped federal allotment, so states enroll on a first-come, first-served basis with preference for people who had QI the prior year. Virginia has not exhausted its QI allotment in recent years.

Important: QI is mutually exclusive with full Medicaid by statute (42 U.S.C. § 1396u-3(c)(1)). A Virginian enrolled in the Commonwealth Coordinated Care Plus (CCC Plus) Waiver or any other full-Medicaid program cannot receive QI; they would be QMB-Plus or SLMB-Plus instead. QI also allows up to three months of retroactive coverage under 42 CFR § 435.915.

Full Virginia MSP Comparison

The resource (asset) limit for all three programs in 2026 is $9,950 for an individual and $14,910 for a couple.1 Your primary residence, one vehicle, household goods, and prepaid burial arrangements do not count toward that limit.

The QMB Billing Prohibition

Federal law (42 U.S.C. § 1396a(n)(3)(B)) prohibits any Medicare provider from billing a QMB enrollee for Medicare cost-sharing.1 This applies to:

• Original Medicare and Medicare Advantage providers
• Providers who do not participate with Virginia Medicaid
• Hospitals, physicians, ambulance services, durable medical equipment suppliers, and skilled nursing facilities

If you have QMB and receive a bill for a Medicare deductible, coinsurance, or copay, do not pay it. Tell the provider you are a QMB and that federal law bars the charge. If the provider will not drop the bill, call 1-800-MEDICARE (1-800-633-4227) or contact Virginia's SHIP program (below). CMS guidance (MLN Matters SE1128) and the CMS final rule at 81 Fed. Reg. 80170 (Nov. 15, 2016) extended these protections explicitly to Medicare Advantage providers.

Part D Extra Help (Automatic for Every MSP Enrollee)

Under the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (42 U.S.C. § 1395w-114), every QMB, SLMB, and QI enrollee is automatically deemed eligible for the full Part D Low-Income Subsidy (LIS), also called Extra Help. No separate application to the Social Security Administration is required.3

In 2026, full Extra Help provides:

Auto-deeming flows from a monthly DMAS data file to CMS. If you are not already in a Part D plan, CMS auto-assigns a $0-premium benchmark plan, and you can switch to any other plan during open enrollment without losing Extra Help. For someone filling several prescriptions a month, capping generics at $5.10 and brand-name drugs at $12.65, with no cost at all after $2,100 in out-of-pocket spending, often saves hundreds to a few thousand dollars a year on top of the Part B premium savings.3

The Income Disregard That Matters Most

Many Virginians look at their gross Social Security check, see it is above the QMB limit, and never apply. The $20 general income disregard is the reason that is a mistake. Under SSI methodology, $20 per month per household is subtracted from unearned income before the FPL test, so someone drawing $1,365 in Social Security still has only $1,345 in countable income, below the 2026 QMB individual limit.1 The disregard is one $20 per household, not one per person.

Earned income from a part-time job is disregarded even more generously under the same SSI rules, so wages count for far less than their gross amount. If you or your spouse work, it is worth having a benefits counselor run the actual numbers before assuming you earn too much.

How to Apply for Virginia Medicare Savings Programs

DMAS decides MSP eligibility through the same system it uses for other Medicaid programs, applying the income and resource limits shown above.1 You can apply four ways:

CommonHelp (online): Apply at commonhelp.virginia.gov, the state's self-service benefits portal, where you can upload documents and track your application.

Cover Virginia call center: Call Cover Virginia at 1-855-242-8282, Monday through Friday, to apply by phone.

Local Department of Social Services (DSS): Walk in or mail a paper application to your local DSS office. DSS eligibility workers process MSP determinations under DMAS authority.

Social Security Administration: Filing for Extra Help with SSA on Form SSA-1020 automatically starts an MSP application referral to DMAS (42 U.S.C. § 1320b-14), and your SSA filing date is protected.

Documents to have ready:

• Medicare card or Medicare Beneficiary Identifier (MBI)
• Social Security card and proof of age
• Proof of Virginia residency (utility bill, lease, or bank statement)
• Most recent Social Security award or cost-of-living-adjustment letter
• Recent bank and investment statements
• Pension or annuity statements

Timeline: Non-disability ABD applications carry a 45-day decision clock (42 CFR § 435.912). DMAS must send a written decision that explains the determination and your right to appeal.

Free help applying: Virginia's State Health Insurance Assistance Program is the Virginia Insurance Counseling and Assistance Program (VICAP), run by the Department for Aging and Rehabilitative Services through local Area Agencies on Aging. VICAP counselors give free, unbiased MSP help and do not sell insurance. Reach them at 1-800-552-3402.

Worked Example: A Single Virginian Applying for QMB

The figures below are hypothetical, shown only to illustrate how the calculation works. They are not a real case and not a prediction of your result.

A retired Virginian, age 68, in Chesterfield County receives Social Security and no other income, holds a modest savings balance, and owns her home and one car. The numbers run as follows.

Income test:

• Gross Social Security: $1,280
• Less the $20 general income disregard: $1,260 countable
• 2026 QMB individual limit: $1,350
• Result: below the ceiling, so she qualifies for QMB.1

Resource test:

• Countable savings: $7,400
• Home and vehicle: excluded
• 2026 resource limit: $9,950
• Result: below the limit.1

Outcome: QMB pays her $202.90 Part B premium every month and covers all her Medicare deductibles, coinsurance, and copays, and she is auto-deemed for full Extra Help.2 Between the premium and the drug-cost caps, she keeps several thousand dollars a year she would otherwise have paid out of pocket.

Learn More

Find personalized help applying for Virginia Medicare Savings Programs at brevy.com.

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.