Virginia Medicare Savings Programs 2026: QMB, SLMB & QI

Virginia Medicare Savings Programs can pay your Medicare Part B premium, reduce your cost-sharing to zero, and automatically enroll you in Part D Extra Help, often saving more than $2,000 per year.

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 Medicare premiums and cost-sharing. The Virginia Department of Medical Assistance Services (DMAS) administers all three MSPs statewide.

There are three programs, each covering a different income band. Together they serve Virginians from the lowest income tier up through 135% of the Federal Poverty Level. Every Virginian on Medicare with limited income should know whether they qualify: the dollar value can reach $4,000 or more per year in saved premiums, deductibles, and copays.

The MSPs use the SSI-related ABD income methodology, not the MAGI methodology used for ACA Marketplace coverage. That means SSI counting rules apply, including a $20 per month general income disregard that is already built into the published income ceilings below.

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

Qualified Medicare Beneficiary (QMB)

QMB is the most comprehensive MSP. It pays:

• The Part A premium (if any)
• The 2026 Part B standard premium of $202.90 per month
• The Part A inpatient hospital deductible ($1,736 per benefit period in 2026)
• The Part B annual deductible ($283 in 2026)
• All Medicare Part A and Part B coinsurance and copays

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

These figures reflect 100% of the Federal Poverty Level plus the $20 monthly disregard. DMAS uses the SSI ABD counting methodology: $20 per household is excluded from unearned income before applying the FPL test. The $20 is one disregard per household, not per person.

QMB coverage begins the month after DMAS determines eligibility. There is no retroactive QMB, federal law (42 USC § 1396a(e)(8)) establishes this limitation. Apply as early as you suspect you may qualify.

Specified Low-Income Medicare Beneficiary (SLMB)

SLMB pays the Part B premium only: $202.90 per month in 2026, or $2,434.80 per year. That is the full scope of the benefit.

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

SLMB applies to income between 100% and 120% FPL. Unlike QMB, SLMB allows up to three months of retroactive coverage under 42 CFR § 435.915 if the applicant met all criteria during those months. Applicants should file as early as possible to protect the retroactive window.

Qualifying Individual (QI)

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

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

QI is funded through a federal capped allotment at 100% FMAP, and states allocate enrollment on a first-come, first-served basis with preference for prior-year QI enrollees. Virginia has not exhausted its QI allotment in recent years.

Important: QI is mutually exclusive with full Medicaid by statute (42 USC § 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 instead be QMB-Plus or SLMB-Plus.

QI also allows up to three months of retroactive coverage under 42 CFR § 435.915.

Full Virginia MSP Comparison

Resource limit (all three programs): $9,950 individual / $14,910 couple in 2026, aligned with the federal Part D Low-Income Subsidy limit. The primary residence of any value, one vehicle, household goods, and burial funds up to $1,500 are excluded from countable resources.

The QMB Billing Prohibition

Federal law (42 USC § 1396a(n)(3)(B)) prohibits any Medicare provider from billing a QMB-enrolled beneficiary for Medicare cost-sharing. 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 are a 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 prohibits the charge. If the provider refuses to drop the bill, call 1-800-MEDICARE (1-800-633-4227) or contact the Virginia SHIP program (see below).

CMS guidance (MLN Matters Article SE1128) and CMS final rule 81 Fed. Reg. 80170 (Nov. 15, 2016) extended these protections explicitly to Medicare Advantage providers.

Part D Extra Help (Automatic for All MSP Enrollees)

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

In 2026, full Part D Extra Help provides:

Auto-deeming flows from DMAS's monthly data file to CMS. If an enrollee is not already in a Part D plan, CMS will auto-assign a benchmark plan. The enrollee can switch to any other Part D plan during open enrollment without losing Extra Help status.

For a senior on several prescriptions per month, the drug-cost reduction alone is often $1,500 to $2,500 per year on top of the Part B savings.

The Income Disregards That Matter

Many Virginians look at their gross Social Security benefit, see it is above the QMB limit, and never apply. Two disregards regularly pull people back under the ceiling:

The $20 general income disregard. Under SSI methodology (20 CFR § 416.1124(c)(12)), $20 per month per household is excluded from unearned income before the FPL test. The ceiling figures in the tables above already reflect this. The $20 is one disregard per household, not per person.

The $65 + ½ earned-income disregard. Under 20 CFR § 416.1112(c)(4)-(5), the first $65 of earned income is excluded, then half the remaining earned income is excluded. A part-time worker earning $800 per month has countable earned income of ($800 - $65) ÷ 2 = $367.50, not $800.

For applicants with both Social Security and part-time wages, running the actual numbers rather than the gross amounts can mean the difference between qualifying and not.

How to Apply for Virginia Medicare Savings Programs

DMAS administers MSPs through the same eligibility system as other Medicaid programs. Applications go through:

CommonHelp (online): Apply at commonhelp.virginia.gov. This is the state's primary self-service portal for Medicaid and other benefits. You can upload documents and track application status.

Cover Virginia call center: 1-855-242-8282. Phone applications are accepted Monday through Friday.

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

Social Security Administration: Applying for Part D Extra Help at SSA on Form SSA-1020 automatically generates an MSP application referral to DMAS under 42 USC § 1320b-14. The SSA filing date is protected.

Documents to bring:

• Medicare card or Medicare claim number (MBI)
• Social Security card and proof of age
• Proof of Virginia residency (utility bill, lease, or bank statement)
• Most recent SSA award or COLA letter
• Recent bank and investment statements
• Pension or annuity statements

Processing timeline: Non-disability ABD applications carry a 45-day clock under 42 CFR § 435.912(c)(3). DMAS must send a written decision explaining the determination and the right to appeal.

Virginia SHIP (State Health Insurance Assistance Program): The Virginia Insurance Counseling and Assistance Program (VICAP) offers free, unbiased MSP application help. Contact through the Virginia Department for Aging and Rehabilitative Services or by calling 1-800-552-3402.

Worked Example: Single Virginian Applying for QMB

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

A retired Virginian, age 68, living in Chesterfield County, receives $1,280 per month in Social Security and no other income. Her savings account holds $7,400. She owns her home and one car.

Income test:

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

Resource test:

• Savings: $7,400 (counted)
• Home and vehicle: excluded
• Total counted resources: $7,400
• 2026 resource limit: $9,950
• Result: below the limit.

Outcome: QMB pays her $202.90 Part B premium every month, plus all Medicare deductibles, coinsurance, and copays. She is auto-deemed for full Part D Extra Help. Total annual savings from QMB plus LIS: approximately $2,500 to $3,500, depending on her Medicare utilization and prescription volume.

Learn More

• Virginia Medicaid Eligibility and Income Limits
• How to Apply for Virginia Medicaid
• Medicaid Personal Needs Allowance Explained

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.