Virginia Medicare Savings Programs 2026: QMB, SLMB & QI

Virginia's three main Medicare Savings Programs (MSPs) pay your Medicare Part B premium, and for the lowest-income enrollees they wipe out Medicare deductibles and copays too. Anyone enrolled in QMB, SLMB, or QI also qualifies for Part D Extra Help automatically. 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 the MSPs, and eligibility is decided by your local Department of Social Services (DSS), by Cover Virginia, or by Virginia's Insurance Marketplace.1

This guide covers the three programs most people qualify through, each covering a different income band, which together serve Virginians from the lowest income tier up through 135% of the Federal Poverty Level (FPL). Cover Virginia lists a fourth level, Qualified Disabled and Working Individuals (QDWI), for people who lost Medicare Part A because of work. Its resource limit is far lower, $4,000 for one person and $6,000 for a couple, so the $9,950 and $14,910 figures in this guide do not apply to it; ask Cover Virginia for its income limit.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.3

Cover Virginia's 2026 aged, blind, and disabled (ABD) flyer states that its MSP income limits include the poverty-level amount plus a standard $20 unearned income disregard. The $20 is already built into the published ceilings below, so do not subtract it again before comparing your income to them. The flyer adds that additional income and resource disregards may apply depending on the kinds of income and resources you have.1

Virginia is a section 209(b) state for Medicaid.4 For the MSPs, Virginia's published 2026 income and resource limits match the federal standards SSA publishes for every state except Alaska and Hawaii. That match is Virginia's current published position, not a level federal law locks in: federal guidance lets states effectively raise these limits by disregarding certain income and resources.1

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 copays3

2026 Virginia QMB income limits (the standard $20 unearned income disregard is already included):1

These figures are 100% of the Federal Poverty Level plus the $20 monthly disregard. Virginia's eligibility manual prints the same limits before the disregard, $1,330 single and $1,804 couple, each exactly $20 lower, so a couple gets one $20 disregard, not $20 each.1

Under federal law (42 U.S.C. § 1396a(e)(8)), a QMB determination applies to services furnished after the end of the month in which you are found eligible, so QMB does not reach back before that decision. Apply as soon as you think you might qualify.5

Specified Low-Income Medicare Beneficiary (SLMB)

SLMB pays the Part B premium only, which is $202.90 per month in 2026.3 It does not cover deductibles or coinsurance the way QMB does.

2026 Virginia SLMB income limits (the standard $20 unearned income disregard is already included):1

SLMB covers income between 100% and 120% FPL.1 The federal provision that fixes QMB's start date names only QMB, and the federal sources this guide relies on set no retroactive window for SLMB or QI, so ask Cover Virginia or your local DSS how far back SLMB coverage can begin before you count on any month before you applied.5 For Medicaid in general, federal law makes eligibility effective as early as the third month before the month you apply, if you received covered services then and would have qualified, and the state plan sets the exact start date. That three-month window is the federal default, a Section 1115 demonstration can make a state's window shorter, and for applications made on or after January 1, 2027 it shrinks to two months for most enrollees. Either way, file as early as you can.6

Qualifying Individual (QI)

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

2026 Virginia QI income limits (the standard $20 unearned income disregard is already included):1

QI is not an entitlement. It runs on a capped annual federal allotment, so states enroll QIs only to the extent funding is available, selecting applicants first-come, first-served, with preference for people who had QI in the last month of the prior year. Once you are selected, you keep QI for the rest of that calendar year as long as you still qualify.7

Important: QI is mutually exclusive with other Medicaid eligibility by statute (42 U.S.C. § 1396a(a)(10)(E)(iv)). 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.6 As with SLMB, the federal QMB start-date provision does not name QI, so confirm with Cover Virginia or your local DSS how far back QI coverage can start.5

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 Virginia's handbook says not all resources are counted, and gives one vehicle you own as an example of one that is not.1 DMAS's resource rules also exclude the home you live in as your principal residence, household goods and personal effects, and certain prepaid burial contracts, and DMAS notes that land contiguous to the home is exempt for the QMB, SLMB, and QI groups.4 The $9,950 and $14,910 pair is the federal standard rather than an absolute cutoff, and states can disregard further income and resources, so someone somewhat over should apply rather than rule themselves out.3 QDWI is the exception to these figures, with a $4,000 single and $6,000 couple limit.1

The QMB Billing Prohibition

Federal law (42 U.S.C. § 1396a(n)(3)(B)) prohibits any Medicare provider or supplier, including pharmacies, from billing a QMB enrollee for Medicare cost-sharing.8 This applies to:

• Original Medicare and Medicare Advantage providers
• Providers who do not accept Virginia Medicaid, and providers who are not fully paid by Medicaid
• Hospitals, physicians, ambulance services, durable medical equipment suppliers, and skilled nursing facilities9

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).10 CMS states that a provider who ignores the QMB billing prohibition is violating its Medicare provider agreement or its Medicare Advantage obligations and may face sanctions, and that it must recall such bills and refund any QMB cost-sharing it collected.9

Part D Extra Help (Automatic for QMB, SLMB, and QI Enrollees)

Under federal regulation (42 CFR § 423.773(c)), 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, and CMS notifies you that you do not need to apply. QDWI enrollees are not deemed eligible.2

In 2026, full Extra Help provides at least the following for an MSP enrollee:

The premium subsidy is pegged to your region's benchmark premium, so if you choose a more expensive plan you pay the difference. The $5.10 and $12.65 copays are the ceiling: if you also have full Virginia Medicaid, you may pay less ($1.60 and $4.90 with income at or below 100% FPL, and $0 if you are institutionalized, as in a nursing facility, or receive home and community-based services). Once your out-of-pocket drug costs reach $2,100, you pay nothing more for covered Part D drugs for the rest of the year.2

The Income Disregard That Matters Most

The published limits already include the standard $20 unearned income disregard, so it is easy to apply it twice. Virginia's eligibility manual prints each limit before the disregard, exactly $20 lower: QMB $1,330 single and $1,804 couple, SLMB $1,596 and $2,164, QI $1,796 and $2,435. If all your income is unearned, such as Social Security, subtract $20 from it and compare the result to those manual figures, or compare your unsubtracted income to the published limits; both give the same answer. Subtracting $20 and then comparing to the published limit counts the disregard twice.1

That said, don't rule yourself out on the headline figure. Cover Virginia's flyer states that additional income and resource disregards may apply depending on the kinds of income and resources you have, and SSA tells its own staff to encourage people whose income or resources look somewhat higher than the limits to apply anyway. If you or your spouse work, it is worth having a benefits counselor run the actual numbers before assuming you earn too much.1

How to Apply for Virginia Medicare Savings Programs

Your local DSS office or Cover Virginia decides MSP eligibility, applying the income and resource limits shown above.1 You can apply four ways:

CommonHelp (online): Apply at commonhelp.virginia.gov, the state's online benefits portal.1

Cover Virginia call center: Call Cover Virginia toll-free at 1-855-242-8282 to apply by phone.1

Local Department of Social Services (DSS): Your local DSS office can give you a paper application, and DSS is one of the offices that determines MSP eligibility.1

Some hospitals: Applications can also be filed at some hospitals, so ask a hospital financial counselor or social worker if you are already there.1

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: Federal rules (42 CFR § 435.912) cap the eligibility decision at 45 days for applicants who do not apply on the basis of disability, except in unusual circumstances, such as when you or an examining physician delays a required step.11

Free help applying: Virginia's State Health Insurance Assistance Program is the Virginia Insurance Counseling and Assistance Program (official page) (VICAP), which sits with the Department for Aging and Rehabilitative Services. VICAP offers free, unbiased, confidential counseling to Medicare beneficiaries. Reach them toll-free at 1-800-552-3402.12

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 one car. The numbers run as follows.

Income test:

• Gross Social Security: $1,280
• 2026 QMB individual limit, with the $20 disregard already built in: $1,350
• Result: below the ceiling, so she qualifies for QMB. (Subtracting the $20 and comparing $1,260 to the manual's $1,330 gives the same answer.)1

Resource test:

• Countable savings: $7,400
• Her car: one vehicle is not a countable resource
• 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.3 She is also deemed eligible for full Extra Help, so her Part D copays are capped and she does not need to apply for it separately.2

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.