Washington Medicare Savings Programs 2026: QMB, SLMB & QI

Washington Medicare Savings Programs pay Medicare premiums and cost-sharing for income-eligible seniors and people with disabilities enrolled in Medicare. The broadest tier, QMB, eliminates the Part B premium and all Medicare cost-sharing in a single program.

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. QMB, SLMB, and QI are mandatory eligibility groups under Title XIX of the Social Security Act, so every state plan must cover them.

Washington Apple Health is administered by the Washington State Health Care Authority (HCA), with long-term care and MSP eligibility processed by the Department of Social and Health Services (DSHS) Home and Community Services division. MSP eligibility uses the SSI-related income methodology, which includes two disregards that reduce countable income: a $20/month general income disregard applied to unearned income, and a $65 plus half of remaining earned income disregard for working applicants. The income figures below already reflect the $20 disregard.

QMB: Qualified Medicare Beneficiary

QMB is the most comprehensive tier. It covers:

• The Medicare Part A premium (most beneficiaries have premium-free Part A after 40 work quarters)
• The Medicare Part B premium ($185.00/month standard rate in 2026 per CMS)
• The Part A inpatient hospital deductible ($1,736 in 2026)
• The Part B annual deductible ($257 in 2026)
• All Medicare coinsurance and copays on every Medicare-covered service

2026 Washington QMB income limits: at or below $1,350/month for a single person, or at or below $1,823/month for a couple. These reflect 100% of the Federal Poverty Level with the $20 general income disregard applied.

Resource limit: $9,950 for one person, $14,910 for a couple. The primary home and one vehicle are excluded entirely.

For a single Washington senior on Social Security, QMB can be worth more than $3,000 a year in saved premiums, deductibles, and copays. Every QMB enrollee is automatically deemed eligible for full Part D Extra Help.

SLMB: Specified Low-Income Medicare Beneficiary

SLMB covers one benefit: the Medicare Part B premium. At the 2026 standard rate, that is $2,220.00 per year.

2026 Washington SLMB income limits: $1,351 to $1,616/month for a single person, $1,824 to $2,186/month for a couple.

Resource limit: same as QMB: $9,950 single, $14,910 couple.

SLMB does not pay deductibles or copays. For a beneficiary with modest Medicare utilization, the Part B premium is typically the largest predictable out-of-pocket Medicare cost, and SLMB removes it.

SLMB also confers automatic Part D Extra Help, which can cut drug costs to $5.10/generic and $12.65/brand-name copays with a $0 deductible and $0 premium on a benchmark Part D plan.

QI: Qualifying Individual

QI covers the Part B premium only, at a higher income band: $1,617 to $1,816/month for a single person, $2,187 to $2,457/month for a couple (2026 Washington figures).

Two structural differences from QMB and SLMB:

1. First-come, first-served. QI is funded through a capped federal allotment. Washington allocates enrollment first-come, first-served, with preference for prior-year QI enrollees. QI is not an entitlement; unlike QMB and SLMB, it carries no guarantee of enrollment.
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 or SLMB-Plus, which combine MSP cost-sharing protection with full Apple Health Medicaid.

Like SLMB, QI enrollment triggers automatic Part D Extra Help.

The QMB Billing Prohibition

Federal law, specifically 42 USC § 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 Washington Apple Health.

If you are a QMB enrollee and receive a bill for a deductible, coinsurance, or copay on a Medicare-covered service. 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 DSHS eligibility notice or Medicare card with the QMB indicator.
• Call 1-800-MEDICARE (1-800-633-4227) to file a complaint.
• Contact the Washington Statewide Health Insurance Benefits Advisors (SHIBA) program at 1-800-562-6900 for free assistance.

A provider who has incorrectly billed a QMB must recall the bill from any collections process and refund payments already collected.

Part D Extra Help / Low-Income Subsidy

Every QMB, SLMB, and QI enrollee in Washington is automatically deemed eligible for full Part D Extra Help (also called the Low-Income Subsidy, or LIS). No separate application is required.

Under the 2026 Part D benefit structure:

• $0 Part D premium on a benchmark plan
• $0 annual deductible
• $5.10 per generic prescription
• $12.65 per brand-name or preferred multi-source drug
• $0 in copays after the annual out-of-pocket cap

For a senior filling six prescriptions per month, Part D Extra Help can represent $1,500 to $2,500 in annual drug-cost savings on top of the Part B premium benefit from SLMB or QI.

The deeming flows automatically from Washington HCA/DSHS 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.

Washington Medicare Savings Programs: 2026 Income Limits at a Glance

Income limits reflect 100% FPL (QMB), 100-120% FPL (SLMB), and 120-135% FPL (QI) with the $20 general income disregard applied. Resource limit for all three: $9,950 single / $14,910 couple.

What Counts as a Resource, and What Doesn't

The $9,950/$14,910 resource test excludes several major asset categories:

Excluded (don't count):

• Primary residence, regardless of value or equity
• One vehicle, regardless of make, model, or value
• Household goods and personal effects
• Prepaid burial arrangements and a burial fund up to $1,500 per person

Counted:

• Checking and savings account balances
• Stocks, bonds, certificates of deposit, mutual funds
• A second vehicle or second home
• Non-exempt cash-value life insurance above the face-value threshold

Washington seniors in high home-value areas often assume their home disqualifies them from MSP. It doesn't. The primary residence is fully excluded from the resource count, regardless of equity.

How to Apply for Washington Medicare Savings Programs

Washington offers multiple application pathways:

1. Online via Washington Connection Apply at washingtonconnection.org. This is Washington's online portal for Medicaid and related benefit programs. Complete the application and upload supporting documents.

2. By phone Call Washington HCA/DSHS at 1-877-501-2233. Staff can take applications by phone for applicants who cannot access the online portal or visit an office.

3. In person at a local DSHS Home and Community Services office Bring your Medicare card, Social Security award letter, recent bank statements, and proof of Washington residency. Staff will assist with the paper application.

Through SSA. Applying for Part D Extra Help at your Social Security office using Form SSA-1020 generates an automatic referral to Washington Medicaid under federal law (42 USC § 1320b-14). Your SSA application date serves as the protected filing date.

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 COLA letter
• Recent bank and investment account statements
• Pension or annuity statements, if applicable
• Proof of Washington residency (utility bill, lease, or mortgage statement)

Effective Dates and Retroactive Coverage

• QMB: coverage begins the first day of the month after DSHS approves your application. Federal law (42 USC § 1396a(e)(8)) prohibits retroactive QMB coverage. Apply early.
• SLMB and QI: up to three months of retroactive coverage is available under 42 CFR § 435.915 if you were eligible during that window. File early even if you can't gather every document immediately.

After approval, DSHS 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.

Washington-Specific Notes

Washington Apple Health does not require a Qualified Income Trust (Miller Trust) for long-term care Medicaid. Instead, an applicant whose income exceeds the special income level can qualify through a medically needy spend-down. For MSPs, this is not relevant; MSP eligibility turns solely on the income and resource tests above.

Washington also elects the higher federal home-equity limit for long-term care Medicaid; for 2026, the home-equity exemption ceiling is $1,130,000 under WAC 182-513-1350. That limit applies to long-term care applications, not to MSP. MSPs have no home-equity cap; the primary residence is excluded from resources without limit. For more on Washington long-term care Medicaid, see Washington Medicaid eligibility and income limits.

Learn More

• Washington Medicaid Eligibility and Income Limits
• How to Apply for Washington Medicaid
• Understanding the Personal Needs Allowance

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.