Washington Medicare Savings Programs 2026: QMB, SLMB & QI

Washington Medicare Savings Programs pay the Medicare premiums and cost-sharing of income-eligible seniors and people with disabilities, and Washington applies no asset test. The broadest tier, the Qualified Medicare Beneficiary (QMB) program, covers the Part B premium and leaves you with no legal obligation to pay Medicare deductibles, coinsurance, or copays.

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. The Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), and Qualifying Individual (QI) programs are mandatory eligibility groups under Title XIX of the Social Security Act, so every state plan must cover them.1

Washington Apple Health is administered by the Washington State Health Care Authority (HCA), the Medicaid agency that runs these programs under WAC 182-517-0100; the Department of Social and Health Services (DSHS) Community Services Offices are one of the channels you apply through. Two things make Washington more generous than the federal baseline: it uses no resource (asset) test for QMB, SLMB, or QI-1, and it sets its income tiers higher than the federal floor, running QI-1 coverage all the way to 138% of the Federal Poverty Level (FPL). The dollar limits below are Washington's own operative figures, effective April 1, 2026.2 The federal QI band, by comparison, tops out at 135% FPL.1

Do this one step before you compare anything. HCA's own worksheet applies the QMB, SLMB, and QI-1 limits below to your income after a $20 deduction: write down your gross monthly household income, subtract $20 (one deduction per household), and compare that total to the chart. It does not settle QDWI, which HCA carves out separately. Washington publishes bare Federal Poverty Level standards, so skipping the deduction can make you look over the limit when you are not.2

QMB: Qualified Medicare Beneficiary

QMB is the most comprehensive tier. In 2026 it 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 at the 2026 standard rate
• The Part A inpatient hospital deductible, $1,736 per benefit period in 2026
• The Part B annual deductible, $283 in 20263
• Medicare coinsurance, copayments, and deductibles for Part A, Part B, and Part C (Medicare Advantage)2

Those federal cost figures are the 2026 amounts published by the Centers for Medicare & Medicaid Services (CMS). Washington's payment of that cost-sharing is subject to the payment limits in WAC 182-502-0110,2 but that is the state's arithmetic with the provider, not yours. A QMB enrollee has no legal obligation to pay Part A or Part B deductibles, coinsurance, or copayments for any Medicare-covered item or service.1

2026 Washington QMB income limit: countable income (gross household income minus the $20 deduction) at or below $1,463/month for a single person, or $1,984/month for a couple. That is 110% of the Federal Poverty Level,2 higher than the federal QMB ceiling of 100% FPL.1 Washington applies no asset test, so savings and other resources never disqualify a QMB applicant.2

For a single Washington senior on Social Security, QMB is worth $2,434.80 a year in Part B premiums alone (at $202.90 a month), before the Part B deductible, the Part A hospital deductible, and every coinsurance it also covers.3 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 of $202.90 a month, that is $2,434.80 per year back in the beneficiary's Social Security check.3

2026 Washington SLMB income limit: countable income above the QMB limit and up to $1,596 for a single person, or $2,165 for a couple (over 110% and up to 120% FPL). As with QMB, Washington counts no assets, and the $20 deduction applies before you compare.2

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 caps covered-drug copays at $5.10 for generics and $12.65 for brand-name drugs.4 Full Extra Help also eliminates the annual Part D deductible outright5 and covers the full premium of any plan priced at or below your region's low-income benchmark.5

QI: Qualifying Individual

QI, administered in Washington as the QI-1 program, covers the Part B premium only, at a higher income band: countable income above the SLMB limit and up to $1,835 for a single person, or $2,490 for a couple (over 120% and up to 138% FPL). Washington counts no assets here either, and the same $20 deduction applies.2

Two structural differences set QI apart from QMB and SLMB:

1. First-come, first-served. QI is funded through a capped federal allotment, and states select applicants in the order they apply, so QI carries no guarantee of enrollment the way QMB and SLMB do.1 In Washington, QI-1 pays the Part B premium until the agency's federal allotment for the year is spent, then resumes at the beginning of the next calendar year.2 You also have to apply for QI every year: being selected one year does not entitle you to assistance in any following year.1
2. Mutually exclusive with full Medicaid. If you qualify for any full-benefit Medicaid category, you cannot be enrolled in QI.1

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

QDWI: Qualified Disabled and Working Individual

Washington runs a fourth Medicare Savings Program that the three tiers above leave out, and it is the one most often missed. QDWI pays the Medicare Part A premium for a person who is under 65, employed, and meets the disability requirements in WAC 182-512-0050. It exists for people who returned to work and lost premium-free Part A as a result.2

2026 Washington QDWI income limit: countable income over 138% FPL and up to 200% FPL, which is up to $2,660/month for a single person or $3,608/month for a couple, effective April 1, 2026. Treat those figures as a guide, not a self-screening threshold: HCA's brochure carves QDWI out of the $20 worksheet, stating the program has special earned income deductions and that you will need to call for assistance in determining eligibility for it. Because a QDWI applicant is by definition working, call HCA rather than screening yourself in or out.2

Two cautions. QDWI is the one Medicare Savings Program that does not carry automatic Part D Extra Help: federal rules deem only QMB, SLMB, and QI enrollees full-subsidy eligible.1 And unlike QMB, SLMB, and QI-1, QDWI eligibility is not simply an income test, so confirm the employment and disability conditions with HCA before assuming you are in or out.

The QMB Billing Prohibition

Federal law, specifically 42 USC § 1396a(n)(3), prohibits Medicare providers and suppliers, including pharmacies, from billing a QMB enrollee for Medicare cost-sharing. A QMB enrollee has no legal obligation to pay Part A or Part B deductibles, coinsurance, or copayments for any Medicare-covered item or service, whether it came through Original Medicare or a Medicare Advantage plan.1

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 Apple Health eligibility notice or Medicare card with the QMB indicator.
• Call 1-800-MEDICARE (1-800-633-4227), the official Medicare contact line, staffed 24 hours a day, 7 days a week except some federal holidays. TTY users call 1-877-486-2048.6
• Contact the Washington Statewide Health Insurance Benefits Advisors (SHIBA) program at 1-800-562-6900 for help.2

Because you had no legal obligation to pay in the first place, ask the provider to pull the bill back out of collections and refund anything you have already paid on it.1

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. QDWI is the exception: federal rules deem only QMB, SLMB, and QI enrollees full-subsidy eligible.1

Under the 2026 Part D benefit, full Extra Help gives you:

• Copays capped at $5.10 per covered generic prescription
• Copays capped at $12.65 per covered brand-name drug
• $0 for covered Part D drugs once your out-of-pocket spending reaches the $2,100 catastrophic threshold for the rest of the calendar year4
• No annual Part D deductible at all. The $615 maximum deductible a 2026 plan may charge applies to people who do not have Extra Help, not to you.5
• A $0 Part D premium on any plan priced at or below your PDP region's low-income benchmark. CMS sets that benchmark separately for each region, so if you pick a plan above your region's benchmark you pay the difference.5

That last point is the one worth acting on: the premium subsidy is a fixed amount, not an open tab, so check that the Part D plan you choose sits at or below your region's benchmark before you enroll.5

Washington Medicare Savings Programs: 2026 Income Limits at a Glance

These are countable-income limits: compare them to gross monthly household income after the $20 deduction, not to your gross figure. The tiers reflect 110% FPL (QMB), 110-120% FPL (SLMB), 120-138% FPL (QI-1), and 138-200% FPL (QDWI) under WAC 182-517-0100. Washington applies no resource test to QMB, SLMB, or QI-1.2

Does an Asset Test Apply in Washington?

No. This is where Washington departs most sharply from the federal Medicare Savings Program rules and from most other states. Under WAC 182-517-0100, Washington applies no resource (asset) test to QMB, SLMB, or QI-1.2

In states that do use the federal asset test, an applicant is capped at a set amount of countable resources, and savings, a second vehicle, or investment accounts can push them over. In Washington, none of that is counted for these three programs. Eligibility turns on countable monthly income, meaning your gross household income after the $20 deduction, measured against the limits above.2 A Washington senior with meaningful savings who assumed they held too much in assets to qualify should still apply, because their bank balance does not count.

If you are applying for Washington long-term care Medicaid instead, a separate asset test does apply there. See Washington Medicaid eligibility and income limits for those rules.

How to Apply for Washington Medicare Savings Programs

Washington residents can apply for a Medicare Savings Program through several pathways, including online at Washington Connection or with help from a local SHIBA counselor. No interview is required.2

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
• Pension or annuity statements, if applicable
• Proof of Washington residency (utility bill, lease, or mortgage statement)

Because Washington uses no asset test for QMB, SLMB, or QI-1, you do not need to document savings or investment balances to qualify for those three.

Effective Dates and Retroactive Coverage

• QMB: coverage begins the first day of the month after your application is approved. Federal law (42 USC § 1396a(e)(8)) prohibits retroactive QMB coverage, so apply early.8
• 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 cannot gather every document immediately.8 Three months is the federal default, and a state can narrow or drop that window for particular coverage groups only under a Section 1115 demonstration waiver, so ask the Health Care Authority how the rule applies to your group.9

After approval you receive a written eligibility notice. Once QMB or SLMB starts, the state takes over the Part B premium,2 so Social Security stops withholding it from your monthly check.

Washington-Specific Notes

Washington's long-term care Medicaid runs on rules that do not apply here. If your income exceeds the special income level for institutional or waiver coverage, Washington's SSI-related medically needy program lets you qualify by incurring medical and care expenses against that excess income, a spend-down under WAC 182-513-1395. None of that touches a Medicare Savings Program application, whose eligibility turns on the income tests above.7

Washington sets its long-term care home-equity limit at the federal maximum allowed, which CMS posts each year; for 2026 that ceiling is $1,130,000 under WAC 182-513-1350. That limit applies to long-term care applications, not to Medicare Savings Programs, which have no asset test and therefore no home-equity cap at all.7 For more on Washington long-term care Medicaid, see Washington Medicaid eligibility and income limits.

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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.