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 runs them with no asset test at all. The broadest tier, the Qualified Medicare Beneficiary (QMB) program, wipes out the Part B premium and every Medicare deductible and copay in one step.

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), with Medicare Savings Program eligibility processed by the Department of Social and Health Services (DSHS). Two things make Washington more generous than the federal baseline: it uses no resource (asset) test for these programs, and it sets its income tiers higher than the federal floor, running QI coverage all the way to 138% of the Federal Poverty Level (FPL) rather than the federal 135%. The dollar limits below are Washington's own operative figures, effective April 1, 2026.2

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 2026
• All Medicare coinsurance and copays on every Medicare-covered service3

Those federal cost figures are the 2026 amounts published by the Centers for Medicare & Medicaid Services (CMS).

2026 Washington QMB income limit: 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, higher than the federal QMB ceiling of 100% FPL. 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: monthly 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.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, with a $0 deductible and $0 premium on a benchmark Part D plan.4

QI: Qualifying Individual

QI, administered in Washington as the QI-1 program, covers the Part B premium only, at a higher income band: monthly 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.2

Two structural differences set QI apart from QMB and SLMB:

1. First-come, first-served. QI is funded through a capped federal allotment. Enrollment is granted first-come, first-served from limited annual funding, so QI carries no guarantee of enrollment the way QMB and SLMB do.1
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 Medicare Savings Program 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.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 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, full Extra Help gives you:

• A $0 Part D premium on a benchmark plan
• A $0 annual deductible
• 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

The deeming flows automatically from Washington HCA/DSHS to CMS each month after Medicare Savings Program 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 110% FPL (QMB), 110-120% FPL (SLMB), and 120-138% FPL (QI-1) under WAC 182-517-0100. Washington applies no resource test to any of the three programs.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 solely on the monthly income limits above. A Washington senior with meaningful savings who assumed they earned 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 free help from a local SHIBA counselor: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 these programs, you do not need to document savings or investment balances to qualify.

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, so 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 cannot 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 Medicare Savings Programs, this is not relevant; eligibility turns solely on the income tests above.5

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 Medicare Savings Programs, which have no asset test and therefore no home-equity cap at all.5 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.