West Virginia 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.
West Virginia Bureau for Medical Services, administered by the West Virginia Department of Human Services (DoHS), administers all three MSP tiers. MSP eligibility uses the SSI-related income methodology, which includes two income 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 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 West Virginia 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 West Virginia 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 West Virginia 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 relatively few Medicare claims, the Part B premium is the dominant fixed annual cost, and SLMB eliminates 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 West Virginia figures).
Two structural differences from QMB and SLMB:
- First-come, first-served. QI is funded through a capped federal allotment. West Virginia DoHS allocates enrollment first-come, first-served, with preference for prior-year QI enrollees. QI is not an entitlement, unlike QMB and SLMB.
- 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 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 West Virginia Medicaid.
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 DoHS eligibility notice or Medicare card with the QMB indicator.
- Call 1-800-MEDICARE (1-800-633-4227) to file a complaint.
- Contact the West Virginia SHIP for free counseling and bill-dispute assistance.
A provider who has 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 West Virginia 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 West Virginia DoHS 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.
West Virginia Medicare Savings Programs: 2026 Income Limits at a Glance
| Program | Single monthly income limit | Couple monthly income limit | What it pays |
|---|---|---|---|
| QMB | $1,350 | $1,823 | Part A + Part B premiums + all cost-sharing |
| SLMB | $1,351-$1,616 | $1,824-$2,186 | Part B premium only |
| QI | $1,617-$1,816 | $2,187-$2,457 | Part B premium only (capped allotment) |
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
Many West Virginia seniors assume their home counts toward the resource limit. It does not. A QMB applicant in a paid-off home can still qualify as long as bank balances and other financial assets stay within $9,950.
How to Apply for West Virginia Medicare Savings Programs
West Virginia offers multiple application pathways:
1. Online via WV PATH Apply at wvpath.wv.gov. This is West Virginia's online portal for Medicaid and related benefit programs. Complete the application and upload supporting documents.
2. By phone Call West Virginia DoHS at 1-877-716-1212. Staff can take applications by phone for applicants who cannot use the online portal or visit an office.
3. In person at a local DoHS county office Bring your Medicare card, Social Security award letter, recent bank statements, and proof of West Virginia 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 West Virginia 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 West Virginia residency (utility bill, lease, or mortgage statement)
Effective Dates and Retroactive Coverage
- QMB: coverage begins the first day of the month after DoHS 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 as early as possible.
After approval, DoHS 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.
West Virginia-Specific Notes
West Virginia operates both an income-cap standard for long-term care Medicaid ($2,982/month, equal to 300% of the 2026 SSI Federal Benefit Rate) and a medically needy spend-down for applicants who exceed that limit. For Medicare Savings Programs, these long-term care income rules are separate from MSP eligibility. MSP qualification turns solely on the QMB/SLMB/QI income bands described above.
West Virginia also has a Personal Needs Allowance of $50/month for nursing-facility residents receiving long-term care Medicaid. For more on West Virginia's full Medicaid rules, see West Virginia Medicaid eligibility and income limits.
Frequently Asked Questions
A West Virginia Medicare beneficiary with monthly income at or below $1,350 (single) or $1,823 (couple) and countable resources at or below $9,950/$14,910. The primary home and one car are excluded. QMB pays Part A and Part B premiums plus all Medicare cost-sharing.
No. Federal law prohibits QI enrollment for anyone who qualifies for full Medicaid. If you qualify for full-benefit West Virginia Medicaid, you would instead be eligible for QMB-Plus or SLMB-Plus.
No. Every West Virginia QMB, SLMB, and QI enrollee is automatically deemed eligible for full Part D Extra Help. DoHS transmits the deeming to CMS monthly. If you are not already in a Part D plan, CMS will assign you to a zero-premium benchmark plan.
Don't pay. Federal law prohibits any Medicare provider from billing QMB enrollees for Medicare cost-sharing. Call 1-800-MEDICARE (1-800-633-4227) to file a complaint.
Yes, for up to three months if you were eligible during that window. QMB has no retroactive coverage. File SLMB and QI applications as early as possible to preserve the full retroactive window.
Learn More
- West Virginia Medicaid Eligibility and Income Limits
- How to Apply for West Virginia 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.