West Virginia Medicare Savings Programs 2026: QMB, SLMB & QI

If your monthly income is $1,350 or less, West Virginia's Qualified Medicare Beneficiary (QMB) program can pay your Medicare Part B premium and your Part A and Part B deductibles and copays. QMB is the broadest of West Virginia's three Medicare Savings Programs, which pay some or all of a low-income senior's or disabled beneficiary's Medicare costs.1

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 Medicaid eligibility groups under section 1902(a)(10)(E) of the Social Security Act, so a state Medicaid plan in any of the 50 states or DC must cover them.2

West Virginia Medicaid is administered by the West Virginia Bureau for Medical Services (BMS), within the West Virginia Department of Human Services (DoHS).3 DoHS runs the Medicare Savings Programs, and its Bureau for Family Assistance calls the benefit "Medicare Premium Assistance." The bureau states each program's income range as a share of the Federal Poverty Level: QMB below 100%, SLIMB (its spelling of SLMB) 101% to 120%, and QI-1 121% to 135%. The dollar limits in this guide are the 2026 federal effective limits for those tiers, and they already build in the $20/month SSI general income exclusion.1 MSP eligibility counts income and resources under Supplemental Security Income (SSI) rules, so a worker also has the first $65 of monthly earnings and half of the rest excluded.4

QMB: Qualified Medicare Beneficiary

QMB is the most comprehensive tier. In 2026 it covers:

• The Medicare Part A premium, if you don't have premium-free Part A (most people do, because they or a spouse paid Medicare taxes long enough while working)
• The Medicare Part B premium ($202.90/month standard rate in 2026 per the Centers for Medicare & Medicaid Services (CMS))
• The Part A inpatient hospital deductible ($1,736 per benefit period in 2026)
• The Part B annual deductible ($283 in 2026)
• Part A and Part B coinsurance and copays on Medicare-covered items and services5,1

QMB doesn't cover your Medicare drug plan's copays. Through Extra Help, you pay no more than $12.65 per covered drug in 2026.1

2026 QMB income limits: at or below $1,350/month for a single person, or at or below $1,824/month for a couple. These are the federal effective limits for West Virginia's below-100%-of-poverty QMB tier, with the $20 general income exclusion built in.1

Resource limit: $9,950 for one person, $14,910 for a couple under the 2026 federal standard. West Virginia's own pages still print two lower, out-of-date pairs of figures, so don't rule yourself out because of them; the resource section below sets them side by side. The home you live in and one car don't count.1

For a single West Virginia senior, QMB in 2026 eliminates the $202.90 monthly Part B premium (about $2,435 a year at $202.90 x 12 months), the $1,736 Part A hospital deductible per benefit period, and the $283 Part B deductible, along with Part A and Part B coinsurance and copays on Medicare-covered services.5,1 Every QMB enrollee is automatically deemed eligible for full Part D Extra Help.1

SLMB: Specified Low-Income Medicare Beneficiary

SLMB covers one benefit: the Medicare Part B premium. At the 2026 standard rate of $202.90/month, that is about $2,435 over a full year ($202.90 x 12 months).5

2026 SLMB income limits: $1,351 to $1,616/month for a single person, $1,825 to $2,184/month for a couple.1

Resource limit: same as QMB: $9,950 single, $14,910 couple under the federal standard, with the same lower, out-of-date figures on West Virginia's own pages.1

SLMB does not pay deductibles or copays. What it does take off your plate is the $202.90 Part B premium, a cost you'd otherwise owe every month whether or not you use any care.5,1

SLMB also confers automatic Part D Extra Help, which caps covered generic drugs at $5.10 and brand-name drugs at $12.65, with a $0 deductible and $0 premium on a benchmark Part D plan.6

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, $2,185 to $2,455/month for a couple (2026 federal effective limits for West Virginia's 121%-to-135%-of-poverty QI-1 tier).1

Two structural differences from QMB and SLMB:

1. First-come, first-served. QI is paid out of a capped annual federal allocation to each state and granted first-come, first-served, with preference for people who had QI in the last month of the previous year. You must reapply every year, and being selected one year doesn't guarantee the next.1
2. Not for people with other Medicaid. Federal law limits QI to people who aren't otherwise eligible for Medicaid under the state plan. Someone who qualifies for an MSP and for full Medicaid is a QMB Plus or an SLMB Plus instead, never a QI.2 The two aren't equal on Medicare cost-sharing: QMB Plus carries QMB's protection from being billed for Medicare Part A and Part B deductibles, coinsurance and copays, while SLMB pays only the Part B premium, and CMS lists SLMB Plus cost-sharing coverage as varying by state.7 West Virginia's own fact sheet says a QI-1 recipient "may be a recipient of other Medicaid coverage," which conflicts with the federal rule, so if you already have West Virginia Medicaid, don't count on QI-1 and ask DoHS which program applies.1

Like SLMB, QI enrollment triggers automatic Part D Extra Help.1

The QMB Billing Prohibition

Federal law, chiefly section 1902(n)(3)(B) of the Social Security Act, prohibits every Medicare provider and supplier, pharmacies included, from billing a QMB enrollee for Medicare Part A or Part B cost-sharing, even when Medicaid pays nothing toward it. A provider who ignores the rule is violating its Medicare provider agreement or, for a Medicare Advantage plan's providers, its Part C obligations.8

If you are a QMB enrollee and you receive a bill for a Part A or Part B deductible, coinsurance, or copay on a Medicare-covered service, do not pay it. You have no legal obligation to pay it, and CMS records that QMBs are still wrongly billed in practice, so treat such a bill as improper.1 The protection stops at Medicare Part A and Part B cost-sharing: QMB doesn't cover your drug plan's copays, and you may also get a bill for a small Medicaid copayment, if one applies.1

If you receive such a bill:

• Tell the provider you are a QMB enrollee and cite the federal billing prohibition.
• Show your Medicare and Medicaid cards (or QMB Program card), or a Medicare Summary Notice showing you're in the QMB Program.8
• If the billing continues, call 1-800-MEDICARE (1-800-633-4227; TTY 1-877-486-2048). Medicare can confirm your QMB status and ask the provider to stop billing you and refund what you've paid.9,8
• Contact West Virginia SHIP at 1-877-987-4463 (www.wvship.org) for free counseling and bill-dispute help.10

CMS tells providers to recall any QMB cost-sharing bills, including ones sent to collections, and to refund any cost-sharing a QMB has already paid.8

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. QDWI, the fourth Medicare Savings Program, does not confer Extra Help.1

Under the 2026 Part D Extra Help benefit:

• $0 Part D premium on a benchmark plan
• $0 annual deductible
• No more than $5.10 per covered generic prescription
• No more than $12.65 per covered brand-name drug
• $0 for the rest of the year once your out-of-pocket drug costs reach the $2,100 catastrophic threshold6

For a senior who fills several prescriptions a month, capping each generic at $5.10 and each brand-name drug at $12.65, with no Part D deductible and no premium on a plan at or under the benchmark, adds up quickly.6 That is on top of the Part B premium relief from SLMB or QI. The premium help is capped at your region's benchmark, so if you pick a pricier plan, you pay the difference.6

Deemed Extra Help lasts at least through the end of the calendar year, and through the following year too if you were deemed between July 1 and December 31. If you later lose your MSP, you'll need to file an Extra Help application for the next year. A change in your Medicaid or Extra Help status also opens a 3-month window to switch Part D plans.11

West Virginia 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 under the 2026 federal standard, though West Virginia's own pages print lower, out-of-date figures. The next section explains what to do about it.1

What Counts as a Resource, and What Doesn't

The 2026 federal resource limit for all three programs is $9,950 for one person and $14,910 for a couple. CMS states that this is the resource standard for single and married QMBs, SLMBs and QIs effective January 1, 2026. West Virginia's own pages haven't caught up: the BMS member brochure still prints $9,660 and $14,470, the federal standard that took effect January 1, 2025, and a Bureau for Family Assistance fact sheet titled "Eligibility and Requirements" prints lower figures again, $9,090 and $13,630. Both pairs are out of date and below the 2026 federal standard.1

The practical takeaway: if your countable resources are at or under $9,950 (single) or $14,910 (couple), don't rule yourself out because of a lower figure on a state page, and apply even if they look somewhat higher. Social Security instructs its own staff to encourage people to apply in exactly this situation, because a state can effectively raise its limits, or drop the resource test altogether, by disregarding some income or resources.1

Several major asset categories don't count at all.1

Excluded (don't count):

• Your home
• One car
• Furniture and other household and personal items
• A burial plot, and up to $1,500 you've set aside for burial expenses1

Counted:

• Cash
• Checking and savings account balances
• Stocks, bonds, annuities, and certificates of deposit1

If you've been assuming your home counts toward the resource limit, it does not. A QMB applicant in a paid-off home is judged on bank balances and other countable assets, not the house, and if those land at or anywhere near $9,950 ($14,910 for a couple), apply and let DoHS run the test.1

How to Apply for West Virginia Medicare Savings Programs

For Medicare Premium Assistance, the Bureau for Family Assistance and the BMS member brochure both point you to your local DoHS office first: call or visit it to see whether you qualify.1 You have a few ways in:

At or through your local DoHS county office You can apply in person at the county office, or print a completed application and mail it there.3 Bring your Medicare card, Social Security award letter, recent bank statements, and proof of West Virginia residency.

Online via WV PATH BMS calls WV PATH its recommended way to apply for most types of health coverage.3

By phone The DoHS hotline at 1-877-716-1212 takes applications for some types of Medicaid, so ask whether it can take yours.3

Through Social Security. An Extra Help application filed with Social Security on form SSA-1020 also starts the MSP application process unless you object, and SSA sends that data to the state Medicaid agency.1

Documents to Gather Before You Apply

• Medicare card (showing your Medicare Beneficiary Identifier, or 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 runs forward only. Under section 1902(e)(8) of the Social Security Act, a QMB determination applies to services furnished after the end of the month in which you're first determined eligible, so apply early.12
• SLMB and QI: that QMB-only rule doesn't name SLMB or QI, and the federal sources behind this guide don't set how far back SLMB or QI coverage can reach. Ask DoHS whether a retroactive start is available for your program, and file as early as possible.12 For Medicaid generally, federal law sets a three-month retroactive window as the default, a Section 1115 demonstration can leave a state's window shorter, and for applications made on or after January 1, 2027, federal law shortens it to two months for most enrollees.2

Once you're approved, the state pays your Part B premium through a buy-in arrangement with Medicare, and the premium stops coming out of your Social Security check. Setting that up can take one or more months, so the deduction may continue for a while after approval; once buy-in takes effect, SSA refunds premiums withheld for any month you were covered.13

If Your Application Is Denied

If DoHS denies your MSP application, or approves you for a lower tier than you expected, you have the right to appeal by requesting a state fair hearing from the West Virginia Board of Review. You have up to 90 days from the effective date of the action to ask, and you can ask verbally or in writing: by mail, by email to OIGBOR@wv.gov, by phone at 304-352-0805, or through the Board's online request form. If you're already getting benefits and you ask before the action takes effect, the action is generally held until the hearing decision, though you may have to repay that help if you lose.14 West Virginia SHIP counselors (1-877-987-4463) explain appeal rights at no cost.10

West Virginia-Specific Notes

Long-term care Medicaid in West Virginia runs on different income rules. The 2026 federal income cap is $2,982/month, 300% of the $994 SSI Federal Benefit Rate, and BMS says some people whose income is too high at application may still qualify through spenddown.3,15 Those long-term care rules are separate from the Medicare Savings Programs, where the QMB, SLMB, and QI income bands and resource limits above apply.

For more on West Virginia's full Medicaid rules, see West Virginia 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.