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 erase your Medicare Part B premium and every Medicare deductible and copay. 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 eligibility groups under Title XIX of the Social Security Act, so every state plan must cover them.

The West Virginia Bureau for Medical Services (BMS), the state's Medicaid agency within the West Virginia Department of Human Services (DoHS), administers all three MSP tiers. MSP eligibility uses the Supplemental Security Income (SSI) income methodology, which applies a $20/month general income disregard to unearned income before comparing it to the limit. The figures throughout this guide already reflect that $20 disregard, and there is an additional earned-income disregard for applicants who work.1

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/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)
• All Medicare coinsurance and copays on every Medicare-covered service2

2026 West Virginia QMB income limits: at or below $1,350/month for a single person, or at or below $1,824/month for a couple. These reflect 100% of the Federal Poverty Level with the $20 general income disregard applied.1

Resource limit: $9,950 for one person, $14,910 for a couple. The primary home and one vehicle are excluded entirely.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 all Medicare coinsurance and copays.2 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/month, that is about $2,435 over a full year ($202.90 x 12 months).2

2026 West Virginia 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.1

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 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.3

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 West Virginia figures).1

Two structural differences from QMB and SLMB:

1. 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.
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 Medicaid.

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

The QMB Billing Prohibition

Federal law, specifically 42 U.S.C. § 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 you 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 the federal billing prohibition.
• Show your DoHS eligibility notice or your Medicare card with the QMB indicator.
• Call 1-800-MEDICARE (1-800-633-4227) to file a complaint.
• Contact West Virginia SHIP at 1-877-987-4463 (wvship.org) for free counseling and bill-dispute help.4

A provider who has billed a QMB enrollee 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 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 threshold3

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 premium or deductible on a benchmark plan, can save hundreds to more than a thousand dollars a year, depending on the drugs involved.3 That is on top of the Part B premium relief 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

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.1

What Counts as a Resource, and What Doesn't

The $9,950/$14,910 resource test excludes several major asset categories.1

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 person1

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 $9,950.1

How to Apply for West Virginia Medicare Savings Programs

West Virginia offers multiple application pathways. Choose whichever is easiest for you:

Online via WV PATH Apply at WV PATH, West Virginia's online portal for Medicaid and related benefit programs. Complete the application and upload supporting documents.

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.5

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 Social Security. 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 U.S.C. § 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, 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 begins the first day of the month after DoHS approves your application. Federal law (42 U.S.C. § 1396a(e)(8)) prohibits retroactive QMB coverage, so apply early.
• SLMB and QI: up to three months of retroactive coverage is available under 42 C.F.R. § 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.

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 fair hearing. The written denial notice explains the reason for the decision and states the deadline to request a hearing, so read it carefully and act before that date. You can file the hearing request in writing through WV PATH or with your local DoHS county office, and West Virginia SHIP counselors (1-877-987-4463) can help you review the notice and prepare your appeal at no cost. You may keep any existing benefits while an appeal is pending if you request the hearing within the timeframe stated on the notice.

West Virginia-Specific Notes

West Virginia operates both an income-cap standard for long-term care Medicaid ($2,982/month in 2026, equal to 300% of the SSI Federal Benefit Rate) and a medically needy spend-down for applicants who exceed that limit.5,6 For Medicare Savings Programs, these long-term care income rules are separate. MSP qualification turns solely on the QMB, SLMB, and QI income bands described above.

West Virginia also sets a Personal Needs Allowance of $50/month for nursing-facility residents receiving long-term care Medicaid.5 For more on West Virginia's full Medicaid rules, see West Virginia Medicaid eligibility and income limits.

Where to Get Help

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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.