Wisconsin Medicare Savings Programs 2026: QMB, SLMB & QI

Wisconsin's three Medicare Savings Programs pay some or all of your Medicare premiums and cost-sharing if your income is limited, and the broadest tier erases the Part B premium entirely. The top tier, the Qualified Medicare Beneficiary (QMB) program, covers the full $202.90 monthly Part B premium plus every Medicare deductible and copay for a single person with monthly income at or below $1,350 in 2026.1,2

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 Medicaid plan must cover them.2

The Wisconsin Department of Health Services (DHS) administers all three tiers through its Division of Medicaid Services, part of Wisconsin Medicaid (branded ForwardHealth). Applications are processed by local Income Maintenance (IM) agencies and Aging and Disability Resource Centers (ADRCs). Eligibility uses the Supplemental Security Income (SSI)-related income methodology, which subtracts a $20 general income disregard from most monthly income before comparing it to the limit, plus an additional disregard for earned income. The monthly limits in this guide are the effective figures after that $20 disregard is applied.3

QMB: The Qualified Medicare Beneficiary Program

QMB is the most comprehensive tier. For a Wisconsin enrollee it covers:

• The Medicare Part A premium (most beneficiaries already have premium-free Part A after 40 work quarters)
• The Medicare Part B premium, which is $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 service1

2026 Wisconsin QMB income limits: at or below $1,350/month for a single person, or $1,824/month for a couple. These are the effective 100% Federal Poverty Level figures after the $20 general income disregard. DHS program pages publish the gross 100% FPL figure before the disregard, which is $1,330/month single and $1,803.33/month for a couple, so the two numbers describe the same limit.2,3

Resource limit: $9,950 for one person, $14,910 for a couple. The primary home and one vehicle are excluded entirely.3

For a single Wisconsin enrollee, QMB is worth at least $2,434.80 a year in Part B premiums alone (the $202.90 monthly premium across 12 months), on top of erasing the $283 Part B deductible and the $1,736 hospital deductible. Every QMB enrollee is also automatically deemed eligible for full Part D Extra Help.1

SLMB: The Specified Low-Income Medicare Beneficiary Program

SLMB covers one benefit: the Medicare Part B premium. At the 2026 standard rate of $202.90 per month, that is $2,434.80 per year.1

2026 Wisconsin SLMB income limits: $1,351 to $1,616/month for a single person, $1,825 to $2,184/month for a couple (100% to 120% of the Federal Poverty Level).2

Resource limit: the same as QMB, $9,950 single and $14,910 couple.3

SLMB does not pay deductibles or copays. For a beneficiary whose Medicare use is modest, the Part B premium is the largest predictable annual cost, and SLMB removes it. SLMB enrollment also triggers automatic Part D Extra Help.

QI: The Qualifying Individual Program

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 (120% to 135% of the Federal Poverty Level in 2026). Wisconsin also calls this tier SLMB+.2

Two structural differences set QI apart from QMB and SLMB:

1. First-come, first-served. QI is funded through a capped federal allotment, so it is not an entitlement the way QMB and SLMB are. Wisconsin allocates enrollment first-come, first-served, with preference for prior-year QI enrollees.
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 pair MSP cost-sharing protection with full Wisconsin Medicaid.

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

What If a Provider Bills You After You Have QMB?

Federal law, specifically 42 U.S.C. Section 1396a(n)(3)(B), prohibits any Medicare provider from billing a QMB enrollee for Medicare cost-sharing. This bar covers Original Medicare and Medicare Advantage providers alike, whether or not they participate with Wisconsin Medicaid.2

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. Take these steps:

• Tell the provider you are a QMB enrollee and cite the federal balance-billing prohibition.
• Show your Wisconsin DHS eligibility notice or your Medicare card with the QMB indicator.
• Call 1-800-MEDICARE (1-800-633-4227) to file a complaint.
• Contact Wisconsin's State Health Insurance Assistance Program (SHIP) at 1-800-242-1060 for free help.

A provider who has incorrectly billed a QMB enrollee must recall the bill and refund any payment already collected.

Part D Extra Help (the Low-Income Subsidy)

Every QMB, SLMB, and QI enrollee in Wisconsin is automatically deemed eligible for full Part D Extra Help, also called the Low-Income Subsidy (LIS). No separate application is required.

Under the 2026 Part D benefit, full Extra Help caps your covered-drug costs at $5.10 per generic and $12.65 per brand-name or preferred multi-source drug, with no plan premium and no deductible on a benchmark plan. Once your out-of-pocket drug spending reaches the $2,100 annual cap, you pay $0 for covered Part D drugs for the rest of the year.4,5

The deeming flows automatically from Wisconsin DHS to the Centers for Medicare & Medicaid Services (CMS) each month after MSP enrollment. If you are not already in a Part D plan, CMS auto-assigns you to a zero-premium benchmark plan.

Wisconsin Medicare Savings Programs: 2026 Income Limits at a Glance

The bands reflect 100% FPL (QMB), 100% to 120% FPL (SLMB), and 120% to 135% FPL (QI) with the $20 general income disregard applied. The resource limit for all three is $9,950 single / $14,910 couple. Because these limits are tied to the Federal Poverty Level, they update every year when the new FPL is published, usually in spring, so confirm the current figure with DHS when you apply.2,3

What Counts as a Resource, and What Doesn't

The $9,950/$14,910 resource test excludes several major asset categories.3

Excluded (they don't count):

• Your 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 modest burial fund set-aside

Counted:

• Checking and savings account balances
• Stocks, bonds, certificates of deposit, and mutual funds
• A second vehicle or a second home
• Non-exempt cash-value life insurance above the applicable threshold

Many Wisconsin seniors rule themselves out of an MSP assuming their home disqualifies them. It does not: the primary residence is fully excluded regardless of its value.

How to Apply for Wisconsin Medicare Savings Programs

You can apply online, by phone, in person, or by mail. The sequence below works for any pathway.

Effective Dates and Retroactive Coverage

• QMB: coverage begins the first day of the month after DHS approves your application. Federal law (42 U.S.C. Section 1396a(e)(8)) bars retroactive QMB coverage, so apply early.
• SLMB and QI: up to three months of retroactive coverage is available under 42 C.F.R. Section 435.915 if you were eligible during that window. File early even if you cannot gather every document immediately.

Wisconsin-Specific Notes

Wisconsin is a medically needy state for long-term care Medicaid, meaning an applicant whose income exceeds the special income level of $2,982/month (300% of the 2026 SSI Federal Benefit Rate of $994) can still qualify by spending excess income down on medical and care costs. For Medicare Savings Programs, that spend-down mechanic does not apply: MSP eligibility turns solely on the income and resource tests above.6

Wisconsin also sets notably generous floors for its long-term care Medicaid spousal protections. The community spouse's asset share minimum is $50,000 (above the federal floor of $32,532), and the community spouse's monthly income allocation floor is $3,525.00 (effective January 1, 2026). These spousal-impoverishment rules govern long-term care applications, not MSPs. For more on Wisconsin's full Medicaid rules, see Wisconsin Medicaid eligibility and income limits.6

Where to Get Help in Wisconsin

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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.