Wisconsin Medicare Savings Programs 2026: QMB, SLMB & QI

Wisconsin 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.

Wisconsin Department of Health Services (DHS) administers all three MSP tiers through its Division of Medicaid Services, with applications processed by local Income Maintenance (IM) agencies and Aging and Disability Resource Centers (ADRCs). MSP eligibility uses the SSI-related income methodology, which includes two income disregards: a $20/month general income disregard applied to unearned income, and a $65 plus half of remaining earned income disregard for working applicants. The income 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 Wisconsin 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 Wisconsin 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 Wisconsin 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 whose Medicare utilization is modest, the Part B premium is the largest predictable annual cost, and SLMB removes 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 Wisconsin figures).

Two structural differences from QMB and SLMB:

1. First-come, first-served. QI is funded through a capped federal allotment. Wisconsin 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 Wisconsin 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, whether or not they participate with Wisconsin 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 Wisconsin DHS eligibility notice or Medicare card with the QMB indicator.
• Call 1-800-MEDICARE (1-800-633-4227) to file a complaint.
• Contact the Wisconsin SHIP (State Health Insurance Assistance Program) at 1-800-242-1060 for free help.

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

Part D Extra Help / 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, 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 Wisconsin DHS 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.

Wisconsin 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.

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 Wisconsin seniors rule themselves out of MSP assuming their home disqualifies them. The primary residence is fully excluded regardless of its value.

How to Apply for Wisconsin Medicare Savings Programs

Wisconsin offers multiple application pathways:

1. Online via ACCESS Apply at access.wisconsin.gov. This is Wisconsin's online portal for Medicaid and related benefit programs. Complete the application and upload supporting documents.

2. Through a local IM agency or ADRC Wisconsin's Income Maintenance agencies and Aging and Disability Resource Centers (ADRCs) can assist with in-person applications. ADRCs in particular specialize in benefits counseling for older adults and people with disabilities. Contact your county ADRC to set up an appointment.

3. Through SSA Applying for Part D Extra Help at your Social Security office using Form SSA-1020 generates an automatic referral to Wisconsin 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 Wisconsin residency (utility bill, lease, or mortgage statement)

Effective Dates and Retroactive Coverage

• QMB: coverage begins the first day of the month after DHS 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 early even if you can't gather every document immediately.

After approval, Wisconsin DHS 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.

Wisconsin-Specific Notes

Wisconsin is a medically needy spend-down state for long-term care Medicaid, meaning applicants whose income exceeds the special income level can qualify by spending down excess income on medical and care costs. For MSPs, the spend-down mechanic is irrelevant; MSP eligibility turns solely on the income and resource tests above.

Wisconsin also sets notably generous floors for its long-term care Medicaid spousal protections: the Community Spouse Resource Allowance minimum is $50,000 (above the federal floor of $32,532), and the minimum monthly maintenance needs allowance for the community spouse is $3,525/month (effective 7/1/2025). These spousal protection rules govern long-term care applications, not MSP. For more on Wisconsin's full Medicaid rules, see Wisconsin Medicaid eligibility and income limits.

Learn More

• Wisconsin Medicaid Eligibility and Income Limits
• How to Apply for Wisconsin 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.