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 Part A and Part B deductible, coinsurance, and copay on Medicare-covered items and services, 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. Federal rules define four of them by income relative to the Federal Poverty Level: QMB, SLMB, QI, and QDWI (a separate program that pays the Part A premium for certain working people with disabilities who lost premium-free Part A). This guide covers the three that matter to most Wisconsin retirees. QI works differently from the other two: it is funded from a capped annual federal allotment and granted first-come, first-served. QMB, SLMB, and QI each confer automatic Part D Extra Help; QDWI does not.2

The Wisconsin Department of Health Services (DHS) administers all three tiers under Wisconsin Medicaid (branded ForwardHealth). For Medicaid help, DHS points applicants to their local Income Maintenance (IM) agency or their Aging and Disability Resource Center (ADRC).3

Two sets of income figures circulate for these programs, and they differ by about $20. DHS measures countable monthly income "after certain credits are applied" and prints the bare Federal Poverty Level figures. SSA and Medicare.gov print the federal limits, which add the $20 monthly Supplemental Security Income (SSI) general income exclusion to the poverty-level figure and round up to the dollar. DHS does not list which credits it applies, so if your income falls between the two figures, apply rather than treating the lower one as a cutoff. The monthly limits in this guide are the federal figures.2

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 Part A and Part B coinsurance and copays on Medicare-covered items and services. Federal law prohibits providers from billing a QMB enrollee for them. Part D drug cost-sharing is handled separately, through Extra Help1,2

2026 Wisconsin QMB income limits: at or below $1,350/month for a single person, or $1,824/month for a couple. Those are the federal figures: 100% of the Federal Poverty Level plus the $20 SSI general income exclusion. DHS's own 2026 table prints 100% of the Federal Poverty Level as $1,330.00 for one person and $1,803.33 for two, measured after credits it does not itemize. A single person with countable income between $1,330 and $1,350 should apply, not assume they are over.2

Resource limit: $9,950 for one person, $14,910 for a couple, counting only countable assets. DHS notes that not all of your income and assets are counted; see what counts as a resource below.2

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.1 Every QMB enrollee is also automatically deemed eligible for full Part D Extra Help.2

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). You must have both Medicare Part A and Part B to qualify.2

Resource limit: the same countable-asset test as QMB, $9,950 single and $14,910 couple.2

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.1 SLMB enrollment also triggers automatic Part D Extra Help.2

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). As with SLMB, you must have both Part A and Part B. Wisconsin calls this tier SLMB+.2

Three structural differences set QI apart from QMB and SLMB:

1. You must apply every year. Selection for QI in one year does not entitle you to continued assistance in any following year, so a QI enrollee reapplies annually to stay in the program.2
2. First-come, first-served. QI is paid out of a capped annual federal allocation to each state. It is granted first-come, first-served, with preference for people who had QI in the last month of the previous year. Because the money is capped, file as early in the year as you can.2
3. Not available alongside other Medicaid. Federal rules make QI available only to people who don't qualify for any other Medicaid coverage or benefits, though they may still qualify for another Medicare Savings Program.2 In Wisconsin, SLMB+ eligibility requires that you not be enrolled in full-benefit Medicaid, Family Planning Only Services, or Tuberculosis-Related Only Services. If you might qualify for full-benefit Wisconsin Medicaid, ask your Income Maintenance agency which category fits you. See Wisconsin Medicaid eligibility and income limits.2

Like SLMB, QI enrollment triggers automatic Part D Extra Help.2

What If a Provider Bills You After You Have QMB?

Federal law prohibits Medicare providers and suppliers, including pharmacies, from billing a QMB enrollee for Medicare cost-sharing: the deductibles, coinsurance, and copays on Medicare-covered items and services. Wisconsin DHS states the same protection: Medicare providers are not allowed to bill a QMB enrollee for services and items Medicare covers.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 not allowed to bill you for it. Two kinds of bill fall outside that protection: QMB does not cover your Part D drug-plan copays, and you may still get a bill for a small Medicaid copayment, if one applies.2 For the cost-sharing QMB does cover, take these steps:

• Tell the provider you are a QMB enrollee and cite the federal balance-billing prohibition.
• Show the provider your Wisconsin DHS eligibility notice.
• Call 1-800-MEDICARE (1-800-633-4227; TTY 1-877-486-2048), Medicare's official contact line, and tell them about the bill.4
• Contact the Wisconsin Medigap Helpline at 1-800-242-1060, or a benefit specialist serving your county or Tribe, funded through the State Health Insurance Assistance Program (SHIP).2 Benefit specialists' help is free; they don't sell anything and aren't paid by a company or plan.5

If you have already paid a bill you did not owe, say so when you call. Ask the provider to correct the claim and return what you paid, and ask 1-800-MEDICARE or the Medigap Helpline to help you press it if the provider will not.

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 Extra Help application is required.2,6

Under the 2026 Part D benefit, Extra Help sets your plan deductible at $0, and if you have an MSP but not full Medicaid, your copay is no more than $5.10 for a generic and $12.65 for a brand-name covered drug. Those are ceilings: people who also have full Medicaid pay $1.60 and $4.90 if their income is at or below 100% of the poverty level, and $0 if they live in an institution or get home and community-based services. 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. What Extra Help pays on your behalf counts toward that cap, not only what you pay yourself.6,7

One detail catches people out. Full Extra Help covers the basic-coverage portion of your Part D premium up to a regional cap set from your region's low-income benchmark, so if your plan's basic-coverage premium is at or below that cap, you pay $0 for its basic coverage. It does not cover the part of an enhanced plan's premium that pays for extra (non-basic) benefits, and if you choose a more expensive plan you are responsible for the difference between the benchmark and your plan's premium. Because the Centers for Medicare & Medicaid Services (CMS) sets the benchmark separately for each Part D region, the set of $0 plans depends on where in Wisconsin you live, so check the plan finder or ask an ADRC benefit specialist before you enroll.8

Wisconsin Medicare Savings Programs: 2026 Income Limits at a Glance

The bands are the federal figures for 100% FPL (QMB), 100% to 120% FPL (SLMB), and 120% to 135% FPL (QI), which include the $20 SSI general income exclusion. DHS's own table prints the bare poverty-level figures for one person as $1,330.00, $1,596.00, and $1,795.50. The resource limit for all three is $9,950 single / $14,910 couple. These limits are based on federal guidelines and may change each year, so confirm the current figures with DHS when you apply. They are the federal standard rather than an absolute cutoff: states can effectively raise both by disregarding certain income and resources, though Wisconsin publishes the unraised federal figures, and SSA tells staff to encourage people to apply even when income or resources appear somewhat higher.2

What Counts as a Resource, and What Doesn't

The $9,950/$14,910 resource test counts only countable assets, and DHS footnotes its 2026 table: "Not all of your income and assets will be counted." DHS's MSP pages do not spell out which assets are left out.2 What Wisconsin does publish is the exclusion list for its elderly, blind, and disabled (EBD) Medicaid, which is a reasonable guide to raise with your Income Maintenance agency, not a ruling on your MSP case.3

Not counted for Wisconsin EBD Medicaid:

• Your home, as long as you, your spouse, or a dependent relative lives there
• One vehicle
• Household items, clothing, and other personal items
• Some burial assets, including burial insurance, certain amounts held in an irrevocable burial trust, and burial plots

What usually counts: for Part D Extra Help, SSA counts cash and assets that can be turned into cash within 20 workdays, such as savings and checking accounts, mutual fund shares, and retirement accounts including IRAs and 401(k)s, plus the equity in real estate other than your home, so expect your Income Maintenance agency to ask about those too.6

Two bounds are worth reading closely, because both are easy to overstate. The home exclusion turns on occupancy, not on value: it holds while you, your spouse, or a dependent relative lives there, so a home you have moved out of permanently is a different question worth raising with your Income Maintenance agency. And the burial exclusion is partial, not categorical: some burial assets are exempt and some are not, so do not assume a prepaid arrangement drops out of the count automatically.3

Still, don't rule yourself out of an MSP because you own the house you live in. Apply and let the agency do the counting.2

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 runs forward, not back. Social Security Act Section 1902(e)(8) applies a QMB determination to services furnished after the end of the month in which the determination is first made, so QMB covers services from the month after you're approved. Apply early.9
• SLMB and QI: neither the federal QMB rule nor the general Medicaid effective-date regulation sets a start date for these two programs, so ask your Income Maintenance agency how far back SLMB or SLMB+ coverage can begin. File early even if you cannot gather every document immediately.9

Wisconsin-Specific Notes

Wisconsin's long-term care Medicaid runs on a different set of numbers, and it is worth keeping them apart from the MSP limits above. Nursing-home (Institutions Categorically Needy) coverage and Group B community waivers use an income standard of $2,982/month, effective January 1, 2026, which is 300% of the 2026 SSI Federal Benefit Rate of $994. Separately, Wisconsin is a medically needy state: its medically needy income limit is $1,330/month for one person and $1,803.33/month for two, effective February 1, 2026, and an applicant who is ineligible solely because income exceeds that medically needy limit can still become eligible by meeting a Medicaid deductible, which means incurring medical costs equal to the total excess income over a six-consecutive-month deductible period. None of those figures are MSP limits; for Medicare Savings Programs, use the income and resource limits above.10,3

Wisconsin also sets a notably generous floor for its long-term care Medicaid spousal asset protection. Under Wisconsin's 2026 spousal-impoverishment chart, a couple with $100,000 or less in total countable assets gets a community spouse asset share of $50,000, which sits above the federal minimum resource standard of $32,532. On the income side, income may be allocated to bring the community spouse up to $4,066.50/month, or to $3,606.66/month plus an excess shelter allowance, whichever is less. The excess shelter allowance is not granted in every case, and $4,066.50 is a standard rather than a hard ceiling: Wisconsin's handbook lets a fair hearing or a court order raise the allocation when the community spouse cannot meet necessary and basic maintenance needs on it. 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.3

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.