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. QMB and SLMB run as ongoing Medicaid eligibility groups; QI is funded from a capped annual federal allotment and is granted first-come, first-served, so it does not work the same way. 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 through its Division of Medicaid Services, part of Wisconsin Medicaid (branded ForwardHealth). Applications are handled by local Income Maintenance (IM) agencies, with free help available from Aging and Disability Resource Centers (ADRCs). Wisconsin measures countable monthly income after certain credits are applied, one of which is the $20 monthly Supplemental Security Income (SSI) general income exclusion. That is why the federal figures published by Medicare.gov and SSA run about $20 above the bare Federal Poverty Level figures DHS prints: the gap is that disregard, not a Wisconsin-specific difference. The monthly limits in this guide are the federal figures, with the $20 disregard already applied.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 says a QMB enrollee has no legal obligation to pay 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. 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

Resource limit: $9,950 for one person, $14,910 for a couple. Your home does not count while you, your spouse, or a dependent relative lives there, and one vehicle does not count.2,3

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 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. 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

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 funded through a capped federal allotment, so it is not an entitlement the way QMB and SLMB are. Federal law directs states to select QI applicants in the order in which they apply, and to hold the year's total to the state's federal allocation. If the allotment runs out, later applicants wait, so file as early in the year as you can.
3. Mutually exclusive with full Medicaid. You cannot be on QI if you qualify for full-benefit Medicaid. In Wisconsin, SLMB+ eligibility also requires that you not be enrolled in Family Planning Only Services or Tuberculosis-Related Only Services. If you do qualify for full-benefit Wisconsin Medicaid, that is generally the better outcome, and your Income Maintenance agency will place you in the right category. See Wisconsin Medicaid eligibility and income limits.2

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

What If a Provider Bills You After You Have QMB?

Federal law prohibits Medicare providers and suppliers, including pharmacies, from billing anyone in the QMB group for Medicare cost-sharing. A QMB enrollee has no legal obligation to pay Part A or Part B deductibles, coinsurance, or copayments for any Medicare-covered item or service. Wisconsin DHS applies the same protection, and it does not depend on whether the provider participates 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), the official Medicare contact line, to file a complaint.4
• Contact the Wisconsin Medigap Helpline at 1-800-242-1060, or a local benefit specialist funded through the State Health Insurance Assistance Program (SHIP), for free help.2

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 application is required.2

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 covered drug. 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.5,6

One detail catches people out. Full Extra Help pays your Part D premium up to your region's low-income benchmark amount, so a plan priced at or below that benchmark costs you $0 a month. Choose a more expensive plan and 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.7

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 income and resource 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, 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. Wisconsin applies its SSI-related asset rules, which leave several major categories out of the count.2,3

Not counted:

• 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

Counted:

• Checking and savings account balances
• Stocks, bonds, certificates of deposit, and mutual funds
• A second vehicle or a second home

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, many Wisconsin seniors rule themselves out of an MSP assuming that owning a house disqualifies them. For an owner living in the home, it does not.

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 is prospective only. Social Security Act Section 1902(e)(8), codified at 42 U.S.C. Section 1396a(e)(8), applies a QMB determination to services furnished after the end of the month in which the determination is first made, so benefits begin the first day of the month after approval and cannot be backdated. Apply early.
• SLMB and QI: these follow the general Medicaid retroactivity rule at 42 C.F.R. Section 435.915, so coverage can reach up to three months before your application month, provided you actually met the eligibility rules in those months. File early even if you cannot gather every document immediately.8

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. For Medicare Savings Programs, none of that applies: MSP eligibility turns solely on the income and resource tests above.9,3

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 a maximum of $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. 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.