Medicare Savings Programs: How QMB, SLMB, QI, and QDWI Can Help Pay Your Medicare Costs (2025)

If you're struggling to afford Medicare premiums, deductibles, or copayments, you're not alone. Many people don't realize that help is available through Medicare Savings Programs—state-run Medicaid programs that can dramatically reduce or eliminate your Medicare costs.

These programs can save you thousands each year, yet millions of eligible people never apply simply because they don't know they exist.

This guide explains what each program covers, who qualifies, and how to apply—whether you're in Ocean County, Monmouth County, elsewhere in New Jersey, or anywhere in the country.

What Are Medicare Savings Programs?

Medicare Savings Programs (MSPs) are Medicaid-administered programs that help people with limited income/resources pay Medicare costs. The four programs are:

• QMB — Qualified Medicare Beneficiary
• SLMB — Specified Low-Income Medicare Beneficiary
• QI — Qualifying Individual
• QDWI — Qualified Disabled & Working Individual

Important distinction: These are NOT full Medicaid. The only purpose is to help you pay Medicare costs.

Major Benefits

• Huge savings ($2,000–$10,000+/year)
• Automatic Extra Help (LIS) for Part D (QMB, SLMB, QI)
• No Part D late-enrollment penalty if Extra Help is triggered
• Retroactive coverage up to 3 months (varies by state)

The Four Medicare Savings Programs Explained

QMB — Qualified Medicare Beneficiary

QMB is the most generous MSP—it's the only program that covers all Medicare cost-sharing.

What QMB Covers

• Medicare Part A premiums (if you owe them)
• Medicare Part B premium
• All Medicare deductibles (A & B)
• All Medicare coinsurance
• All Medicare copays

Federal Balance Billing Protection

Under federal law: Providers are prohibited from billing QMB beneficiaries for any Medicare Part A or B cost-sharing—even if the state Medicaid program pays them $0.

This is separate from state payment policy. Federal law protects the patient regardless. If you get a bill, you should not pay it.

2025 QMB Eligibility (Estimated — Final CMS Limits Released January)

After applying the $20 income disregard:

• Individual: ~$1,325/month
• Couple: ~$1,783/month

Asset limits (federal minimums):

• Individual: $9,660
• Couple: $14,470

(Some states ignore assets entirely — listed later.)

Extra Help Under QMB

You automatically receive full Extra Help, which gives nominal, low copays for Part D drugs. (Exact 2025 copay amounts update annually.)

SLMB — Specified Low-Income Medicare Beneficiary

SLMB is for people who earn slightly more than QMB beneficiaries.

What SLMB Covers

• Medicare Part B premium only

What SLMB Does NOT Cover

• Deductibles
• Coinsurance
• Copays

2025 SLMB Eligibility (Estimated)

• Individual: approx $1,325–$1,585/month
• Couple: approx $1,783–$2,135/month

Asset limits: Same as QMB unless state waives them.

Extra Help

SLMB automatically qualifies you for full Extra Help for prescriptions.

QI — Qualifying Individual

QI helps people on the next income tier up.

What QI Covers

• Medicare Part B premium only

What QI Does NOT Cover

• Deductibles
• Coinsurance
• Copays

Important Rules

• Must reapply every year
• First-come, first-served (federal allotment)
• Cannot be receiving full Medicaid

2025 QI Eligibility (Estimated)

• Individual: approx $1,585–$1,781/month
• Couple: approx $2,135–$2,400/month

Asset limits: Same as QMB unless state waives them.

Extra Help

QI automatically qualifies you for full Extra Help.

QDWI — Qualified Disabled and Working Individual

QDWI is a niche program for people under 65 who lost premium-free Part A because they returned to work.

What QDWI Covers

• Part A premium only (Can be as high as ~$518/month in 2025)

What QDWI Does NOT Cover

• Part B premium
• Deductibles
• Copays
• Coinsurance
• Prescription drugs

2025 QDWI Eligibility (Federal Minimums)

Income limit: Up to 200% of FPL, roughly

• Individual: ~$2,610/month
• Couple: ~$3,525/month

Asset limit:

• Individual: $4,000
• Couple: $6,000

Extra Help

QDWI does not automatically qualify for Extra Help.

Medicare Savings Programs: Quick Comparison (2025)

(Income ranges are estimates; final limits are released annually by CMS.)

QMB

• Income: ~$1,325 individual / ~$1,783 couple
• Assets: $9,660 individual / $14,470 couple
• What It Covers: Part A & B premiums + all cost-sharing; no billing allowed
• Extra Help? Yes

SLMB

• Income: ~$1,325–$1,585 individual / ~$1,783–$2,135 couple
• Assets: $9,660 individual / $14,470 couple
• What It Covers: Part B premium
• Extra Help? Yes

QI

• Income: ~$1,585–$1,781 individual / ~$2,135–$2,400 couple
• Assets: $9,660 individual / $14,470 couple
• What It Covers: Part B premium
• Extra Help? Yes

QDWI

• Income: ~$2,610 individual / ~$3,525 couple
• Assets: $4,000 individual / $6,000 couple
• What It Covers: Part A premium
• Extra Help? No

Note: Income + asset rules vary by state. Many states waive asset limits entirely.

States With NO Asset Limits for MSPs (As of 2025)

• Alabama
• Arizona
• Connecticut
• Delaware
• Louisiana
• Mississippi
• New Mexico
• New York
• Oregon
• Vermont
• Washington, DC

If you live in one of these states, the asset numbers in the chart do not apply to you.

How to Apply for Medicare Savings Programs

MSPs are administered through state Medicaid offices—not Medicare.

What You Need

• Proof of income
• Bank statements
• Investment/account balances
• Medicare card
• Proof of residency
• Social Security number

Where to Apply

New Jersey residents (Ocean, Monmouth, all counties):

• County Board of Social Services
• NJ SHIP: 1-800-792-8820

Other states:

• Call SHIP: 1-877-839-2675
• Visit your local Medicaid office
• Call Medicare: 1-800-MEDICARE

When Benefits Begin

• Usually the month after approval
• Some states provide 3 months retroactive coverage

Common Questions

Does QMB mean I never pay anything?

For Medicare-covered services: correct. Providers cannot bill you for deductibles, coinsurance, or copays.

Do SLMB or QI stop billing?

No. SLMB and QI only pay the Part B premium. You still owe deductibles and coinsurance.

Can I use MSPs with Medicare Advantage?

Yes. MSPs pay premiums and cost-sharing regardless of whether you're in Original Medicare or a Medicare Advantage plan.

What if I'm slightly over the limit?

Apply anyway — states use different income-counting rules and may exclude some income or assets.

Real-World Savings

QMB Example

• Part B premium: $2,220/year
• Part A deductible + B deductible + coinsurance: $1,500–$3,000
• Extra Help: ~$6,200/year
• Total savings: ~$10,000–$12,000/year

SLMB or QI Example

• Part B premium: $2,220/year
• Extra Help: ~$6,200/year
• Total savings: ~$8,400/year

QDWI Example

• Part A premium: ~$6,216/year
• Total savings: ~$6,200/year

Don't Leave Money on the Table

Millions qualify for MSPs and never apply. These programs can reduce your Medicare costs dramatically, giving you financial breathing room for essentials like food, rent, and transportation.

If you're in New Jersey or anywhere nationwide and want help understanding or applying for MSPs, SageAlly can guide you step-by-step.

We can help:

• Confirm eligibility
• Review documentation
• Submit applications
• Follow up on decisions
• Coordinate MSP + Extra Help + other assistance

You deserve healthcare that works for you. Let's make sure you have it.