Here’s the simple version: QMB pays your Part B premium and almost all Medicare copays/deductibles; SLMB and QI pay Part B premium only. QI has slightly higher income limits and is first-come, first-served. Below, you’ll see exactly how each program changes a real bill—with links to apply. Medicare+1
What Medicare Savings Programs do (1-minute primer)
Medicare Savings Programs (MSPs) are state-run benefits that help people with Medicare and limited income/resources pay Medicare costs. You apply through your state Medicaid agency; the state screens you for QMB, SLMB, and QI, and enrollment also confers Extra Help for Part D automatically. Medicare
- QMB (Qualified Medicare Beneficiary): Pays Part A and Part B premiums (if owed) and all Medicare cost-sharing—deductibles, coinsurance, and copays—for Medicare-covered services. Providers generally cannot bill you for those amounts while you’re active in QMB. Medicare+1
- SLMB (Specified Low-Income Medicare Beneficiary): Pays Part B premium only. States can reimburse Part B premiums paid up to 3 months before the application month if you were eligible then. National Council on Aging
- QI (Qualifying Individual): Pays Part B premium only, typically for incomes above SLMB’s limit but below the QI ceiling; funding is limited and first-come, first-served (you need to reapply each year). Some states also allow retroactive Part B premium reimbursement similar to SLMB. National Council on Aging
Source: Medicare.gov, NCOA, Medicare Rights; last checked: Oct 17, 2025. Medicare+2National Council on Aging+2
Bottom line: If you want your copays covered, you’re aiming for QMB. If you mainly need the Part B premium off your bill, SLMB or QI can do it.
QMB vs SLMB vs QI at a glance (what changes on your bill)
| Feature | QMB | SLMB | QI |
|---|---|---|---|
| What it pays | Part B premium; may pay Part A premium if you owe it; plus Medicare cost-sharing (deductibles/coinsurance/copays) for covered A/B services | Part B premium only | Part B premium only |
| Can providers bill you for Medicare cost-sharing? | No—balance billing is prohibited while enrolled for covered services | Yes—you still owe standard Medicare cost-sharing | Yes—you still owe standard Medicare cost-sharing |
| Retroactive premium payback | No (generally not retroactive) | Yes, up to 3 months if eligible | Often Yes, up to 3 months if eligible (state processes vary) |
| Funding/renewal | Entitlement group | Entitlement group | First-come, first-served; must reapply each year |
| Typical use case | Need copays/deductibles covered | Over income for QMB but need Part B premium help | Over SLMB but under QI income cap; need Part B premium help |
Sources: Medicare.gov; NCOA; Medicare Rights, last checked Oct 17, 2025. Medicare+2National Council on Aging+2
Bottom line: QMB is the most comprehensive. SLMB/QI focus on the Part B premium.
Real bill examples (simple math you can copy)
For illustration, we’ll assume 2025 Part B premium = $185/month (national standard; your exact amount may vary). Local deductibles/coinsurance rules for A/B services apply per Medicare. Always confirm with your state. National Council on Aging
Example 1 — Routine outpatient visit + your monthly Part B premium
- Without any MSP:
- Part B premium: $185 due monthly.
- Outpatient visit: Medicare pays 80% after deductible; you owe 20% coinsurance.
- With SLMB or QI:
- Part B premium: $0 (state pays it).
- Outpatient visit: You still owe 20% coinsurance.
- With QMB:
- Part B premium: $0.
- Outpatient visit: $0 for Medicare-covered coinsurance; providers can’t bill you beyond permitted amounts while you’re QMB. Medicare Interactive
What you actually pay this month
- No MSP: $185 + coinsurance
- SLMB/QI: $0 premium + coinsurance
- QMB: $0 premium + $0 for covered coinsurance (balance-billing protections apply)
Source: Medicare.gov; Medicare Rights, last checked Oct 17, 2025. Medicare+1
Example 2 — Two-day hospital stay (Part A) + specialist follow-up
- Without MSP: You’re subject to the Part A inpatient deductible (one-time per benefit period) and standard Part B cost-sharing for follow-up.
- With SLMB/QI: The Part B premium is paid, but hospital cost-sharing (A) and coinsurance (B) are still yours.
- With QMB: The Part A and Part B cost-sharing that Medicare would normally have you pay is covered by QMB, so your out-of-pocket for Medicare-covered hospital and follow-up services is $0 while enrolled. Providers may not bill you for those amounts. Medicare+1
Bottom line on Examples 1–2: If your main worry is copays/deductibles, QMB changes your bill the most. If your main worry is the monthly Part B premium, SLMB or QI is enough.
Example 3 — Mid-year approval and retroactive reimbursements
- You applied in August and were found eligible for SLMB (or QI) dating back 3 months (May–July) because your income during those months met the limits. Your state can refund the Part B premiums you paid for those months.
- If you were approved for QMB in August, providers can’t bill you for covered services starting the first day of the month after the state had all information to determine eligibility; QMB is not retroactive like SLMB/QI premium refunds. Center for Medicare Advocacy
Source: Center for Medicare Advocacy (effective date/retroactivity); Medicare Rights. Last checked: Oct 17, 2025. Center for Medicare Advocacy+1
Bottom line: SLMB/QI can put cash back in your pocket for recently paid Part B premiums; QMB prevents future provider billing for cost-sharing once it starts.
Income & asset basics for 2025 (and why your state matters)
- Income: Each MSP ties to a percent of the Federal Poverty Level (FPL) plus a general $20 disregard. Typical national references for 2025 list monthly limits (e.g., SLMB ≈ 120% FPL + $20, QI ≈ 135% FPL + $20), with higher figures for Alaska/Hawaii. States implement these and some set higher thresholds. Check your state’s page. secure.ssa.gov
- Assets/resources: Many states still reference baseline resource limits (e.g., $9,660 individual / $14,470 couple for QMB/SLMB/QI), but some states waive the asset test entirely. (QDWI often keeps a separate, lower resource test.) cmsnationaltrainingprogram.cms.gov
- State variation example: Oregon publishes clear 2025 income thresholds and descriptions of what each program pays. Your state page will look similar, with numbers updated each spring. Oregon
Related reading: If you specifically want states with no MSP asset test, see our separate guide and map. (Internal link recommended.)
Bottom line: Use national numbers as a ballpark, but apply through your state—they make the final call. If you’re close, apply anyway. Medicare
How to pick the right program (5-step checklist)
- List your pain point: Biggest issue is copays/deductibles → aim for QMB; biggest issue is monthly Part B premium → SLMB or QI. Medicare
- Estimate your income vs. FPL: If you’re just over SLMB, QI might still qualify (slightly higher income limit). National Council on Aging
- Consider timing: If you’ve been paying Part B for months and qualify now, SLMB/QI may refund up to 3 months of premiums. Center for Medicare Advocacy
- Assets: If your state waives assets, great—focus on income. If not, compare against the typical baselines and exclusions. cmsnationaltrainingprogram.cms.gov
- Apply for MSP screening (all three): Tell your state you want to be screened for QMB, SLMB, and QI so you’re placed in the best program you qualify for. Medicare
Bottom line: For maximum bill relief, QMB is the target. If you’re over QMB’s income but still need help, SLMB/QI can at least erase the Part B premium.
How to apply fast (and what to expect)
Where to apply: Your state Medicaid office/portal. Search “[Your state] Medicare Savings Program apply,” or call your SHIP counselor for free help. Medicare
What to ask for:
- “Please screen me for QMB, SLMB, and QI.”
- “If I qualify for SLMB or QI, will you refund Part B premiums for the last three months?” Center for Medicare Advocacy
Timeline & start dates:
- QMB typically starts the first day of the month after the agency has everything needed to determine eligibility (providers can’t bill cost-sharing while active). SLMB/QI premium help can reach back three months if you were eligible. Center for Medicare Advocacy
After approval:
- Your Part B premium is removed from your Social Security check (or you get refunds if SLMB/QI retroactive applies).
- If QMB, tell your providers you’re QMB; they should update billing and not charge Medicare cost-sharing for covered services. Medicare Interactive
Bottom line: Apply online/phone, ask to be screened for all three, and confirm retroactive rules if placed in SLMB/QI.
Comparison table: QMB vs SLMB vs QI (save/print)
| QMB | SLMB | QI | |
|---|---|---|---|
| Pays Part B premium? | Yes | Yes | Yes |
| Pays Part A premium (if you owe it)? | Yes (QMB can) | No | No |
| Pays Medicare cost-sharing? | Yes for A/B covered services | No | No |
| Balance billing allowed? | No (providers generally cannot bill you) | Yes | Yes |
| Retroactive Part B premium refunds? | No | Yes (up to 3 months) | Often yes (up to 3 months) |
| Funding cap / annual reapply? | No cap / standard Medicaid group | No cap / standard Medicaid group | Funding-limited, first-come; reapply yearly |
| Best for… | People who need copays/deductibles paid | Those over QMB income but need Part B premium help | Those just over SLMB who still need Part B premium help |
Source: Medicare.gov; NCOA; Medicare Rights. Last checked: Oct 17, 2025. Medicare+2National Council on Aging+2
Disclaimers
This guide is educational and general—not individualized legal, financial, or medical advice. Eligibility rules vary by state and change periodically. Always confirm with your state Medicaid office or a SHIP/SHIIP counselor. Numbers shown are typical national references; your state may use different thresholds or waive assets. Medicare+1
Sources
- Medicare.gov — Medicare Savings Programs overview & how to apply through your state. Source: Medicare.gov; last checked Oct 17, 2025. Medicare
- CMS National Training Program — 2025 MSP income/resource references. Source: CMS NTP; last checked Oct 17, 2025. cmsnationaltrainingprogram.cms.gov
- SSA POMS — 2025 MSP monthly income standards and resource baselines. Source: SSA; last checked Oct 17, 2025. secure.ssa.gov
- Medicare Rights (Medicare Interactive) — QMB/SLMB/QI benefits, retroactivity, billing protections. Last updated 2025; last checked Oct 17, 2025. Medicare Interactive+2Medicare Interactive+2
- NCOA — MSP eligibility & QI vs SLMB differences (2025). Last checked Oct 17, 2025. National Council on Aging+1
- State example (Oregon) — 2025 thresholds and program descriptions (illustrative). Last checked Oct 17, 2025. Oregon
- MACPAC — MSP background and enrollment context. Last checked Oct 17, 2025. MACPAC+1
3–5 takeaways
- QMB = premium + all Medicare cost-sharing for covered A/B services (no balance billing). SLMB/QI = Part B premium only. Medicare+1
- QI often has higher income limits than SLMB and is first-come/annual reapply. National Council on Aging
- SLMB/QI can refund up to 3 months of previously paid Part B premiums; QMB generally isn’t retroactive. Center for Medicare Advocacy
- Numbers vary by state; some states waive asset tests entirely—apply even if you’re unsure. Medicare+1
- Approval also triggers Extra Help for Part D automatically. Medicare
Next steps
- Apply through your state Medicaid portal/office and ask to be screened for QMB, SLMB, and QI. Medicare
- If you’re close on income, apply anyway—and ask about retroactive Part B refunds if you land in SLMB/QI. Center for Medicare Advocacy
FAQs
1) What’s the simplest difference between QMB, SLMB, and QI?
QMB pays your Part B premium and Medicare cost-sharing; SLMB/QI pay Part B premium only. Medicare
2) Does QMB cover my copays and deductibles?
Yes—for Medicare-covered A/B services; providers generally cannot bill you while you’re active in QMB. Medicare Interactive
3) Which has higher income limits—SLMB or QI?
QI typically has higher income limits than SLMB and is first-come, first-served, with annual reapplication. National Council on Aging
4) Can SLMB or QI pay me back for premiums I already paid?
Often yes—states can refund up to 3 months of Part B premiums if you were eligible in those months. QMB isn’t retroactive like that. Center for Medicare Advocacy
5) Will I also get Extra Help for Part D if I qualify?
Yes. MSP eligibility confers Extra Help automatically. Medicare
6) Do assets count?
Some states use baseline resource limits, others waive the asset test for MSPs. Check your state—or apply and let them decide. cmsnationaltrainingprogram.cms.gov
7) Where do I apply?
Through your state Medicaid office or online portal; ask to be screened for all three programs. Medicare
8) When does coverage start?
QMB usually starts the first of the month after the state finds you eligible; SLMB/QI premium help can be retroactive up to 3 months. Center for Medicare Advocacy