The federal government offers Medicare Savings Programs (MSPs) to help low-income beneficiaries manage healthcare costs. These programs are administered by state Medicaid agencies and provide financial assistance for various Medicare expenses. The two most common MSPs are the Qualified Medicare Beneficiary (QMB) program and the Specified Low-Income Medicare Beneficiary (SLMB) program. Both programs lighten the financial burden of Medicare, but they offer different levels of support based on the beneficiary’s income level.
Defining the Scope of QMB and SLMB Assistance
The Qualified Medicare Beneficiary (QMB) program is the most comprehensive form of Medicare Savings Program assistance available. It is designed to virtually eliminate most out-of-pocket costs associated with Medicare Parts A and B for eligible individuals. QMB provides a robust layer of secondary insurance coverage for low-income seniors and people with disabilities.
The Specified Low-Income Medicare Beneficiary (SLMB) program offers a more limited, yet important, level of financial support. SLMB is for those whose income is slightly too high for QMB but still low enough to need help with basic premiums. This program focuses on subsidizing a single, specific cost within the Medicare structure.
Financial Eligibility Requirements
The primary factor distinguishing QMB from SLMB is the maximum allowable income threshold. Eligibility for QMB requires a monthly income at or below 100% of the Federal Poverty Level (FPL), while SLMB allows for a slightly higher income, up to 120% of the FPL. For instance, in 2025, the federal monthly income limit for QMB is $1,325 for an individual and $1,783 for a married couple in the 48 contiguous states and the District of Columbia.
The SLMB program allows an individual monthly income up to $1,585 and a married couple up to $2,135, which is notably higher than the QMB limits. These figures include a $20 general income disregard, which is not counted toward the limit during eligibility determination. The asset limits for both QMB and SLMB are the same, set at $9,660 for an individual and $14,470 for a married couple in 2025.
Assets that count toward this limit include money in bank accounts, stocks, and bonds. Certain resources are excluded from the asset calculation, such as the person’s primary residence, one motor vehicle, household furnishings, and up to $1,500 set aside for burial expenses. Some states have completely eliminated these asset limits, meaning an individual must only meet the income requirements to qualify for either program.
The Critical Difference in Covered Benefits
The most significant distinction between the two programs is the scope of the benefits provided. QMB, the more comprehensive program, covers Medicare Part A and Part B premiums, along with all Part A and Part B deductibles, coinsurance, and copayments. This coverage means a QMB beneficiary has virtually no out-of-pocket costs for Medicare-covered services.
The law explicitly prohibits Medicare providers from billing a QMB beneficiary for any Part A or Part B cost-sharing, offering considerable financial protection against unexpected medical bills. QMB enrollment also automatically qualifies the beneficiary for the Extra Help program, which significantly lowers the cost of prescription drugs under Medicare Part D.
In contrast, the SLMB program offers a single, specific benefit: it only pays the monthly Medicare Part B premium. While this saves the beneficiary a substantial amount annually, the SLMB recipient remains fully responsible for all Medicare deductibles, copayments, and coinsurance. This means a person enrolled in SLMB will still have out-of-pocket costs for medical services covered by Medicare.
Applying for Assistance and Maintaining Enrollment
The application process for both the QMB and SLMB programs is managed through the state Medicaid office, not the federal Medicare office. Interested beneficiaries must contact their local state Medicaid agency or social services office to begin the application. This involves submitting an application form and providing documentation to verify income, assets, and Medicare eligibility.
Once approved, eligibility for a Medicare Savings Program is not permanent and must be maintained through a periodic review process called redetermination. States are required to review the beneficiary’s income and assets annually to ensure continued qualification for the specific program tier. A change in circumstances, such as an income increase, could cause a beneficiary to move from QMB to SLMB, or potentially lose eligibility entirely.