The Medicaid SLMB program, short for Specified Low-Income Medicare Beneficiary, pays your monthly Medicare Part B premium if your income falls between 100% and 120% of the federal poverty level. For 2026, a single person earning up to $1,616 a month or a couple earning up to $2,184 a month can have the full Part B premium covered by their state Medicaid agency. SLMB is one of four Medicare Savings Programs, and being enrolled also triggers automatic Extra Help with your Part D prescription drug costs.1Medicare. Medicare Savings Programs
Who Qualifies for SLMB
Medicare Enrollment
You must be enrolled in both Medicare Part A and Part B. Most people 65 and older get premium-free Part A based on their own or a spouse’s work history. Younger people with qualifying disabilities, end-stage renal disease, or ALS can also have Part A.2HHS.gov. Who’s Eligible for Medicare? If you have Part A but haven’t signed up for Part B yet, you’ll need to enroll in Part B before SLMB can take effect.1Medicare. Medicare Savings Programs
Income Limits
Your monthly income must fall between 100% and 120% of the federal poverty level. In the 48 contiguous states for 2026, the upper limits are $1,616 a month for an individual and $2,184 a month for a couple. Those figures already include a standard $20 monthly income disregard that applies in most states, so the first $20 of your monthly income doesn’t count.1Medicare. Medicare Savings Programs Higher limits apply in Alaska and Hawaii, which use separate poverty guidelines.
Income for this purpose includes Social Security benefits, pensions, wages, and investment income. If your income sits below 100% of the poverty level, you likely qualify for QMB instead, which covers substantially more than the Part B premium alone.
Resource Limits
In most states, your countable assets can’t exceed $9,950 as an individual or $14,910 as a couple in 2026.3Medicaid.gov. January 2026 SSI and Spousal CIB Countable resources include checking and savings accounts, stocks, bonds, and real estate other than your primary home. Your home, one vehicle, burial plots, and personal belongings like furniture don’t count.
Before you assume you’re over the limit, check your state’s rule. About a dozen states and the District of Columbia have eliminated the asset test entirely for Medicare Savings Programs, meaning savings and investments won’t disqualify you regardless of the amount. Your state Medicaid office can confirm whether an asset test applies where you live.
Residency and Citizenship
You must be a resident of the state where you apply. U.S. citizens and certain qualified non-citizens are eligible. Most non-citizens must have held qualified immigration status for at least five years before receiving federally funded Medicaid benefits like SLMB, though some categories of immigrants are exempt from that waiting period.
What SLMB Pays For
The Part B Premium
SLMB covers the standard Medicare Part B premium, which is $202.90 per month in 2026.4Centers for Medicare & Medicaid Services. 2026 Medicare Parts A and B Premiums and Deductibles That’s $2,434.80 per year no longer coming out of your pocket. If your premium is currently deducted from your Social Security check, that deduction stops once SLMB kicks in, and your Social Security payment goes up by the premium amount.
SLMB does not cover Part B deductibles, coinsurance, or copayments. If you need help with those costs, the program to look at is QMB, which has a lower income threshold but covers those additional expenses.1Medicare. Medicare Savings Programs
Automatic Extra Help With Prescription Drugs
Enrolling in SLMB automatically qualifies you for Extra Help, also called the Low-Income Subsidy, which reduces your Part D prescription drug costs.5Medicare. Help With Drug Costs You don’t need a separate application. Extra Help eliminates your Part D plan premium and deductible, and caps what you pay per prescription at $5.10 for generic drugs and $12.65 for brand-name drugs in 2026.6Centers for Medicare & Medicaid Services. Calendar Year (CY) 2026 Resource and Cost-Sharing Limits for Low-Income Subsidy (LIS) For someone on multiple brand-name medications, that can be worth thousands of dollars a year on top of the Part B premium savings.
Extra Help also gives you more flexibility with your Part D plan. Starting in 2025, people who receive Extra Help can switch their Part D drug plan once a month instead of being locked into annual enrollment periods.5Medicare. Help With Drug Costs
Protection From Estate Recovery
Medicaid programs generally allow states to recover costs from your estate after you die, especially for nursing facility and long-term care services. Medicare Savings Program benefits are treated differently. Federal rules specifically prevent states from recovering Medicare cost-sharing amounts paid on behalf of Medicare Savings Program enrollees.7Medicaid.gov. Estate Recovery The Part B premiums Medicaid paid on your behalf through SLMB won’t come back as a bill against your estate. People sometimes hesitate to apply because they worry about Medicaid clawbacks; that concern doesn’t apply here.
How SLMB Compares to the Other Medicare Savings Programs
Four Medicare Savings Programs exist, each keyed to a different income band and covering different costs. It’s worth knowing where you sit, because you might qualify for more help than you think, or you might fall just above SLMB limits and still qualify elsewhere.
- QMB covers Part A and Part B premiums plus deductibles, coinsurance, and copayments, for people with income at or below 100% of the federal poverty level.
- SLMB covers the Part B premium only, for people between 100% and 120% of the poverty level.
- QI also covers the Part B premium only, for people between 120% and 135% of the poverty level.
- QDWI covers the Part A premium for certain working people with disabilities who lost premium-free Part A.
SLMB and QI look similar because both pay only the Part B premium, but QI operates under capped federal funding. States approve QI applications on a first-come, first-served basis and give priority to people who received QI benefits the previous year. You must reapply for QI every year. SLMB has no such cap; if you qualify, you get the benefit.1Medicare. Medicare Savings Programs
How to Apply
Where to File
Your state Medicaid agency handles SLMB applications. Depending on the state, you can apply online, by mail, by phone, or in person at your local Medicaid or Department of Social Services office.1Medicare. Medicare Savings Programs Contact your state Medicaid office to find out which options are available and to get the application form. Your local State Health Insurance Assistance Program (SHIP) can walk you through the process at no cost.
Documents You’ll Need
Requirements vary by state, but plan to have:
- Proof of income, such as Social Security benefit statements, pension statements, or recent pay stubs
- Proof of resources, such as bank statements and investment account summaries
- Your Medicare card showing Part A and Part B enrollment
- Proof of identity and citizenship, such as a birth certificate, passport, or immigration documentation
- Proof of state residency, such as a utility bill or lease
Processing Time and Retroactive Coverage
Federal regulations require state Medicaid agencies to make an eligibility decision within 45 days of receiving your application.8eCFR. 42 CFR 435.912 – Timely Determination and Redetermination of Eligibility If you’re approved, coverage can be made retroactive for up to three months before the month you applied, as long as you met all eligibility requirements during that period. You can also be reimbursed for Part B premiums deducted from your Social Security check during those retroactive months.
One quirk catches people off guard. Even after approval, it can take three to four months for the state to actually start paying your premium through the buy-in system with CMS. Premiums may continue coming out of your Social Security check during that gap. You should be reimbursed for any premiums you paid after your coverage effective date once buy-in processing is complete.9Centers for Medicare & Medicaid Services. Frequently Asked Questions About Medicare Part A and B Buy-in
Keeping Your Benefits
SLMB eligibility isn’t a one-time determination. States conduct periodic redeterminations, and most require some form of annual renewal. You may get paperwork in the mail asking you to verify that your income, resources, and circumstances haven’t changed. Failing to return that paperwork can end your benefits even if you still qualify, so watch your mail during renewal periods.
Changes in income or resources during the year can also trigger a review. Income above 120% of the poverty level ends SLMB eligibility, though if you stay below 135% you may qualify for QI instead. Going the other way, a drop below 100% of the poverty level could move you into QMB, which covers more. Report changes to your state Medicaid office when they happen instead of waiting for the annual renewal.
What to Do If You’re Denied
If your application is denied, the state will send you a written notice explaining why. Read it carefully. Denials often come down to income or resources slightly over the limit, missing documentation, or an error in how income was counted. Sometimes the fix is as simple as providing a missing document or correcting whose income was included.
You have the right to appeal through a fair hearing, an administrative proceeding before a hearing officer. The deadline is typically 90 days or less from the date of the denial notice, and the notice will state your exact deadline. File the appeal in writing even if your state doesn’t strictly require it, and keep a dated copy. Before the hearing, you can review your case file and the documents the state relied on, and you can ask for more time if you need to gather evidence.
If you were already receiving SLMB and your coverage is being terminated rather than an initial application being denied, you may be able to keep your benefits running during the appeal by requesting a hearing within 10 days of the termination notice. That window is short, so act quickly if you want coverage to continue while the appeal is pending.