What Is the Medicare Cost-Sharing Program? (2026)

Direct Answer

It depends on your income and resources. The Medicare Cost-Sharing Program pays some or all of your Medicare Part A and Part B premiums, deductibles, coinsurance, and copays if you fall under the 2026 income limit for one of four tiers, QMB, SLMB, QI, or QDWI. QMB pays the most; the other three pay only the Part B or Part A premium. Every state runs the program through its Medicaid agency, so contact your state Medicaid office to apply.

What the Medicare Cost-Sharing Program Actually Covers

Original Medicare, meaning Medicare Part A (hospital insurance) and Medicare Part B (medical insurance), leaves beneficiaries with real out-of-pocket exposure: a Part B premium every month, a Part A hospital deductible per benefit period, a Part B deductible each year, and 20% coinsurance on most Part B services with no annual cap. The Medicare Cost-Sharing Program exists to absorb that exposure for people whose income falls near or below the federal poverty level. QMB enrollees see almost none of that cost sharing; providers are legally barred from billing QMB enrollees for Medicare's cost sharing at all, even a small copay.

Medicare Part D (prescription drug coverage) connects to this program too: anyone approved for QMB, SLMB, or QI is automatically enrolled in Extra Help, the federal Low-Income Subsidy that caps generic drug copays at a few dollars in 2026. People who qualify for full Medicaid rather than just the cost-sharing program also gain Medicaid's essential health benefits, such as dental, vision, and hearing services, on top of whatever Medicare already covers.

How the 2026 Income and Resource Limits Work

Federal law sets the Medicare Cost-Sharing Program's income limits as a percentage of the federal poverty level: 100% for QMB, 120% for SLMB, and 135% for QI, each with a standard $20 general income disregard already baked into the published monthly figures above. QDWI uses a completely different formula, up to 200% of the federal poverty level with additional earned-income disregards, because it targets working people under 65 who kept Medicare through disability but lost premium-free Part A when they returned to work.

Countable resources include checking and savings account balances, stocks, bonds, and additional real estate. A primary home, one vehicle, household goods, burial plots, and life insurance policies with a face value under $1,500 do not count toward the $9,950 individual or $14,910 couple resource limit that applies to QMB, SLMB, and QI in 2026. More than a dozen states, including several of the largest by Medicare enrollment, have dropped the resource test entirely, so residents there qualify on income alone.

Cost Without the Medicare Cost-Sharing Program in 2026

Someone paying full Medicare cost sharing in 2026 owes the standard $202.90 monthly Part B premium, a $283 annual Part B deductible, a $1,736 Part A deductible for each benefit period requiring hospitalization, and 20% coinsurance on most outpatient services with no yearly out-of-pocket maximum under Original Medicare. Over a full year, a beneficiary who needs one hospitalization and regular outpatient care can easily spend $4,000 to $6,000 out of pocket, an amount that vanishes entirely for someone approved for QMB.

People whose income slightly exceeds every Medicare Cost-Sharing Program limit are the group most likely to fall back on a Medicare Advantage plan with a low or $0 premium, since Medicare Advantage caps annual out-of-pocket spending in a way Original Medicare does not. That trade-off carries its own network and referral restrictions, so it is not a substitute for the cost-sharing program for someone who actually qualifies.

How to Apply for the Medicare Cost-Sharing Program

Applications for the Medicare Cost-Sharing Program go to your state Medicaid agency, not to Social Security or Medicare directly, even though the benefit reduces Medicare costs. There is no annual enrollment window; you can apply any month of the year, and most states allow retroactive coverage back to the application month or, in some states, up to three months earlier if you were eligible then.

• Step 1: Confirm you have Medicare Part A, or are eligible for it, since all four tiers require Part A enrollment.
• Step 2: Gather proof of income, resources, Medicare enrollment, Social Security number, and state residency.
• Step 3: Contact your state Medicaid or Medical Assistance office; medicare.gov's Medicare Savings Programs page links to every state agency.
• Step 4: Submit the application by mail, online, phone, or in person, depending on what your state offers.
• Step 5: Wait for a determination, typically 30 to 45 days, and respond quickly to any request for additional documents.

Alternatives If You Do Not Qualify

Extra Help, the Part D Low-Income Subsidy, has its own income and resource test that runs slightly higher than QMB in many cases, so it is worth applying separately even after a Medicare Cost-Sharing Program denial. A Medicare Advantage Special Needs Plan for dual-eligible beneficiaries, called a D-SNP, is only available to people who have at least some Medicaid benefit, but a handful of states offer a limited version to Medicare Cost-Sharing Program enrollees specifically.

Because Medicare cannot deny anyone for a preexisting condition, income and resources, not health status, are what decide eligibility for the Medicare Cost-Sharing Program. People who narrowly miss every income cutoff sometimes buy a Medigap policy or a standalone ACA-compliant dental or vision plan instead, but both carry monthly premiums that the cost-sharing program would otherwise erase completely. State Pharmaceutical Assistance Programs, available in about a dozen states, and hospital charity-care policies are worth checking as a last resort.

Does Medicare run the Medicare Cost-Sharing Program?

No. Medicare administers Part A and Part B, but Medicaid, through each state's Medicaid agency, runs the Medicare Cost-Sharing Program (QMB, SLMB, QI, and QDWI) and pays the premiums, deductibles, coinsurance, or copays on the beneficiary's behalf. You apply through your state Medicaid office, not through Social Security or Medicare directly.

What is the 2026 income limit for QMB?

The federal baseline is $1,350 a month for an individual and $1,824 a month for a married couple in 2026, already including the standard $20 general income disregard. Some states set a higher limit, so check your specific state agency; a linked state-by-state lookup is available on this site.

What is the difference between QMB and SLMB?

QMB pays your Part A premium if owed, your full Part B premium, and all Medicare deductibles, coinsurance, and copays. SLMB pays only the Part B premium, worth $202.90 a month in 2026, and does not touch deductibles or coinsurance. SLMB has a higher income limit than QMB, so it catches people who earn slightly too much for the more generous QMB tier.

If I qualify for QMB, do I automatically get Extra Help?

Yes. Anyone approved for QMB, SLMB, or QI is automatically enrolled in Extra Help, the Part D Low-Income Subsidy, which caps prescription drug copays at a few dollars per prescription in 2026 and eliminates the Part D late enrollment penalty.

Do all states use the same Medicare Cost-Sharing Program income limits?

No. The figures above are the federal baseline. More than a dozen states have eliminated the resource test entirely, and several set income limits above 100% to 135% of the federal poverty level. Contact your state Medicaid agency for the exact numbers where you live.

Can I have a Medicare Advantage plan and the Medicare Cost-Sharing Program at the same time?

Yes. The Medicare Cost-Sharing Program follows you whether you are enrolled in Original Medicare or a Medicare Advantage plan. QMB, in particular, still bars providers from billing you for Medicare's standard cost sharing, including any Medicare Advantage plan copays tied to Medicare-covered services.

What happens if my income is too high for every tier?

Apply for Extra Help separately since its income limit runs slightly higher than QMB's in many states. Also check whether your state runs a State Pharmaceutical Assistance Program, ask your hospital about charity care, and compare a low-premium Medicare Advantage plan against a Medigap policy to cap your annual out-of-pocket exposure.

How long does a Medicare Cost-Sharing Program application take?

Most state Medicaid agencies issue a determination within 30 to 45 days of receiving a complete application. Coverage often starts the month you applied, and some states allow up to three months of retroactive coverage if you were already eligible before you applied.