Medicare Savings Programs (MSPs) are federal-state partnerships that pay some or all of a Medicare beneficiary's out-of-pocket costs. South Carolina administers MSPs through Healthy Connections, the state Medicaid agency, at SCDHHS. For 2026, South Carolina offers three main MSP tiers: QMB (Qualified Medicare Beneficiary), SLMB (Specified Low-Income Medicare Beneficiary), and QI (Qualifying Individual), plus QDWI for disabled workers. Together these programs can eliminate thousands of dollars in annual Medicare cost-sharing for low- and moderate-income beneficiaries.
South Carolina is a non-expansion Medicaid state, meaning most low-income adults under 65 do not qualify for full Healthy Connections Medicaid. However, once you turn 65 or qualify for Medicare due to disability, you can apply for an MSP regardless of whether you qualify for full Medicaid. This page covers the 2026 income and resource limits for each MSP tier, what each program pays for, and how to apply through SCDHHS.
Direct Answer: Do You Qualify for a South Carolina MSP in 2026?
Yes, if you have Medicare Part A and monthly income at or below $1,816 as an individual in 2026. South Carolina's Healthy Connections administers four MSP tiers: QMB (100% FPL) covers all premiums, deductibles, and coinsurance; SLMB (120% FPL) and QI (135% FPL) each pay only the 2026 Part B premium of $202.90 per month. Resource limits are $9,950 individual and $14,910 couple.
What Each South Carolina MSP Tier Covers in 2026
South Carolina administers four MSP tiers through Healthy Connections, each covering a different set of Medicare costs. Understanding the difference matters because QMB enrollment can save over $6,000 per year, while SLMB and QI save around $2,435 per year (12 months of the 2026 Part B premium of $202.90 per month).
QMB enrollees in South Carolina also automatically qualify for Extra Help with Medicare Part D prescription drug costs. Extra Help eliminates the Part D deductible, caps copays at $4.50 for generics and $11.20 for brand-name drugs in 2026, and eliminates late-enrollment penalties for Part D.
South Carolina Medicare Savings Program coverage by tier 2026| Program | Income Limit (Individual) | What It Pays | Extra Help |
|---|
| QMB (100% FPL) | $1,350/month | Part A premium, Part B premium ($202.90/mo), Part A deductible ($1,736 in 2026), Part B deductible ($283 in 2026), coinsurance and copays for all Medicare-covered services | Automatic full Extra Help |
| SLMB (120% FPL) | $1,616/month | Part B premium only ($202.90/month in 2026). Does not cover Part A costs, deductibles, or coinsurance. | Automatic full Extra Help |
| QI (135% FPL) | $1,816/month | Part B premium only ($202.90/month in 2026). First-come, first-served annual funding cap. | Automatic full Extra Help |
| QDWI (200% FPL) | $5,405/month | Part A premium only (up to $565/month in 2026 for those who need to buy in). For disabled workers under age 65 who returned to work. | Not included |
Part B premium: $202.90/month (standard 2026). Part A inpatient deductible: $1,736 per benefit period in 2026. Part B deductible: $283 in 2026. Part D insulin cap: $35/month per IRA 2022. Extra Help income limits differ from MSP limits; QMB, SLMB, and QI enrollment provides automatic Extra Help without a separate application.
Source: CMS 2026 MSP Eligibility Standards; SCDHHS Program Eligibility and Income Limits (effective 03/01/2026)
QMB Billing Protection: What South Carolina QMB Enrollees Must Know
South Carolina QMB enrollees have a federally protected right under Section 1902(n)(3)(B) of the Social Security Act. Medicare providers, including physicians, hospitals, labs, and pharmacies, are legally prohibited from billing QMB enrollees for any Medicare cost-sharing, including deductibles, coinsurance, and copayments for covered services. This rule applies even if the provider is not enrolled in South Carolina Healthy Connections Medicaid.
If a provider bills you improperly as a South Carolina QMB enrollee, you have three options. First, show the provider your QMB card and reference the federal prohibition. Second, call 1-800-MEDICARE (1-800-633-4227) to report the improper billing. Third, file a complaint with SCDHHS or your Medicare managed care plan if you are enrolled in Medicare Advantage. Providers who repeatedly bill QMB enrollees improperly face exclusion from the Medicare and Medicaid programs.
South Carolina Is a Non-Expansion State: What That Means for MSP Applicants
South Carolina has not expanded Medicaid under the ACA. The 10 non-expansion states as of 2026 are Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming. In non-expansion states, adults between 19 and 64 without minor children or a qualifying disability face the ACA gap: family size of one income must fall below 100% of the Federal Poverty Level ($15,960 in 2026) yet those individuals are also ineligible for full Medicaid at 138% FPL, and too poor for ACA marketplace subsidies. For household composition with children, rules differ by state and program.
The Medicare Savings Program is not affected by the non-expansion status. MSPs are separate federal-state programs for people who already have Medicare, and South Carolina must fund them under federal law. Once a South Carolina resident turns 65 or qualifies for Medicare due to disability, MSP eligibility is evaluated independently of whether the state has expanded Medicaid for non-Medicare adults. South Carolina residents who are approaching 65 should apply for Medicare Part A and Part B during their Initial Enrollment Period, then immediately apply for an MSP through Healthy Connections.
2026 Healthy Connections Prime Ended: What Dual-Eligible South Carolinians Must Do
As of January 1, 2026, South Carolina's Healthy Connections Prime, the state Medicare-Medicaid Plan (MMP) that integrated Medicare and Medicaid benefits for dual-eligible enrollees, ended. SCDHHS directed former Prime members to enroll in a Dual Special Needs Plan (D-SNP) through one of the private Medicare Advantage carriers operating in South Carolina. D-SNPs serve people who have both Medicare and Medicaid (including QMB or higher Medicaid coverage) and must coordinate benefits across both programs.
South Carolina dual-eligible residents who previously enrolled in Healthy Connections Prime should confirm they have selected a D-SNP for 2026 coverage. Medicare Advantage D-SNPs in South Carolina that serve Medicaid beneficiaries include plans from Absolute Total Care, Healthy Blue of SC, First Choice by Select Health, Humana Healthy Horizons in SC, and Molina Healthcare of SC. Regardless of which plan you choose, your QMB billing protection and Extra Help for Part D remain active.
What Counts as Income for South Carolina MSP Eligibility?
South Carolina MSPs use a modified income counting methodology. The key rule is the standard $20 monthly income disregard: SCDHHS subtracts $20 from your countable monthly income before comparing it to the program limit. That is why the QMB limit is $1,350 rather than exactly $1,330 (100% FPL for 2026 is $15,960 annually, or $1,330 monthly).
South Carolina MSP income counting follows federal rules. Income types counted toward the MSP limit include Social Security retirement and disability benefits, SSI payments, wages from employment, self-employment income, pension and annuity income, and rental income. Income types that are NOT counted include most veterans' disability payments, the value of SNAP or other food assistance, energy assistance payments, and certain other irregular payments. If you are unsure whether a specific income source counts, contact SCDHHS directly at 888-549-0820.
- Counted: Social Security retirement or disability benefit, SSI, wages, self-employment income, pension/annuity/retirement distributions, rental income, alimony (if divorce finalized before 2019 under federal tax rules)
- NOT counted: Veterans' disability compensation, SNAP/food stamps, Low Income Home Energy Assistance Program (LIHEAP), most Social Security Medicare premiums withheld (they are an expense, not income), and Medicare Savings Program payments themselves
- Standard deductions: The $20/month general income disregard is applied before comparing to the program limit. An additional $65/month earned income disregard plus one-half of remaining earned income is applied if you have wages.
How to Appeal a South Carolina MSP Denial
South Carolina residents denied an MSP have the right to a fair hearing. SCDHHS must send a written denial notice explaining the reason for the denial. You have 30 days from the date of the notice to request an appeal. File the appeal in writing with your name, address, SCDHHS case number, and a brief statement of what you are appealing and why. Mail or fax the appeal to SCDHHS Appeals Division at P.O. Box 100101, Columbia, SC 29202-3101 or fax to 803-255-8263.
During the appeal, you may request continuation of any MSP benefits you currently receive while the hearing is pending. If the denial was for a resource reason and you believe an asset was incorrectly counted (for example, your primary home, one vehicle, or burial funds up to $1,500 per person), document the exempt status of that asset and include it with your appeal. Free legal assistance for appeals is available through South Carolina Legal Services at sclegal.org.
MSP and Extra Help: Prescription Drug Savings for South Carolina Residents
South Carolina QMB, SLMB, and QI enrollees automatically qualify for Extra Help (also called the Low Income Subsidy, or LIS) for Medicare Part D prescription drug coverage. Extra Help is a separate federal program that reduces drug costs, but enrolling in any of the three MSP tiers in South Carolina triggers automatic Extra Help enrollment without a separate application.
For 2026, South Carolina MSP enrollees receiving full Extra Help pay no more than $4.50 per generic prescription and $11.20 per brand-name prescription at the pharmacy. The Part D deductible is waived entirely. The IRA 2022 insulin cap ($35 per month for covered insulin products under Part D) also applies. If you are currently paying full retail prices for prescriptions while enrolled in an MSP, contact 1-800-MEDICARE to confirm your Extra Help status is active.
Frequently Asked Questions
What is the income limit for QMB in South Carolina in 2026?
The 2026 QMB income limit in South Carolina is $1,350 per month for an individual and $1,824 per month for a married couple. These figures include the standard $20 monthly income disregard applied by SCDHHS. QMB is the most comprehensive Medicare Savings Program tier: it pays Part A and Part B premiums, the 2026 Part A inpatient deductible ($1,736), the 2026 Part B deductible ($283), and all Medicare coinsurance and copays for covered services.
What is the difference between QMB, SLMB, and QI in South Carolina?
All three are Medicare Savings Programs administered through Healthy Connections (SC Medicaid). QMB (up to 100% FPL) provides the most help: it covers all Medicare premiums, deductibles, and coinsurance. SLMB (100-120% FPL) and QI (120-135% FPL) each cover only the Medicare Part B monthly premium ($202.90 in 2026). All three also provide automatic Extra Help for Part D drug costs. QI is capped by annual federal funding; apply early.
Can I apply for a Medicare Savings Program in South Carolina even though the state did not expand Medicaid?
Yes. Medicare Savings Programs are federally mandated and exist in all 50 states regardless of Medicaid expansion status. South Carolina must fund QMB, SLMB, and QI for all eligible Medicare beneficiaries. The non-expansion status of South Carolina Medicaid affects adults under 65 without Medicare but does not affect MSP availability for people who already have Medicare.
Does having too much in savings disqualify me from a South Carolina MSP?
Possibly. In 2026, South Carolina MSPs (QMB, SLMB, and QI) have a resource limit of $9,950 for individuals and $14,910 for couples. Countable resources include checking and savings accounts, stocks, bonds, and IRAs. Your primary home, one vehicle, household items, personal effects, and burial funds up to $1,500 per person are excluded. If you are just over the resource limit, spending down on medical bills or permitted exempt items can bring you under the threshold.
What happens to Healthy Connections Prime members now that it ended in 2026?
Healthy Connections Prime, South Carolina's dual Medicare-Medicaid managed care plan, ended January 1, 2026. Former Prime members were directed to enroll in a Dual Special Needs Plan (D-SNP) through a private Medicare Advantage carrier. QMB and Medicaid benefits continue seamlessly through D-SNPs. Contact SCDHHS at 888-549-0820 or 1-800-MEDICARE if you have not yet enrolled in a replacement D-SNP.
How long does it take to get approved for a South Carolina MSP?
SCDHHS has up to 45 days to process a standard MSP application submitted through the Healthy Connections portal at apply.scdhhs.gov. If your application is approved, MSP benefits typically begin the first day of the month following approval. Applying online is the fastest method. If you have an urgent need (for example, you are facing a large Medicare bill), contact SCDHHS at 888-549-0820 to ask about expedited processing.
Do I need to reapply for the South Carolina MSP every year?
Yes. South Carolina MSPs must be renewed annually. SCDHHS will send a renewal notice. Respond promptly to the renewal notice to avoid any gap in coverage. QI program funding is particularly important to renew early because federal QI funding is allocated each year and can be exhausted. If you miss a renewal, you can reapply immediately through apply.scdhhs.gov.
Can I get a Medicare Savings Program in South Carolina if I also have Medicare Advantage?
Yes. MSP enrollment is based on your Medicare eligibility and income, not on whether you have Original Medicare or Medicare Advantage. If you are enrolled in a Medicare Advantage plan and qualify for QMB, your plan cannot charge you premiums, deductibles, or cost-sharing beyond what Original Medicare would charge. QMB billing protection applies to Medicare Advantage enrollees. SLMB and QI enrollees with Medicare Advantage still receive the Part B premium credit.
