Virginia's Medicare Savings Program (MSP) is a Medicaid-funded benefit that pays some or all of a Medicare beneficiary's out-of-pocket Medicare costs. In 2026, more than 430,000 Virginia residents qualify for at least one of the three tiers: Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), or Qualifying Individual (QI). The program is administered by Virginia's Department of Medical Assistance Services (DMAS) and applied for through Cover Virginia or a local Department of Social Services (DSS) office.
Virginia expanded Medicaid in 2019 under the Affordable Care Act, making the state one of 40 expansion states plus DC. However, the Medicare Savings Program serves a separate population: people who are already enrolled in Medicare (typically age 65+ or receiving Social Security Disability Insurance) but have limited income and resources. If your income is below 135% of the 2026 federal poverty level, Virginia's MSP can eliminate or dramatically reduce your Medicare premium costs.
Quick answer: Virginia's 2026 MSP income thresholds
Yes. Virginia's Medicare Savings Program covers Medicare costs for residents with income at or below 135% of the 2026 federal poverty level. Three tiers exist: QMB (up to $1,350/month individual), SLMB (up to $1,616/month individual), and QI (up to $1,816/month individual). All three tiers also include automatic Part D Extra Help worth up to $5,700 per year in 2026. Virginia residents must be enrolled in Medicare Part A and Part B and have limited assets to qualify.
Virginia Medicare Savings Program income limits by tier (2026)
Virginia's MSP uses three income thresholds tied to the federal poverty level. The 2026 FPL for a single person is $15,960 per year ($1,330/month). Each program tier adds a standard $20 unearned income disregard, meaning Social Security recipients can have gross income that is $20 higher than the stated limits and still qualify.
Virginia Medicare Savings Program income and benefits by tier 2026| Program tier | Monthly income limit (individual) | Monthly income limit (couple) | FPL % | What Virginia pays |
|---|
| QMB (Qualified Medicare Beneficiary) | $1,350/month | $1,824/month | 100% FPL | Part A + Part B premiums, deductibles, coinsurance, copays |
| SLMB (Specified Low-Income MB) | $1,616/month | $2,184/month | 120% FPL | Part B premium ($202.90/month in 2026) only |
| QI (Qualifying Individual) | $1,816/month | $2,455/month | 135% FPL | Part B premium ($202.90/month in 2026); first-come, first-served; annual reapplication required |
Virginia applies a $20/month income disregard to unearned income (Social Security, pensions). The asset limit for QMB and SLMB is $9,660 (individual) and $14,470 (couple) in 2026. QI asset limits are $9,950 (individual) and $14,910 (couple). Primary home, one vehicle, and household goods are exempt. Source: CMS Medicare Savings Program 2026 standards; Virginia DMAS.
Source: CMS 2026 Medicare Savings Program Income Standards; Virginia DMAS; coverva.dmas.virginia.gov
What Virginia's Medicare Savings Program actually pays in 2026
Virginia QMB enrollees receive the most comprehensive assistance. In 2026, QMB eliminates the $202.90 monthly Part B premium, the $1,736 Part A inpatient hospital deductible per benefit period, the $283 annual Part B deductible, and all Part A and Part B coinsurance and copayments. Crucially, Virginia Medicaid (as the secondary payer) is legally prohibited from billing QMB enrollees for any Medicare cost-sharing. Providers who accept Medicare must accept Virginia's MSP payment as payment in full and cannot bill the patient the difference.
Virginia SLMB and QI enrollees receive the Part B premium savings only: $202.90 per month, or $2,434.80 per year in 2026. While SLMB and QI do not eliminate deductibles or copays, both programs still trigger automatic Extra Help enrollment for Medicare Part D prescription drug coverage. Extra Help reduces your Part D plan premium (in many cases to $0), eliminates the Part D deductible of up to $590 in 2026, and caps drug copays at $5.10 for generic drugs and $12.65 for brand-name drugs in 2026. Note that the Medicare Savings Program does not use MAGI (Modified Adjusted Gross Income) to count income. Instead, Virginia uses SSI-related income counting rules, which allow certain deductions (including a $20 unearned income disregard) that can lower your countable income below your gross income.
How to apply for Virginia's Medicare Savings Program
Virginia residents can apply for the Medicare Savings Program year-round. The primary application portal is Cover Virginia at coverva.dmas.virginia.gov. Applications are also accepted by phone at 1-855-242-8282 (Monday through Friday, 8 a.m. to 7 p.m., starting April 4, 2026), in person at any Virginia Department of Social Services (DSS) office, or by mail to Cardinal Care Correspondence Center, P.O. Box 1820, Richmond, VA 23218.
Virginia is a 209(b) state, meaning it uses its own Medicaid eligibility rules rather than automatically following SSI (Supplemental Security Income) rules for some MSP categories. This can affect how income and assets are counted. Free application help is available from Virginia's State Health Insurance Assistance Program (SHIP) by calling 1-877-310-6560 or visiting the Virginia SHIP website. SHIP counselors are available statewide and provide unbiased, no-cost help with MSP applications.
Documents needed to apply for Virginia's Medicare Savings Program
Virginia's Cover Virginia portal and local DSS offices require specific documentation to determine MSP eligibility. Gather these items before applying to avoid processing delays. Virginia applicants do not need to be U.S. citizens for MSP, but they must be lawfully present residents with at least 5 years of qualifying immigration status (or exempt from the 5-year bar, such as refugees and asylees).
- Medicare card showing your Medicare number and coverage start dates for Part A and/or Part B
- Social Security number for each applicant (Social Security card, W-2, or official SSA correspondence)
- Proof of income: Social Security benefit verification letter (printed from ssa.gov/myaccount), recent pay stubs, pension or annuity statements, or 1099-R forms
- Bank account statements for all checking and savings accounts (last 2 to 3 months)
- Proof of Virginia residency: utility bill, lease or rental agreement, mortgage statement, or official mail addressed to your Virginia address dated within 60 days
- Government-issued photo ID: Virginia driver's license, Commonwealth of Virginia identification card, or U.S. passport
- Documentation of other assets if applicable: investment brokerage statements, life insurance cash value documents, certificates of deposit, or savings bonds
Is Virginia a Medicaid expansion state, and how does that affect MSP?
Virginia expanded Medicaid in January 2019 under the Affordable Care Act, joining 40 states plus DC as an expansion state. Expansion covers adults ages 19 through 64 with income up to 138% of the federal poverty level (approximately $22,025 per year for an individual in 2026) and is administered through Virginia Medicaid managed care plans. However, Medicaid expansion and the Medicare Savings Program serve distinct populations.
Virginia's Medicare Savings Program is specifically for people who are already enrolled in Medicare, which generally means adults age 65 and older or people under 65 with disabilities who receive Medicare due to SSDI enrollment or end-stage renal disease. People who are newly eligible for Medicare at age 65 and have limited income can use MSP to eliminate or reduce their Medicare cost-sharing even if they also recently had Virginia Medicaid coverage as a working-age adult. Virginia DMAS coordinates both programs and can assist with the transition.
Common reasons Virginia MSP applications are denied
Virginia's Department of Social Services issues denials in writing with a specific reason. If you are denied, you have the right to request a fair hearing within 30 days of the denial notice. Contact Virginia DMAS or a free legal aid organization such as Virginia Legal Aid or the Virginia SeniorNavigator for appeal assistance.
- Income over the QI ceiling ($1,816/month individual or $2,455/month couple in 2026): Virginia applies a $20 unearned income disregard to all Social Security income, so your countable income may be lower than your gross income. Apply even if gross income is slightly above these limits.
- Resources exceed the asset test limit ($9,660 individual or $14,470 couple for QMB/SLMB in 2026): Primary home, one vehicle, household goods, and burial funds up to $1,500 are exempt. If you are near the limit, a SHIP counselor or elder law attorney can help identify exempt assets.
- Not enrolled in both Medicare Part A and Part B: Some Virginia residents have Part A only (at no premium cost) but have declined Part B because of the monthly premium. MSP can pay that Part B premium, making it worthwhile to enroll in Part B and apply for MSP simultaneously.
- Missing documentation: incomplete applications are delayed or denied. Virginia DSS requires original or certified copies of income and asset documents. Photocopies of bank statements and award letters are generally accepted.
- QI program funding exhausted for the year: QI is funded by Congress annually with fixed appropriations. If Virginia's QI allotment is used up before year-end, new applicants are waitlisted. Apply early in the calendar year for the best chance of QI enrollment.
How to appeal a Virginia MSP denial
Virginia residents who are denied Medicare Savings Program benefits have the right to a state fair hearing. The denial notice from your local Virginia DSS office will explain the specific reason for denial and the deadline to appeal (typically 30 days from the date on the notice). To request a fair hearing, call Virginia DMAS at 804-786-8099 or write to the DMAS Appeals Division, 600 East Broad Street, Richmond, VA 23219.
Virginia Legal Aid provides free representation in MSP fair hearings for income-eligible applicants. Virginia SeniorNavigator (virginianavigator.org) connects older adults with local legal services and SHIP counseling. During the appeal period, if you were receiving MSP benefits that were terminated (rather than an initial denial), you can request continuation of benefits while the appeal is pending by making that request in writing within 10 days of the termination notice.
Virginia Medicare Savings Program context: what it is and who administers it
Virginia's Medicare Savings Program is authorized under Title XIX of the Social Security Act (Medicaid) and Title XVIII (Medicare). The program exists because Medicare does not cover all costs: in 2026, a beneficiary without supplemental coverage faces the $202.90 monthly Part B premium, the $283 Part B deductible, a $1,736 Part A hospital deductible per benefit period, and 20% coinsurance for most outpatient services with no annual out-of-pocket cap under Original Medicare. For a low-income Medicare beneficiary on a fixed Social Security income, these costs can consume a significant portion of monthly income.
Virginia's Department of Medical Assistance Services (DMAS) administers the MSP on the state side. Eligibility determinations are made by local Virginia Departments of Social Services offices throughout Virginia's 95 counties and 38 independent cities. The program has no annual enrollment window: Virginia accepts applications year-round. As of 2026, Virginia Medicaid covers more than 1.8 million residents across all programs, with MSP serving the Medicare-eligible subset with limited income and resources.
Frequently Asked Questions
What are the income limits for Virginia's QMB program in 2026?
Virginia's QMB (Qualified Medicare Beneficiary) income limit in 2026 is $1,350 per month for an individual and $1,824 per month for a couple. Virginia applies a $20 unearned income disregard to Social Security, so apply even if your gross monthly Social Security check is up to $1,370 (individual). QMB covers Part A and Part B premiums, deductibles, and all coinsurance and copays, and also triggers automatic Extra Help for Part D drugs.
What is the income limit for Virginia SLMB and QI in 2026?
Virginia's SLMB income limit is $1,616 per month (individual) or $2,184 per month (couple) in 2026. The QI limit is $1,816 per month (individual) or $2,455 per month (couple). Both programs pay only the Part B premium of $202.90 per month in 2026 and both trigger automatic Part D Extra Help. QI operates on first-come, first-served basis with annual reapplication required, while SLMB has no enrollment cap.
How do I apply for Virginia's Medicare Savings Program?
Virginia residents apply through Cover Virginia at coverva.dmas.virginia.gov or by calling 1-855-242-8282 (Monday through Friday, 8 a.m. to 7 p.m.). Applications are also accepted in person at any local Virginia Department of Social Services office. There is no enrollment window: apply year-round. Free help is available from Virginia SHIP by calling 1-877-310-6560.
What is the asset limit for Virginia's Medicare Savings Program in 2026?
Virginia's asset limits for QMB and SLMB in 2026 are $9,660 for an individual and $14,470 for a couple. The QI asset limits are $9,950 (individual) and $14,910 (couple). Exempt assets include your primary home, one vehicle, household furnishings, personal belongings, and burial funds up to $1,500. Countable assets include bank accounts, stocks, bonds, and savings.
Does Virginia's MSP automatically enroll me in Extra Help for Part D?
Yes. Enrollment in any tier of Virginia's Medicare Savings Program (QMB, SLMB, or QI) automatically qualifies you for Part D Extra Help (Low Income Subsidy). In 2026, Extra Help reduces generic drug copays to $5.10 and brand-name drug copays to $12.65, and may eliminate your Part D plan's premium and $590 deductible entirely. You do not need to apply for Extra Help separately.
Can I qualify for Virginia's MSP if I have too many assets?
You may still qualify even with assets above the limit, because many items are exempt. Your primary home (regardless of value), one vehicle, household furnishings, burial funds up to $1,500, and personal belongings are not counted. If your countable assets are near or above the limit, a Virginia SHIP counselor can help you understand which of your assets count and whether any legal spend-down options apply.
Is Virginia a Medicaid expansion state, and does that affect MSP eligibility?
Yes, Virginia expanded Medicaid in 2019 under the ACA, covering adults ages 19 through 64 at up to 138% FPL. However, expansion Medicaid and the Medicare Savings Program are separate programs: MSP is specifically for people enrolled in Medicare (generally age 65+ or under 65 with a qualifying disability). MSP eligibility does not depend on Virginia's expansion status.
What happens if I am denied Virginia's Medicare Savings Program?
Virginia DSS issues denials in writing with the specific reason. You have 30 days to request a state fair hearing. To appeal, call Virginia DMAS at 804-786-8099 or write to DMAS Appeals Division, 600 East Broad Street, Richmond, VA 23219. Free legal help for MSP appeals is available through Virginia Legal Aid and Virginia SHIP (1-877-310-6560).
What is the difference between QMB and SLMB in Virginia?
Virginia QMB covers the most: Part A and Part B premiums, the $1,736 Part A deductible (2026), the $283 Part B deductible (2026), and all coinsurance and copays. Virginia SLMB covers only the Part B premium of $202.90 per month (2026). The income limit differs: QMB is 100% FPL ($1,350/month individual) while SLMB goes up to 120% FPL ($1,616/month individual). Both include automatic Extra Help for Part D.
