Medicare Savings Programs (the state pays Medicare premiums: QMB, SLMB, QI, QDWI): who qualifies, what you get, how to apply, and what happens next
Medicare Savings Programs are four state programs that pay Medicare premiums for people with limited income: QMB also pays Part A and Part B cost sharing, SLMB and QI pay the Part B premium, and QDWI pays Part A for working people with disabilities. California uses its own 2026 income table and an asset limit of $130,000 for one person. Apply through the county Medi-Cal process or BenefitsCal.
What Medicare Savings Programs is, in one paragraph
Medicare Savings Programs are four programs, run by each state with federal rules, that pay Medicare costs for people with limited income and assets. QMB (Qualified Medicare Beneficiary) pays the Part A and Part B premiums and the deductibles, coinsurance and copayments; Medicare providers may not bill a QMB member for covered services. SLMB (Specified Low-Income Medicare Beneficiary) and QI (Qualifying Individual) pay the Part B premium. QDWI (Qualified Disabled and Working Individual) pays the Part A premium for people with disabilities who lost premium-free Part A by returning to work (rule:qmb_benefit, rule:slmb_qi_benefit, rule:qdwi_benefit). In California they are part of Medi-Cal and are applied for through the county.
$202.90
the standard monthly Medicare Part B premium in 2026, which QMB, SLMB and QI pay (Medicare.gov, rule:part_b_premium_2026)
Who may qualify
Three facts decide it: monthly income, assets, and which parts of Medicare the person has.
Income. California publishes its own 2026 gross income limits (rule:ca_income_limits_2026). They include amounts that are not counted, so a person slightly over can still qualify:
Program
Pays
Individual, monthly
Individual, yearly
Couple, monthly
Couple, yearly
QMB
Part A and B premiums, deductibles, copays
$1,330
$15,960
$1,804
$21,640
SLMB
Part B premium
$1,596
$19,152
$2,165
$25,968
QI
Part B premium
$1,796
$21,546
$2,436
$29,214
QDWI
Part A premium
$2,660
$31,920
$3,608
$43,280
California states that annual income under $22,025 for one person or $29,864 for a couple makes a person eligible for a Medicare Savings Program (rule:ca_any_msp_line).
Assets. From 1 January 2026 California's asset limit is $130,000 for one person plus $65,000 for each additional household member, up to 10 (rule:ca_asset_limit_2026). This is far above the federal resource limits Medicare.gov lists for other states ($9,950 for one person), which do not apply in California (rule:federal_limits_2026).
Medicare. SLMB and QI require Part A and Part B. QI is only for people who get no other Medi-Cal, must be renewed every year, and is approved first come, first served (rule:qi_yearly). QDWI is for working people with disabilities and cannot be combined with Medi-Cal (rule:qdwi_benefit). Since 1 January 2025 California enrolls full-scope Medi-Cal members with Part B who qualify for QMB into Part A automatically and pays that premium (rule:part_a_buy_in).
How to apply, and what happens after
The application is the Medi-Cal application: online at BenefitsCal, by mail, by phone or in person at the county social services office. To apply only for a Medicare Savings Program, mail form MC 14A to the county's Medicare Savings Program contact (rule:apply_where). Medicare.gov says to apply even if unsure (rule:apply_even_if_unsure). An application for Extra Help with Social Security also starts a Medicare Savings Program application unless the person says no (rule:extra_help_link).
The county verifies income and Medicare status and sends a Notice of Action. Once enrolled, the state pays the premium, Extra Help with drug costs starts automatically, and a QMB member shows the QMB or Medi-Cal card so providers do not bill Medicare cost sharing (rule:qmb_benefit). QI must be applied for every year (rule:qi_yearly); the other programs renew with Medi-Cal (rule:renewal).
Disagree with a decision? Request a State Hearing within 90 days of receiving the notice. To keep benefits during the hearing, request it before the action takes effect, or within 10 days of the notice when no advance notice is required (rule:fair_hearing_90).
The procedure, stage by stage, as data
JSONThe procedure, stage by stage, as data
[12 items
{10 keys
"id": "stage:discover",
"order": 1,
"name": "Discover",
"what_happens": "A person with Medicare and limited income learns the state can pay the Part B premium, and for QMB the Part A premium and cost sharing",
"who_acts": "Person / SHIP counselors / Social Security",
"timeline": "No deadline",
"evidence": "None",
"failure_mode": "Not applying because the person thinks the income is too high; California counts less than the table suggests",
"model_role": "State the 2026 limits and that the state decides which program fits",
"automation_class": "A"
},{10 keys
"id": "stage:screen_eligibility",
"order": 2,
"name": "Screen eligibility",
"what_happens": "Income against the California 2026 table for QMB, SLMB, QI and QDWI; assets against the $130,000 limit; Medicare parts held; Medi-Cal status",
"failure_mode": "Using federal resource limits instead of California's much higher asset limit",
"model_role": "Place the person in the highest-benefit program the figures allow",
"automation_class": "A"
},{10 keys
"id": "stage:gather_documents",
"order": 3,
"name": "Gather documents",
"what_happens": "Medicare card, proof of income, bank statements",
"who_acts": "Person",
"timeline": "Before or with the application",
"evidence": "Medicare card, award letters, statements",
"failure_mode": "Missing income verification",
"model_role": "List documents",
"automation_class": "A"
},{10 keys
"id": "stage:complete_application",
"order": 4,
"name": "Complete application",
"what_happens": "Medi-Cal application, or form MC 14A for a Medicare Savings Program only",
"who_acts": "Person",
"timeline": "One sitting",
"evidence": "Application",
"failure_mode": "Filling the full Medi-Cal application when only MSP is wanted, or the reverse",
"model_role": "Explain the MC 14A choice",
"automation_class": "A"
},{10 keys
"id": "stage:submit",
"order": 5,
"name": "Submit",
"what_happens": "Online at BenefitsCal, by mail, by phone or in person at the county; an Extra Help application to Social Security also starts it",
"who_acts": "Person",
"timeline": "Same day",
"evidence": "Submission",
"failure_mode": "Waiting",
"model_role": "Give the county route",
"automation_class": "B"
},{10 keys
"id": "stage:interview_verification",
"order": 6,
"name": "Interview / verification",
"what_happens": "The county verifies income; Social Security confirms Medicare status",
"who_acts": "County",
"timeline": "County processing",
"evidence": "Verification requests",
"failure_mode": "Unanswered county requests",
"model_role": "Track the request",
"automation_class": "C - county work"
},{10 keys
"id": "stage:decision",
"order": 7,
"name": "Decision",
"what_happens": "Notice of Action naming the program",
"who_acts": "County",
"timeline": "County processing",
"evidence": "Notice of Action",
"failure_mode": "Not reading the notice; it starts the 90-day hearing clock",
"model_role": "Read the notice against the rules",
"automation_class": "A"
},{10 keys
"id": "stage:issuance_use",
"order": 8,
"name": "Issuance / use",
"what_happens": "The state pays the premium; for QMB providers may not bill Medicare cost sharing; Extra Help starts automatically",
"who_acts": "State / Medicare",
"timeline": "After approval",
"evidence": "QMB card or Medi-Cal card",
"failure_mode": "Paying bills a QMB member does not owe",
"model_role": "Explain the QMB billing protection",
"automation_class": "D"
},{10 keys
"id": "stage:report_changes",
"order": 9,
"name": "Report changes",
"what_happens": "Report income and household changes to the county",
"who_acts": "Person",
"timeline": "As changes happen",
"evidence": "Updated income",
"failure_mode": "Unreported changes",
"model_role": "Flag changes that cross a program line",
"automation_class": "A"
},{10 keys
"id": "stage:renew_recertify",
"order": 10,
"name": "Renew / recertify",
"what_happens": "Renewed with Medi-Cal; QI must be applied for every year",
"who_acts": "Person / county",
"timeline": "QI every year; other interval not stated on the pages read",
"evidence": "Renewal packet",
"failure_mode": "Losing QI by not reapplying",
"model_role": "Remind QI members each year",
"automation_class": "B"
},{10 keys
"id": "stage:denial_response",
"order": 11,
"name": "Denial response",
"what_happens": "Read the Notice of Action and decide on a hearing",
"who_acts": "Person",
"timeline": "Immediately",
"evidence": "Notice of Action",
"failure_mode": "Letting the 90 days pass",
"model_role": "Name the deadline",
"automation_class": "A"
},{10 keys
"id": "stage:appeal_fair_hearing",
"order": 12,
"name": "Appeal / fair hearing",
"what_happens": "Request a State Hearing on the back of the notice, by mail, fax, online or phone to the California Department of Social Services",
"who_acts": "Person / CDSS State Hearings Division",
"timeline": "Within 90 days of receiving the notice; within 10 days to keep benefits during the hearing",
"evidence": "Hearing request",
"failure_mode": "Missing the 10-day window for aid paid pending",
"model_role": "State both deadlines",
"automation_class": "B"
}
]
The same facts open other programs
Monthly income, assets and Medicare status are the facts this program runs on. They are the first facts of every program for older adults and people with disabilities.
Hearings: Medi-Cal Fair Hearing; California Department of Social Services, State Hearings Division, P.O. Box 944243, Mail Station 21-37, Sacramento, California 94244-2430
Medicare Savings Programs in California: asset limits — California Department of Health Care Services“Starting January 1, 2026, the asset limits to determine MSP eligibility are $130,000 for an individual, and $65,000 for each additional household member up to 10.”
Medicare Savings Programs in California: MC 14A — California Department of Health Care Services“If you only want to apply for a Medicare Savings Program, you may fill out the application (MC 14A) and mail it to the Medicare Savings Program contact at your local county office.”
Medicare Savings Programs — Medicare.gov (Centers for Medicare & Medicaid Services)“You’ll apply for Medicare Savings Programs through your state.”
Medicare Savings Programs: apply — Medicare.gov (Centers for Medicare & Medicaid Services)“Even if you don’t think you qualify, you should still apply.”
Medicare Savings Programs: QMB billing — Medicare.gov (Centers for Medicare & Medicaid Services)“Medicare providers aren’t allowed to bill you for services and items Medicare covers, including deductibles, coinsurance, and copayments.”
Medicare Savings Programs: QI — Medicare.gov (Centers for Medicare & Medicaid Services)“You must apply every year to stay in the QI Program.”
Medicare Savings Programs: QDWI — Medicare.gov (Centers for Medicare & Medicaid Services)“Lost Your Social Security disability benefits and Medicare premium-free Part A because you returned to work”
Medicare costs: Part B premium 2026 — Medicare.gov (Centers for Medicare & Medicaid Services)“$202.90 each month (or higher depending on your income).”
Help with drug costs: apply together — Medicare.gov (Centers for Medicare & Medicaid Services)“You can apply for Extra Help and Medicare Savings Programs (MSPs) at the same time.”
Medi-Cal Fair Hearing — California Department of Health Care Services“You may be able to file after 90 days if you have a good reason, like illness or a disability.”
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"slug":"california-medicare-savings-programs",
"title":"Medicare Savings Programs (the state pays Medicare premiums: QMB, SLMB, QI, QDWI): who qualifies, what you get, how to apply, and what happens next",
"kind":"procedure",
"summary":"Medicare Savings Programs are four state programs that pay Medicare premiums for people with limited income: QMB also pays Part A and Part B cost sharing, SLMB and QI pay the Part B premium, and QDWI pays Part A for working people with disabilities. California uses its own 2026 income table and an asset limit of $130,000 for one person. Apply through the county Medi-Cal process or BenefitsCal.",
"tags": [
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"facts": {
"measured_at":"2026-10-09T13:00:00Z",
"article": {
"id":"msp-ca",
"slug":"california-medicare-savings-programs",
"program_id":"B013",
"jurisdiction":"US-CA",
"aliases": [
"Medicare Savings Programs",
"MSP",
"Qualified Medicare Beneficiary",
"QMB",
"Specified Low-Income Medicare Beneficiary",
"SLMB",
"Qualifying Individual",
"QI",
"Qualified Disabled and Working Individual",
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"procedure": {
"id":"proc:apply_msp_ca",
"type":"procedure",
"program_id":"B013",
"authority":"California Department of Health Care Services through the county social services offices; Social Security and Medicare confirm Medicare status",
"outcome":"the state pays Medicare premiums (and, for QMB, Medicare cost sharing)",
"apply_at":"https://benefitscal.com",
"stages": [
{
"id":"stage:discover",
"order":1,
"name":"Discover",
"what_happens":"A person with Medicare and limited income learns the state can pay the Part B premium, and for QMB the Part A premium and cost sharing",
"who_acts":"Person / SHIP counselors / Social Security",
"timeline":"No deadline",
"evidence":"None",
"failure_mode":"Not applying because the person thinks the income is too high; California counts less than the table suggests",
"model_role":"State the 2026 limits and that the state decides which program fits",
"automation_class":"A"
},
{
"id":"stage:screen_eligibility",
"order":2,
"name":"Screen eligibility",
"what_happens":"Income against the California 2026 table for QMB, SLMB, QI and QDWI; assets against the $130,000 limit; Medicare parts held; Medi-Cal status",
"who_acts":"Model + person",
"timeline":"Minutes",
"evidence":"Monthly income, assets, Medicare card",
"failure_mode":"Using federal resource limits instead of California's much higher asset limit",
"model_role":"Place the person in the highest-benefit program the figures allow",
"automation_class":"A"
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{
"id":"stage:gather_documents",
"order":3,
"name":"Gather documents",
"what_happens":"Medicare card, proof of income, bank statements",
"who_acts":"Person",
"timeline":"Before or with the application",
"evidence":"Medicare card, award letters, statements",
"failure_mode":"Missing income verification",
"model_role":"List documents",
"automation_class":"A"
},
{
"id":"stage:complete_application",
"order":4,
"name":"Complete application",
"what_happens":"Medi-Cal application, or form MC 14A for a Medicare Savings Program only",
"who_acts":"Person",
"timeline":"One sitting",
"evidence":"Application",
"failure_mode":"Filling the full Medi-Cal application when only MSP is wanted, or the reverse",
"model_role":"Explain the MC 14A choice",
"automation_class":"A"
},
{
"id":"stage:submit",
"order":5,
"name":"Submit",
"what_happens":"Online at BenefitsCal, by mail, by phone or in person at the county; an Extra Help application to Social Security also starts it",
"who_acts":"Person",
"timeline":"Same day",
"evidence":"Submission",
"failure_mode":"Waiting",
"model_role":"Give the county route",
"automation_class":"B"
},
{
"id":"stage:interview_verification",
"order":6,
"name":"Interview / verification",
"what_happens":"The county verifies income; Social Security confirms Medicare status",
"who_acts":"County",
"timeline":"County processing",
"evidence":"Verification requests",
"failure_mode":"Unanswered county requests",
"model_role":"Track the request",
"automation_class":"C - county work"
},
{
"id":"stage:decision",
"order":7,
"name":"Decision",
"what_happens":"Notice of Action naming the program",
"who_acts":"County",
"timeline":"County processing",
"evidence":"Notice of Action",
"failure_mode":"Not reading the notice; it starts the 90-day hearing clock",
"model_role":"Read the notice against the rules",
"automation_class":"A"
},
{
"id":"stage:issuance_use",
"order":8,
"name":"Issuance / use",
"what_happens":"The state pays the premium; for QMB providers may not bill Medicare cost sharing; Extra Help starts automatically",
"who_acts":"State / Medicare",
"timeline":"After approval",
"evidence":"QMB card or Medi-Cal card",
"failure_mode":"Paying bills a QMB member does not owe",
"model_role":"Explain the QMB billing protection",
"automation_class":"D"
},
{
"id":"stage:report_changes",
"order":9,
"name":"Report changes",
"what_happens":"Report income and household changes to the county",
"who_acts":"Person",
"timeline":"As changes happen",
"evidence":"Updated income",
"failure_mode":"Unreported changes",
"model_role":"Flag changes that cross a program line",
"automation_class":"A"
},
{
"id":"stage:renew_recertify",
"order":10,
"name":"Renew / recertify",
"what_happens":"Renewed with Medi-Cal; QI must be applied for every year",
"who_acts":"Person / county",
"timeline":"QI every year; other interval not stated on the pages read",
"evidence":"Renewal packet",
"failure_mode":"Losing QI by not reapplying",
"model_role":"Remind QI members each year",
"automation_class":"B"
},
{
"id":"stage:denial_response",
"order":11,
"name":"Denial response",
"what_happens":"Read the Notice of Action and decide on a hearing",
"who_acts":"Person",
"timeline":"Immediately",
"evidence":"Notice of Action",
"failure_mode":"Letting the 90 days pass",
"model_role":"Name the deadline",
"automation_class":"A"
},
{
"id":"stage:appeal_fair_hearing",
"order":12,
"name":"Appeal / fair hearing",
"what_happens":"Request a State Hearing on the back of the notice, by mail, fax, online or phone to the California Department of Social Services",
"who_acts":"Person / CDSS State Hearings Division",
"timeline":"Within 90 days of receiving the notice; within 10 days to keep benefits during the hearing",
"evidence":"Hearing request",
"failure_mode":"Missing the 10-day window for aid paid pending",
"model_role":"State both deadlines",
"automation_class":"B"
}
],
"stage_ids": [
"stage:discover",
"stage:screen_eligibility",
"stage:gather_documents",
"stage:complete_application",
"stage:submit",
"stage:interview_verification",
"stage:decision",
"stage:issuance_use",
"stage:report_changes",
"stage:renew_recertify",
"stage:denial_response",
"stage:appeal_fair_hearing"
]
},
"rules": [
{
"id":"rule:msp_definition",
"kind":"definition",
"text":"Medicare Savings Programs are state programs that pay Medicare Part A and Part B premiums, and for some people the deductibles, coinsurance and copayments. They are applied for through the state.",
"jurisdiction":"US",
"source":"s_mgov_msp_state",
"status":"verified 2026-10-09"
},
{
"id":"rule:ca_income_limits_2026",
"kind":"income_test",
"text":"California gross income limits for 2026, by program, for an individual and for an individual and spouse. The limits include amounts not counted in the determination, so a person over the line can still apply.",
"jurisdiction":"US-CA",
"effective":"2026",
"values_usd_monthly": {
"QMB": {
"individual":1330,
"couple":1804
},
"SLMB": {
"individual":1596,
"couple":2165
},
"QI": {
"individual":1796,
"couple":2436
},
"QDWI": {
"individual":2660,
"couple":3608
}
},
"values_usd_annual": {
"QMB": {
"individual":15960,
"couple":21640
},
"SLMB": {
"individual":19152,
"couple":25968
},
"QI": {
"individual":21546,
"couple":29214
},
"QDWI": {
"individual":31920,
"couple":43280
}
},
"source":"s_dhcs_msp_table",
"status":"verified 2026-10-09 (DHCS Medicare Savings Programs page, read in a browser on the Mac; the build cannot read DHCS pages)"
},
{
"id":"rule:ca_any_msp_line",
"kind":"income_test",
"text":"California states that people with annual income under $22,025 (individual) or $29,864 (couple) are eligible for a Medicare Savings Program.",
"jurisdiction":"US-CA",
"effective":"2026",
"values_usd_annual": {
"individual":22025,
"couple":29864
},
"source":"s_dhcs_msp_line",
"status":"verified 2026-10-09"
},
{
"id":"rule:ca_asset_limit_2026",
"kind":"asset_test",
"text":"From 1 January 2026 the California asset limit for Medicare Savings Programs is $130,000 for an individual and $65,000 for each additional household member, up to 10. Assets include bank accounts, cash, second homes and vehicles.",
"jurisdiction":"US-CA",
"effective":"from 2026-01-01",
"values_usd": {
"individual":130000,
"each_additional_member":65000,
"max_members":10
},
"source":"s_dhcs_msp_assets",
"status":"verified 2026-10-09"
},
{
"id":"rule:federal_limits_2026",
"kind":"income_test",
"text":"The federal monthly income and resource limits for 2026 published by Medicare.gov. States may set higher limits; California's own table and asset limit apply in California.",
"jurisdiction":"US",
"effective":"2026",
"values_usd_monthly": {
"QMB": {
"individual":1350,
"couple":1824
},
"SLMB": {
"individual":1616,
"couple":2184
},
"QI": {
"individual":1816,
"couple":2455
},
"QDWI": {
"individual":5405,
"couple":7299
}
},
"values_usd_resources": {
"QMB_SLMB_QI": {
"individual":9950,
"couple":14910
},
"QDWI": {
"individual":4000,
"couple":6000
}
},
"source":"s_mgov_msp_state",
"status":"verified 2026-10-09 (Medicare.gov); the two official pages state different QDWI income figures"
},
{
"id":"rule:qmb_benefit",
"kind":"benefit",
"text":"QMB pays Part A premiums (when Part A is not premium-free) and Part B premiums, deductibles, coinsurance and copayments. Medicare providers may not bill a QMB member for Medicare-covered services.",
"jurisdiction":"US",
"source":"s_mgov_msp_billing",
"status":"verified 2026-10-09"
},
{
"id":"rule:slmb_qi_benefit",
"kind":"benefit",
"text":"SLMB and QI pay the Part B premium only. Both require Part A and Part B.",
"jurisdiction":"US",
"source":"s_mgov_msp_state",
"status":"verified 2026-10-09"
},
{
"id":"rule:qdwi_benefit",
"kind":"categorical",
"text":"QDWI pays the Part A premium only, for a person with a disability who is working and lost premium-free Part A and disability benefits because of returning to work. In California the person cannot also receive Medi-Cal.",
"jurisdiction":"US",
"source":"s_mgov_msp_qdwi",
"status":"verified 2026-10-09"
},
{
"id":"rule:qi_yearly",
"kind":"renewal",
"text":"QI must be applied for every year. States approve QI first come, first served, with priority to people who had QI the year before. QI is only for people who do not qualify for any other Medicaid.",
"jurisdiction":"US",
"source":"s_mgov_msp_qi",
"status":"verified 2026-10-09"
},
{
"id":"rule:part_b_premium_2026",
"kind":"benefit",
"text":"The standard Medicare Part B premium in 2026 is $202.90 a month (higher for some incomes). QMB, SLMB and QI pay it.",
"jurisdiction":"US",
"effective":"2026",
"value_usd_monthly":202.9,
"source":"s_mgov_costs_b",
"status":"verified 2026-10-09"
},
{
"id":"rule:part_a_buy_in",
"kind":"benefit",
"text":"From 1 January 2025 California is a Medicare Part A Buy-In state: full-scope Medi-Cal members enrolled in Part B who qualify for QMB are enrolled in Part A automatically and the state pays the Part A premium.",
"jurisdiction":"US-CA",
"effective":"from 2025-01-01",
"source":"s_dhcs_msp_buyin",
"status":"verified 2026-10-09"
},
{
"id":"rule:extra_help_link",
"kind":"categorical",
"text":"A person in a Medicare Savings Program gets Extra Help with drug costs automatically; Extra Help and Medicare Savings Programs can be applied for at the same time.",
"jurisdiction":"US",
"source":"s_mgov_xh_together",
"status":"verified 2026-10-09"
},
{
"id":"rule:apply_where",
"kind":"procedure",
"text":"In California the application is the same as Medi-Cal: online at BenefitsCal, by mail, by phone or in person at the county social services office. A person who wants only a Medicare Savings Program can mail form MC 14A to the county Medicare Savings Program contact.",
"jurisdiction":"US-CA",
"source":"s_dhcs_msp_mc14a",
"status":"verified 2026-10-09"
},
{
"id":"rule:apply_even_if_unsure",
"kind":"procedure",
"text":"Even a person who does not think they qualify should still apply; the state decides which program fits.",
"jurisdiction":"US",
"source":"s_mgov_msp_apply",
"status":"verified 2026-10-09"
},
{
"id":"rule:renewal",
"kind":"renewal",
"text":"Medicare Savings Programs in California are applied for through the Medi-Cal process and renewed with Medi-Cal. The renewal interval is not stated on the pages read.",
"jurisdiction":"US-CA",
"value_months":"UNKNOWN",
"source":"s_dhcs_msp_process",
"status":"verified 2026-10-09 that the process is the Medi-Cal process; the renewal interval could not be checked on an official page"
},
{
"id":"rule:fair_hearing_90",
"kind":"appeal",
"text":"A State Hearing can be requested within 90 days of receiving the Notice of Action, later with good cause such as illness. Benefits continue pending the hearing (Aid Paid Pending) when the request is made before the action takes effect, or within 10 days of the notice when 10-day notice is not required.",
"jurisdiction":"US-CA",
"value_days": {
"request":90,
"aid_paid_pending":10
},
"source":"s_dhcs_fh",
"status":"verified 2026-10-09"
},
{
"id":"rule:contact",
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"id":"text_for_help",
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},
{
"id":"open_article_chat",
"kind":"chat",
"label":"Chat about this article",
"title":"Medicare Savings Programs: ask the article",
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"starters": [
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"Will the state pay my Part B premium?",
"Do my savings count against me?",
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}
],
"context": {
"instructions":"You are helping one person or couple with Medicare Savings Programs in California. Use only the rules in this article's facts.rules, naming the rule id and its source id beside every figure. Use California's 2026 table (rule:ca_income_limits_2026) and California's asset limit (rule:ca_asset_limit_2026); the federal limits (rule:federal_limits_2026) are context only and do not apply in California. Start with monthly income and marital status, then assets, then which Medicare parts the person has and whether they have Medi-Cal. Name the highest-benefit program the figures fit (QMB, then SLMB, then QI; QDWI only for working people with disabilities). Report results as: potentially eligible, potentially ineligible, insufficient information, or requires county determination; always say the county decides, and that the income table includes amounts not counted, so a person slightly over should still apply. Ask for at most two facts at a time and restate each as a canonical fact line (household.income.monthly_gross = 1450). Give the next step (rule:apply_where) and, for a dispute, the hearing deadlines (rule:fair_hearing_90). Use facts.ontology.related_programs to name other programs the same facts open. Never claim an application was filed. Keep it short.",
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},
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"submission":"no automated submission to any agency; the person applies at BenefitsCal or the county social services office"
},
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"body": [
"## What Medicare Savings Programs is, in one paragraph\n\nMedicare Savings Programs are four programs, run by each state with federal rules, that pay Medicare costs for people with limited income and assets. **QMB** (Qualified Medicare Beneficiary) pays the Part A and Part B premiums and the deductibles, coinsurance and copayments; Medicare providers may not bill a QMB member for covered services. **SLMB** (Specified Low-Income Medicare Beneficiary) and **QI** (Qualifying Individual) pay the Part B premium. **QDWI** (Qualified Disabled and Working Individual) pays the Part A premium for people with disabilities who lost premium-free Part A by returning to work (rule:qmb_benefit, rule:slmb_qi_benefit, rule:qdwi_benefit). In California they are part of Medi-Cal and are applied for through the county.",
{
"type":"stat",
"value":"$202.90",
"label":"the standard monthly Medicare Part B premium in 2026, which QMB, SLMB and QI pay (Medicare.gov, rule:part_b_premium_2026)"
},
"## Who may qualify\n\nThree facts decide it: **monthly income**, **assets**, and **which parts of Medicare the person has**.\n\n**Income.** California publishes its own 2026 gross income limits (rule:ca_income_limits_2026). They include amounts that are not counted, so a person slightly over can still qualify:\n\n| Program | Pays | Individual, monthly | Individual, yearly | Couple, monthly | Couple, yearly |\n|---|---|---|---|---|---|\n| QMB | Part A and B premiums, deductibles, copays | $1,330 | $15,960 | $1,804 | $21,640 |\n| SLMB | Part B premium | $1,596 | $19,152 | $2,165 | $25,968 |\n| QI | Part B premium | $1,796 | $21,546 | $2,436 | $29,214 |\n| QDWI | Part A premium | $2,660 | $31,920 | $3,608 | $43,280 |\n\nCalifornia states that annual income under $22,025 for one person or $29,864 for a couple makes a person eligible for a Medicare Savings Program (rule:ca_any_msp_line).\n\n**Assets.** From 1 January 2026 California's asset limit is **$130,000** for one person plus **$65,000** for each additional household member, up to 10 (rule:ca_asset_limit_2026). This is far above the federal resource limits Medicare.gov lists for other states ($9,950 for one person), which do not apply in California (rule:federal_limits_2026).\n\n**Medicare.** SLMB and QI require Part A and Part B. QI is only for people who get no other Medi-Cal, must be renewed every year, and is approved first come, first served (rule:qi_yearly). QDWI is for working people with disabilities and cannot be combined with Medi-Cal (rule:qdwi_benefit). Since 1 January 2025 California enrolls full-scope Medi-Cal members with Part B who qualify for QMB into Part A automatically and pays that premium (rule:part_a_buy_in).",
"## What the model on this page can do for you\n\nThis article is also the context of a model you can text or chat with. The buttons under the title open Messages with a note already written, or a chat on this page. The model has read this exact page: the rules above with their source ids, the procedure below, and the other programs the same facts open. It asks for one or two facts at a time, starting with monthly income and whether you are married, then assets and which parts of Medicare you have, tells you which of the four programs the figures fit, and gives the exact next step. It has no tools: it cannot apply for you, and it says so. Every message is kept on this build's Ledger.\n\nA screening here is a screening, not a decision. The county decides.",
"## How to apply, and what happens after\n\nThe application is the **Medi-Cal application**: online at **[BenefitsCal](https://benefitscal.com)**, by mail, by phone or in person at the county social services office. To apply only for a Medicare Savings Program, mail form **MC 14A** to the county's Medicare Savings Program contact (rule:apply_where). Medicare.gov says to apply even if unsure (rule:apply_even_if_unsure). An application for Extra Help with Social Security also starts a Medicare Savings Program application unless the person says no (rule:extra_help_link).\n\nThe county verifies income and Medicare status and sends a **Notice of Action**. Once enrolled, the state pays the premium, Extra Help with drug costs starts automatically, and a QMB member shows the QMB or Medi-Cal card so providers do not bill Medicare cost sharing (rule:qmb_benefit). QI must be applied for every year (rule:qi_yearly); the other programs renew with Medi-Cal (rule:renewal).\n\n**Disagree with a decision?** Request a State Hearing within 90 days of receiving the notice. To keep benefits during the hearing, request it before the action takes effect, or within 10 days of the notice when no advance notice is required (rule:fair_hearing_90).",
{
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"## The same facts open other programs\n\nMonthly income, assets and Medicare status are the facts this program runs on. They are the first facts of every program for older adults and people with disabilities.\n\n- **Medicare Part D Extra Help (Low-Income Subsidy) (B014)**: [[california-medicare-extra-help]]. Every Medicare Savings Program member gets Extra Help with drug costs automatically.\n- **Medi-Cal (Medicaid) (B011)**: [[california-medi-cal]]. The application is the Medi-Cal application; many people qualify for both.\n- **SSI + California SSP (B023)**: [[california-ssi-ssp]]. SSI recipients usually have Medi-Cal and the state pays their Medicare premiums.\n- **CalFresh (SNAP) (B001)**: [[california-calfresh]]. The same monthly income and date of birth screen a household for food benefits.\n- **PACE (Program of All-Inclusive Care for the Elderly) (B073)**: [[california-pace]]. Older adults with Medicare and Medi-Cal may also fit an all-inclusive care program.",
{
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"## How this page works\n\nThis page is one JSON object. The page, the Markdown and the machine copy at [/a/california-medicare-savings-programs.json](https://miscsubjects.com/a/california-medicare-savings-programs.json) are three views of it. Its `facts` carry the article's identity and jurisdiction, the procedure with its stages, every rule with its source id and verification status, the fields a screening asks for with their canonical fact names, the ontology edges into the benefits graph, the declared actions, the model's instructions, and the permissions the model has (none). The model's context is served separately at [/a/california-medicare-savings-programs/context](https://miscsubjects.com/a/california-medicare-savings-programs/context): the same object, projected for a model, so there is one source of truth for the reader and the machine.\n\nWhat is saved: a thread per phone number that texts, holding which articles it asked about, how many messages, and the facts it stated, so a person who comes back continues rather than restarts. Every message, in either direction, is a row on this build's Ledger.\n\nFigures carry their status in `facts.rules[].status`. California's 2026 income table and the $130,000 asset limit were read on the DHCS page in a browser on the Mac on 9 October 2026, because DHCS refuses automated fetches. The federal limits and the 2026 Part B premium were fetched from Medicare.gov. The renewal interval for QMB, SLMB and QDWI is not stated on the pages read and is UNKNOWN.",
"## Official addresses\n\n- Apply: [BenefitsCal](https://benefitscal.com) or the county social services office\n- The program in California, the 2026 table and form MC 14A: [DHCS Medicare Savings Programs in California](https://www.dhcs.ca.gov/individuals/medicare-savings-programs-in-california/)\n- The four programs, nationally: [Medicare.gov Medicare Savings Programs](https://www.medicare.gov/basics/costs/help/medicare-savings-programs)\n- Hearings: [Medi-Cal Fair Hearing](https://www.dhcs.ca.gov/services/medi-cal-resources/medi-cal-fair-hearing/); California Department of Social Services, State Hearings Division, P.O. Box 944243, Mail Station 21-37, Sacramento, California 94244-2430\n- Phone: Medi-Cal Helpline (800) 541-5555; hearings (800) 743-8525, TDD (800) 952-8349, fax (833) 281-0905 (rule:contact)"
],
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