Alabama Medicare Savings Program for Couples

Married couples face a specific set of income-counting rules for Alabama's Medicare Savings Programs that single applicants do not. The couple limits are higher than the individual limits, but the calculation is not as simple as adding two Social Security checks together — especially when only one spouse has Medicare.

2026 Couple Income Limits

QMB: up to $1,824 per month combined SLMB: up to $2,184 per month combined QI: up to $2,455 per month combined

These limits already include the standard $20 monthly income disregard. No additional reduction is needed.

Alabama applies no asset test for couples applying for Medicare Savings Programs. Joint bank accounts, retirement funds, home equity, and vehicles are not counted. Only combined monthly income is evaluated.

Both Spouses on Medicare

When both spouses are on Medicare and living together, the calculation is straightforward: add both spouses' gross monthly income, and test the total against the couple limit.

A couple where one spouse receives $1,100 per month in gross Social Security and the other receives $700 per month has a combined gross income of $1,800. After the $20 general disregard, countable income is $1,780. That falls below the QMB couple limit of $1,824, so both spouses qualify for QMB.

Each spouse files a Form 210. Both receive QMB benefits: Part B premium paid, all Medicare cost-sharing eliminated, and automatic Extra Help for Part D prescriptions.

Only One Spouse on Medicare

This is where the rules get more nuanced. When only one spouse has Medicare and applies for MSP, Alabama Medicaid performs two income tests:

Individual test: The applying spouse's individual countable income cannot exceed the individual limit ($1,350 for QMB, $1,616 for SLMB, $1,816 for QI).

Couple test: The combined countable income of both spouses, after applying spousal deeming allocation rules, cannot exceed the couple limit ($1,824 for QMB, $2,184 for SLMB, $2,455 for QI).

Both tests must be satisfied. If the applying spouse's individual income exceeds the individual limit, they do not qualify even if the couple's combined income falls below the couple threshold.

Consider a household where the husband (age 66, on Medicare) receives $1,700 per month in Social Security and the wife (age 62, not on Medicare) receives $400 per month from a private pension. The husband's individual countable income ($1,700 minus $20 disregard = $1,680) exceeds the QMB individual limit ($1,350). The couple's combined income ($2,100 minus $20 = $2,080) falls below the SLMB couple limit ($2,184). The husband qualifies for SLMB — not QMB — and Alabama Medicaid pays his $202.90 Part B premium.

Parent Living with an Adult Child

This comes up frequently when adult children assume their own income affects a parent's MSP eligibility. It does not. When an elderly parent resides with an adult child, the child's income is never deemed to the parent. The parent is evaluated as a single household (or couple, if living with a spouse). Room and board contributions from the child are not counted unless provided as direct cash gifts.

A parent living with a working adult child and receiving $1,200 per month in Social Security qualifies on their own merits. The child's $80,000 salary is invisible to the MSP eligibility determination.

What to File

Both spouses on Medicare each file a separate Form 210. When only one spouse has Medicare, only that spouse files. The non-Medicare spouse's income is included in the couple calculation but they do not receive MSP benefits themselves.

The Alabama Medicare Savings Programs & Extra Help Guide includes worked examples for each household scenario and an eligibility worksheet that handles the dual individual-and-couple income test.

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