California QMB, SLMB, and QI: What Each Program Covers
The Three Main Tiers
California administers three Medicare Savings Program tiers that most families encounter: QMB, SLMB, and QI. A fourth tier — QDWI — exists for disabled working individuals but is rarely used. Each tier pays a different slice of Medicare costs, and the county assigns your parent to the highest tier they qualify for based on income and assets.
Understanding what each tier actually covers prevents two common mistakes: assuming all three programs are the same, and turning down a lower tier because it does not sound like enough.
QMB — Qualified Medicare Beneficiary (Aid Code 80)
QMB is the most comprehensive tier. It pays:
- Part B premium ($202.90/month in 2026) — the state pays this to CMS; SSA stops deducting it from your parent's Social Security check
- Part A premium — if your parent lacks premium-free Part A (fewer than 40 work quarters), the state pays the full premium (up to $565/month) through the Part A buy-in under Senate Bill 311
- Part A deductible ($1,736 per benefit period in 2026) — the hospital inpatient deductible
- Part B deductible ($283/year in 2026) — the annual outpatient deductible
- Part A and Part B coinsurance and copays — the 20% coinsurance on outpatient services, the daily coinsurance for extended hospital stays, skilled nursing facility coinsurance
In practical terms, a QMB beneficiary should pay nothing out of pocket for Medicare-covered services. Providers are legally prohibited from billing QMB patients for any Medicare cost-sharing under 42 U.S.C. § 1396a(n)(2). If a doctor or hospital sends a bill for a Medicare copay or deductible, that bill is illegal and must be disputed.
QMB coverage is prospective: it starts the first day of the month after county approval. There is no retroactive coverage.
2026 income limits: $1,330/month gross (single), $1,804 (couple). Asset limits: $130,000 (single), $195,000 (couple).
SLMB — Specified Low-Income Medicare Beneficiary (Aid Code 8C)
SLMB pays one thing only: the Part B premium. That is $202.90 per month, or $2,434.80 per year returned to your parent's Social Security check.
SLMB does not pay:
- Part A premiums (your parent pays their own if they lack premium-free Part A)
- Part A or Part B deductibles
- Coinsurance or copays on doctor visits, hospital stays, or lab work
SLMB coverage can be retroactive up to three calendar months before the month of application, if your parent met the eligibility criteria during those months. This means up to $608.70 in additional premium refunds for the retroactive period.
2026 income limits: $1,330–$1,596/month gross (single), $1,804–$2,165 (couple). Same asset limits as QMB.
Free Download
Get the California — Medicare Savings Program Eligibility Checklist
Everything in this article as a printable checklist — plus action plans and reference guides you can start using today.
QI — Qualifying Individual (Aid Code 8D)
QI covers the same thing as SLMB: the Part B premium only. The difference is the income range and the funding mechanism.
QI serves applicants whose income is above the SLMB limit but below 135% of the Federal Poverty Level. It is funded through a capped annual federal grant rather than open-ended Medicaid entitlement funding. In practice, California has managed QI allocations to prevent waitlists, so eligible applicants are not turned away.
QI also allows retroactive coverage up to three calendar months before the month of application.
One important rule: QI is mutually exclusive with full-scope Medi-Cal. If your parent receives full-scope Medi-Cal benefits, they cannot be placed in the QI tier. The county can assess them for QMB or SLMB if they meet that tier's eligibility rules.
2026 income limits: $1,596–$1,796/month gross (single), $2,165–$2,436 (couple). Same asset limits.
Extra Help Comes Automatically
All three MSP tiers — QMB, SLMB, and QI — automatically trigger "deemed" eligibility for the federal Part D Low-Income Subsidy, also called Extra Help. No separate SSA application is needed.
Extra Help reduces or eliminates:
- Part D plan premiums (benchmark plans become $0)
- Part D deductible (eliminated)
- Part D copays (capped at a few dollars per prescription)
- The Part D coverage gap (eliminated)
This is a significant additional benefit that families often do not realize comes with MSP enrollment. For a parent taking multiple prescriptions, Extra Help can save hundreds of dollars per month in drug costs on top of the premium savings.
How the County Decides Which Tier
When your parent applies for a Medicare Savings Program, the county evaluates their income and assets against all tiers. They do not need to specify which tier they want — the county assigns the highest tier they qualify for.
The county makes the determination after applying income disregards and issues a Notice of Action confirming the aid code. For a single applicant with only unearned income, countable income up to $1,350 can fall within QMB; above $1,350 through $1,616 within SLMB; and above $1,616 through $1,816 within QI.
If your parent's income changes — a Social Security COLA increase, a pension adjustment, loss of earned income — the county reassesses the tier at the next redetermination or upon notification. Moving from QMB down to SLMB means losing cost-sharing coverage but keeping the premium payment.
Our California Medicare Savings Programs & Extra Help Guide breaks down what each tier covers with a comparison table, the income calculation with disregards, and a checklist for verifying the correct aid code after approval.
Get Your Free California — Medicare Savings Program Eligibility Checklist
Download the California — Medicare Savings Program Eligibility Checklist — a printable guide with checklists, scripts, and action plans you can start using today.