Louisiana QMB vs SLMB vs QI — Which Program Fits

Three Programs, Three Income Bands

Louisiana runs three Medicare Savings Programs through the Department of Health. All three help pay Medicare costs, but they cover different things and serve different income levels. The state eliminated the asset test for all three, so your savings don't matter — only monthly income.

Here's how they break down for 2026:

All limits are after Louisiana applies the $20/month general income disregard. If your gross Social Security is $1,370/month, your countable income is $1,350 — still within QMB range.

QMB: The Fullest Coverage

QMB is the only tier that covers cost-sharing. Beyond paying the $202.90/month Part B premium, QMB absorbs the $283 Part B annual deductible, the $1,736 Part A hospital deductible, and all coinsurance and copays for Medicare-covered services.

QMB also carries federal balance billing protection under Social Security Act § 1902(n)(3)(B) (42 U.S.C. § 1396a(n)(3)(B)). Providers cannot bill QMB enrollees for any amount Medicare doesn't pay — even if Louisiana Medicaid reimburses $0 on the claim. This protection applies whether you're in Original Medicare or a Medicare Advantage plan.

One limitation: QMB coverage is not retroactive. It starts the first of the month after LDH approves your application.

SLMB: Part B Premium Relief

SLMB covers a single benefit — the Part B premium. That's $202.90/month, or $2,434.80/year, returned to your budget. You remain responsible for all deductibles and coinsurance.

Unlike QMB, SLMB can be retroactive up to three months before your application date if you met the income requirements during those months. That means LDH can direct SSA to refund up to three months of Part B premiums deducted before you applied.

SLMB does not carry balance billing protection. Providers can still bill you for Medicare cost-sharing amounts.

QI: Same Benefit, Different Funding

QI covers the same thing as SLMB — the Part B premium — and has the same retroactivity rules. The practical difference is how it's funded: QI runs on a capped annual federal block grant, which means enrollment is technically first-come, first-served if the allocation runs out.

In practice, QI funding has been reauthorized every year, and Louisiana has not reported turning eligible applicants away due to funding gaps. But QI does require annual reapplication, unlike QMB and SLMB where renewals are initiated by LDH.

QI also has a unique rule: you cannot receive QI benefits if you're already receiving full Medicaid coverage. If your income drops and you qualify for full Medicaid, QI stops and your Medicaid coverage takes over the premium payment.

All Three Trigger Extra Help

Regardless of which program you qualify for, enrollment automatically deems you eligible for Extra Help (the Part D Low-Income Subsidy). LDH reports your MSP status to CMS monthly, and CMS grants Extra Help without requiring a separate application through Social Security.

This is significant because SSA's own Extra Help application enforces a federal resource test. In 2026, the countable-resource limit is $16,590 for an individual or $33,100 for a married couple, plus an exclusion of up to $1,500 per person for burial expenses when applicable. Going through LDH sidesteps that test entirely, since Louisiana waives resources for all MSP tiers.

How to Determine Which Program You Qualify For

Start with your gross monthly income — the amount on your Social Security award letter or 1099, not your net deposit. Subtract $20 for the general income disregard. If you have earned income, subtract $65 plus half the remainder.

Compare the result to the table above. LDH will place you in the highest tier you qualify for — someone at $1,340/month countable income gets QMB, not SLMB.

If you're close to a threshold, small changes matter. A Social Security COLA in January can push you from QMB into SLMB territory, though Louisiana disregards the COLA amount until the new FPL guidelines publish (usually March). During that window, the old limits apply.

The Louisiana Medicare Savings Programs & Extra Help Guide includes a worksheet that walks through the income calculation for all three tiers, including earned income scenarios and spousal deeming rules.

See more Louisiana guides →