North Dakota Social Security COLA and Medicare Premium: What Changes for MSP Recipients
The Annual COLA Problem
Every January, Social Security checks get a Cost-of-Living Adjustment. And every January, families on the edge of North Dakota's Medicare Savings Program income limits hold their breath.
The 2026 Part B premium is $202.90 per month. The published 2026 gross income limits for a single applicant are $1,350 monthly for QMB, $1,616 for SLMB, and $1,816 for QI. ND HHS subtracts the $20 general unearned-income disregard before comparing countable income; the corresponding countable limits are $1,330, $1,596, and $1,796.
North Dakota has a safeguard for this. Under ND HHS policy manual section 510-05-85-40, the state disregards the January Social Security COLA for QMB, SLMB, and QI eligibility determinations during January, February, and March. Updated Federal Poverty Guidelines take effect on April 1.
Why the Disregard Matters
Federal poverty guidelines are published in late January and typically take effect for Medicaid and MSP purposes on April 1. The COLA takes effect January 1. Without the disregard, there would be a three-month window where a person's income went up but the qualifying thresholds hadn't caught up yet — and the state would have to terminate coverage.
The disregard bridges that gap. During January through March, ND HHS evaluates MSP eligibility without counting the January Social Security COLA increase.
This applies to QMB, SLMB, and QI recipients.
The Premium Deduction Lag After Approval
A separate timing issue catches families off guard after initial MSP approval. Once ND Health and Human Services approves your parent for any MSP tier (QMB, SLMB, or QI), SSA may continue deducting the $202.90 Part B premium while the state buy-in is processed.
The reason is bureaucratic plumbing: ND HHS transmits a buy-in code to CMS, which updates the state buy-in files, which SSA's payroll system eventually reads. Three agencies, three data systems, each processing on its own cycle.
During this lag:
- Your parent is approved and eligible for MSP benefits
- Medicare providers should not be billing QMB cost-sharing
- But the Part B premium keeps coming out of the Social Security check
SSA refunds Part B premiums deducted after the MSP effective date once the state buy-in is processed.
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What to Do Each January
Check your parent's countable monthly income against the current MSP income limits after applying the $20 general income disregard and any January-through-March COLA disregard.
If the COLA appears to push them over the limit, do not assume coverage has ended. The January COLA disregard applies to QMB, SLMB, and QI through March; the updated income limits take effect April 1.
If you receive an adverse notice, you may request a fair hearing in writing or verbally within 30 calendar days from the date printed on the notice. To keep benefits in place while the hearing is pending, submit the request on or before the adverse action's effective date. Form SFN 162 is the Request for Hearing form.
The North Dakota Medicare Savings Programs & Extra Help Guide includes an income worksheet that walks through the gross-to-countable calculation with the $20 disregard, along with a renewal calendar so you're never surprised by a redetermination notice.
Get Your Free North Dakota — Medicare Savings Program Eligibility Checklist
Download the North Dakota — Medicare Savings Program Eligibility Checklist — a printable guide with checklists, scripts, and action plans you can start using today.