Pennsylvania Medicare Savings Program Income Limits 2026

2026 QMB, SLMB, and QI Income Limits in Pennsylvania

Pennsylvania runs its Medicare Savings Programs under the name Healthy Horizons, administered by the Department of Human Services through 67 County Assistance Offices. Three tiers cover different income ranges, each paying some or all of your Medicare costs:

All three tiers share the same resource limits: $9,950 for a single person and $14,910 for a couple.

The $20 Disregard That Changes Everything

The income figures above are what Pennsylvania counts after applying a mandatory $20 monthly unearned income disregard under 55 Pa. Code § 140.281. The County Assistance Office subtracts $20 from your gross unearned income — Social Security, pensions, VA benefits — before comparing it to the limit.

In practice, a single person receiving a gross Social Security check of $1,370 has countable income of $1,350, which still qualifies for QMB. Many families assume they're over the line when they're actually under it because published federal poverty tables don't include the disregard.

What Counts as Income — and What Doesn't

Counted: Social Security retirement or disability benefits, private pensions, annuities, VA pensions, rental income.

Earned income gets extra protection. After the $20 general disregard, Pennsylvania excludes the first $65 of gross earnings plus half of what remains. A part-time worker earning $400 per month in wages would have only $157.50 counted.

When you live with a spouse who isn't applying, spousal deeming rules under 55 Pa. Code § 140.282 apply — the CAO calculates their gross income, subtracts a standard living allowance, and adds the remainder to yours.

Resource Limits and Exempt Assets

The $9,950/$14,910 resource limit sounds tight, but Pennsylvania excludes more than you might expect:

• Your home — exempt regardless of equity value, as long as you or your spouse live there
• One vehicle — any value, if used for transportation
• Household goods and personal effects — furniture, clothing, appliances
• Burial spaces — gravesites, vaults, caskets for you, your spouse, and immediate family
• Irrevocable prepaid funeral contracts
• Term life insurance — policies with no cash surrender value (whole-life exempt only if total face value across all policies stays under $1,500 per person)

What counts: cash, checking and savings accounts, CDs, stocks, bonds, non-exempt life insurance, and real estate beyond your primary residence.

The January COLA Gap

Every January, Social Security's cost-of-living adjustment bumps gross income before the federal government updates poverty guidelines — usually not until late February or March. Pennsylvania bridges this gap with an interim COLA disregard: during January and February, the CAO ignores the new COLA increase and holds your countable income at last year's level until the new poverty tables take effect.

This prevents the nightmare scenario where a $50 COLA increase temporarily pushes you over the QMB line and triggers a coverage gap.

How QI Differs from QMB and SLMB

QMB and SLMB are entitlements — if you qualify, you're in. QI works differently. It runs on a capped federal block grant, and Pennsylvania allocates slots on a first-come, first-served basis after re-enrolling the prior year's recipients. You also can't be on QI if you receive full Medical Assistance.

The practical difference is timing. Apply early in the year if you fall in the QI income range.

Next Steps

If these numbers suggest your parent might qualify, the Pennsylvania Medicare Savings Programs, Extra Help & PACE/PACENET Guide walks through the full application from start to finish — which form to file, what documents to bring, and what happens to the Part B premium once approved. It includes a net income calculation worksheet so you can confirm eligibility before contacting the County Assistance Office.

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