The Pennsylvania Medicare Savings Program pays your Medicare Part B premium — $202.90 a month in 2026 — and at the top level pays your deductibles and copays too. It is run by Pennsylvania Medicaid, not by Medicare, and roughly one in three people who qualify never apply. This Pennsylvania medicare savings program guide gives the 2026 limits as Pennsylvania applies them, the asset rule, how it triggers Part D Extra Help, and where to apply.
Limits below are from the National Council on Aging’s 2026 table built on the federal poverty guidelines, checked against Pennsylvania’s own rules; they reset each spring when the new guidelines take effect.
In This Pennsylvania Medicare Savings Program Guide:
Pennsylvania Medicare Savings Program at a Glance (2026)
| 2026 income limits (single) | Federal (QMB $1,350 / SLMB $1,616 / QI $1,816 single; $1,824 / $2,184 / $2,455 couple) |
| 2026 asset test | Federal ($9,950 single / $14,910 couple) |
| What Pennsylvania calls the levels | Pennsylvania uses the familiar federal names — Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB) and Qualifying Individual (QI) — but runs them inside its Medical Assistance program under the Healthy Horizons banner. |
| Part B premium it can pay | $202.90 per month in 2026 |
| State prescription program | Yes. |
| Where to apply | The application goes to the Pennsylvania Department of Human Services (DHS), not to Medicare or Social Security. |
The Three Levels of the Pennsylvania Medicare Savings Program
- QMB (Qualified Medicare Beneficiary): pays the Part A and Part B premiums and the deductibles, coinsurance and copays. Providers who take Medicare may not bill a QMB enrollee for Medicare cost-sharing at all.
- SLMB (Specified Low-Income Medicare Beneficiary): pays the Part B premium only.
- QI (Qualifying Individual): also pays the Part B premium only, with a slightly higher income limit; funding is capped and first-come, first-served each year.
Pennsylvania labels: Pennsylvania uses the familiar federal names — Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB) and Qualifying Individual (QI) — but runs them inside its Medical Assistance program under the Healthy Horizons banner.. Whatever the name, one application covers all three; the office places you at the highest level you qualify for.
Pennsylvania Medicare Savings Program Income and Asset Limits
The federal floors for a single person in 2026 are $1,350 a month for QMB, $1,616 for SLMB and $1,816 for QI, each including a $20 disregard. Pennsylvania’s figures: Federal (QMB $1,350 / SLMB $1,616 / QI $1,816 single; $1,824 / $2,184 / $2,455 couple).
Assets: Federal ($9,950 single / $14,910 couple). The home, one vehicle, household goods and burial funds up to $1,500 do not count.
Pennsylvania counts income the way Social Security counts it for SSI-related Medicaid, so the county looks mainly at your monthly Social Security benefit, any pension or annuity, wages, and interest or dividends. Certain amounts are set aside before the county compares your figure to the limit, including a general disregard and a further disregard applied to money you earn from working.
If you are married and living with your spouse, that spouse’s income and resources are generally counted alongside yours, even when the spouse is not applying and is not on Medicare.
Pennsylvania does treat the three levels differently, and this catches families by surprise. Under the Healthy Horizons QMB Medicare Cost-Sharing Program there is no retroactive coverage at all — help with premiums and cost-sharing starts going forward once the county approves you, so applying sooner genuinely matters.
For SLMB and QI, the state does allow eligibility to reach back and cover Part B premiums for prior months in which you would have qualified. The exact number of months allowed is UNVERIFIED here and comes from the verified data file.
The QMB Billing Protection Most People Never Use
Federal law forbids any provider who accepts Medicare from billing a QMB enrollee for Medicare deductibles, coinsurance or copays. If a bill arrives, the enrollee does not owe it. Show the QMB card, cite the rule, and if it continues report it to 1-800-MEDICARE or the Pennsylvania SHIP. This one protection is worth more than the premium for anyone with regular hospital or specialist care.
Pennsylvania Medicare Savings Program and Part D Extra Help
Once the county assistance office approves you for QMB, SLMB or QI, Pennsylvania reports that enrollment to the federal government, and you are automatically treated as eligible for the Medicare Part D Low-Income Subsidy, better known as Extra Help. You do not file a second application with Social Security for it; the drug-cost help follows the MSP approval on its own.
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The reverse also happens — if you apply to Social Security for Extra Help first, Social Security can forward your information to Pennsylvania to start an MSP application unless you decline that referral.
Pennsylvania Prescription Help Beyond Medicare
Yes. — Pennsylvania runs its own drug-cost program for seniors alongside Extra Help. Ask The application goes to the Pennsylvania Department of Human Services (DHS), not to Medicare or Social Security. or the SHIP whether you qualify for both.
How to Apply for the Pennsylvania Medicare Savings Program
Where: The application goes to the Pennsylvania Department of Human Services (DHS), not to Medicare or Social Security. — application. Free help: Pennsylvania’s State Health Insurance Assistance Program is called PA MEDI, short for Pennsylvania Medicare Education and Decision Insight; longtime residents may still know it by its former name, APPRISE..
Bring the Medicare card, proof of all income, and — in states with an asset test — bank statements. A decision usually takes a few weeks; the Part B premium refund appears as a larger Social Security deposit once the change reaches Social Security.
Who Typically Qualifies for the Pennsylvania Medicare Savings Program
A widow living on one Social Security check. A retired couple whose combined income is modest once one pension stopped. A person under 65 on Medicare through disability. Anyone who receives Supplemental Security Income already qualifies at the top level. Homeowners qualify as easily as renters, because the home is never counted, and in the states without an asset test savings are not counted either.
The Pennsylvania Medicare Savings Program Calendar
New federal poverty guidelines are published in January or February; states adopt the new Pennsylvania medicare savings program limits in the weeks after, usually by March or April. A person who was just over the limit in December may be under it in April without their income changing. The Part B premium itself changes each January, so the value of the program rises with it. QI funding is allocated by calendar year and can run out; apply early rather than late.
If the Pennsylvania Medicare Savings Program Application Is Denied
The denial notice states the reason and the deadline to ask for a hearing. The three fixable reasons are missing proof of income, income counted that should have been excluded, and — in asset-test states — a burial fund or life insurance that should not have been counted. Fix the reason and reapply; nothing prevents a second application. The state SHIP will review a denial for free.
The Pennsylvania Medicare Savings Program Versus Full Medicaid
The program pays Medicare costs; it does not make you a Medicaid patient. You keep your doctors, your Medicare card and your plan. Full Medicaid, with its lower income limit, adds coverage Medicare does not have — long-term care above all. Many people qualify for the Pennsylvania medicare savings program first and for full Medicaid only later, when care needs and costs rise. The two applications go to the same office.
What to Do Next
If you qualify for a Pennsylvania medicare savings program, apply before you shop for plans: the premium help changes which Medigap or Advantage plan makes sense. Your SHIP counselor can do both in one visit.
Official Sources
- Pennsylvania Medicare Savings Programs: https://www.pa.gov/agencies/dhs/resources/aging-physical-disabilities/medicaid-older-people-and-people-with-disabilities is the best single Department of Human Services page describing Medical Assistance help with Medicare premiums, deductibles and coinsurance for older adults and people with disabilities under Healthy Horizons. Two companion pages are worth bookmarking beside it: https://www.pa.gov/agencies/dhs/programs-services/apply-for-benefits for the application itself, and https://www.pa.gov/agencies/dhs/contact/cao-information to find the county assistance office that will handle your case and answer questions about it.
- The application goes to the Pennsylvania Department of Human Services (DHS), not to Medicare or Social Security.
- Medicaid.gov spousal impoverishment standards: medicaid.gov
- Medicare.gov Medicare Savings Programs: medicare.gov
This Pennsylvania medicare savings program guide was checked against the state Medicaid agency, CMS and the statute cited above in September 2026. Figures reset on their own calendars (most on January 1); if a number here disagrees with a notice you received, the notice wins — and please tell us. This page is general information, not legal, financial or medical advice.