Medicare Savings Programs in Michigan (2026): QMB, SLMB and ALMB

Every month, a parent on Medicare pays a Part B premium. In 2026 the standard Part B premium is $202.90 a month, according to CMS. Most families never question it, because it looks like a fixed cost of being on Medicare.

For a lot of seniors in Troy and across Michigan, it is not fixed. Michigan Medicaid runs a set of programs whose whole job is to pay that premium, and in one case a great deal more than the premium. They are called the Medicare Savings Programs. They are not full Medicaid, and their asset limit is several times higher than the one most people have heard of.

Four categories, one manual

Michigan's core rules for these programs are in one item of the state's Bridges Eligibility Manual, BEM 165. It names the categories:

• QMB, Qualified Medicare Beneficiaries. The manual also calls it full-coverage QMB.
• SLMB, Specified Low-Income Medicare Beneficiaries, also called limited-coverage QMB.
• ALMB, Additional Low-Income Medicare Beneficiaries, which the manual says is also referred to as Q1. The same item's income table labels it ALMB (QI), and Social Security's own manual calls the same group Qualified Individuals.
• NMB, a fourth category for people who already have full-coverage Medicaid and Medicare Part A or B, but whose income and assets are above the ALMB limits.

The manual is blunt about what sorts people into them: "Income is the major determiner of category."

What each one pays

This is the part worth reading slowly, because the four do not pay the same things.

QMB pays Medicare premiums, Medicare coinsurances and Medicare deductibles. That includes the Part A premium for what the manual calls "those few people that have them". For scale, CMS puts the 2026 Part B deductible at $283 and the Part A inpatient hospital deductible at $1,736.

SLMB pays the Medicare Part B premium.

ALMB pays the Medicare Part B premium "provided funding is available." That qualifier is in the rule itself. ALMB also runs on slightly different rules, which we will get to.

NMB pays the Part B premium, and the Part A premium for the few who have one, for full-coverage Medicaid members who are not otherwise eligible for a Medicare Savings Program.

So for SLMB and ALMB the benefit is the premium itself: $202.90 a month in 2026, with that funding condition on ALMB. For QMB it is the premium plus the cost sharing that tends to arrive at the worst possible moment, a hospital stay or a long run of outpatient care.

One more rule that surprises people: you do not get to pick. BEM 165 says a person eligible for one category cannot choose a different one. Someone eligible for QMB cannot choose SLMB instead, even to get coverage started sooner.

The income test

Michigan sets the limits as a share of the federal poverty level, and the test is on net income:

• QMB: net income cannot exceed 100% of poverty.
• SLMB: over 100% of poverty, but not over 120%.
• ALMB: over 120% of poverty, but not over 135%.

The state publishes the dollar amounts in its Reference Tables Manual, in RFT 242. Each limit there is the poverty percentage plus a $20 disregard for Social Security income, so the dollar line sits a little above the poverty level itself.

We are deliberately not printing the dollar limits in this article. When we read RFT 242 in October 2026, the newest column in the published table was still the one effective April 1, 2025. Both columns in that table take effect on April 1, so a figure copied into an article ages quickly. Read the current table, or let the caseworker run the numbers, rather than trusting a figure from any article, including this one.

Net income is not the same as the gross amount on a Social Security statement. It is countable income after the deductions in Michigan's SSI-related Medicaid rules, which is one more reason a family should not rule a parent out from a bank statement.

There is also a rule for the start of each year worth knowing. BEM 165 says federal law requires that for January, February and March, the Social Security cost-of-living increase received starting in January is disregarded, and the income limits for the preceding December are used. The January raise does not count against a parent for the first three months of the year.

The asset limit is higher than families expect

This is where families most often rule themselves out without checking.

Most people have heard that Medicaid requires a person to have almost nothing, and for some SSI-related Medicaid categories in Michigan the limit really is $2,000 for one person and $3,000 for a couple. BEM 400, the state's asset manual, says so.

The Medicare Savings Programs are not those categories. BEM 400 sets their asset limit, which they share with certain other categories, effective January 1, 2026, at $9,950 for an asset group of one and $14,910 for an asset group of two.

And not everything a parent owns counts toward it. Under Michigan's SSI-related Medicaid rules, the homestead the person lives in is excluded, one homestead per asset group, and so is one motorized vehicle. The rest of the asset rules run through BEM 400, 401 and 402, and the details matter enough that a determination beats a guess.

When coverage starts

The three main programs start differently, and the difference can be worth real money.

QMB begins the calendar month after the processing month, which is the month the eligibility decision is made. The manual is explicit: QMB is not available for past months or for the processing month. For QMB, every month of delay in applying is a month of premiums and cost sharing nobody gets back.

SLMB is available for retroactive Medicaid months and later months.

ALMB is also available for retroactive months, but never for any time in a previous calendar year. The manual's own example: an application made December 27, 2015 and decided January 3, 2016 cannot be approved for anything before January 1, 2016. ALMB also has to be redetermined before the end of every calendar year. An application filed late in the year can lose its earlier months if the decision lands in January.

The benefit inside the benefit: Extra Help

Social Security's operations manual says that people with Medicare who are covered under a Medicare Savings Program, as a QMB, SLMB or QI, are automatically deemed eligible for Extra Help, the federal program that subsidizes Part D prescription drug premiums, deductibles and copayments. They should not file a separate Extra Help application. CMS makes that determination from the monthly data state Medicaid agencies send it.

The connection runs the other way too. Since January 1, 2010, unless the person declines, the information from an Extra Help application filed with Social Security is sent to the state to start the Medicare Savings Program application process.

For a parent on a fixed income with several prescriptions, that second program can matter as much as the first.

Some people already qualify without asking

BEM 165 lists Medicaid categories whose members are considered QMB eligible without a separate determination, provided they are entitled to Medicare Part A. People receiving SSI are on that list.

The manual also directs the department to complete an MSP determination for anyone entitled to Part A who is on Medicaid in the categories it lists, and says that person does not have to request it or reapply.

Even so, it is worth confirming that the Part B premium has actually stopped being charged.

How to apply

A family does not need a separate Medicare Savings Program application. BEM 165 says a Health Care Coverage application is used for an MSP-only determination.

A parent can also ask ahead of time. The manual says a person may contact the department before enrolling in Medicare to learn whether Medicaid will pay the premiums, even before turning 65, for example during the three months before the 65th birthday. In that case the department uses current information, does not ask for verification, and explains that changes may affect the actual determination.

A few eligibility details are worth having in hand before that conversation:

• The person has to be entitled to Medicare Part A. For SLMB and ALMB, that means receiving premium-free Part A.
• QMB and SLMB can be held alongside full Medicaid under another category. ALMB is not available to someone eligible for and receiving Medicaid under another category, though the manual carves out people in an active Medicaid deductible.
• BEM 165 says Michigan's divestment policy, BEM 405, applies to these programs because there could be a Medicare coinsurance or deductible for long-term care or home and community-based services. Ask the caseworker before moving money around to get under the limit.

If you are also sorting out which kind of Medicare coverage makes sense, we have written separately about Original Medicare and Medicare Advantage in Michigan.

The short version

Michigan's Medicare Savings Programs pay Medicare costs for people with limited income. QMB pays premiums, deductibles and coinsurance. SLMB and ALMB pay the Part B premium, which is $202.90 a month in 2026, ALMB provided funding is available. The income limits run up to 135% of the poverty level plus a $20 disregard, and the 2026 asset limit is $9,950 for one person or $14,910 for a couple, with the home and one vehicle not counted.

QMB starts the month after the decision, with no retroactive months, so the clock matters. Enrollment in any of the three also brings Extra Help with prescription drugs, without a separate application.

If your parent is still paying the Part B premium and their savings sit under those limits, the Health Care Coverage application is the place to start. Because QMB never pays for months before the decision, sooner is worth more than later.