SLMB Medicaid pays your Medicare premiums, not your medical bills
SLMB stands for Specified Low-Income Medicare Beneficiary. It is a Medicaid program that pays three Medicare costs for people who have Medicare but cannot afford the premiums: the Part B premium, the Part D premium, and sometimes the Part A premium. SLMB does not pay for doctor visits, hospital stays, prescriptions, or any other medical services. It only covers what you owe to Medicare itself.
You must already have Medicare to use SLMB. The program exists because Medicare premiums can cost hundreds of dollars per month, and for people living on very little income, that cost alone can force them to drop coverage. SLMB lets you keep Medicare active by having Medicaid cover the premium bills.
SLMB is run by your state Medicaid office, not by Medicare or the federal government. The income and asset limits, the application process, and the speed of approval all vary by state. Some states process SLMB applications in weeks; others take months.
Key Takeaways
- SLMB covers only Medicare premiums (Part B, Part D, and sometimes Part A), not medical services, prescriptions, or hospital costs.
- You must have Medicare already and meet your state's income limit, which is usually around 120 to 135 percent of the federal poverty line.
- Your state Medicaid office handles SLMB, so application methods and approval timelines differ by location.
- Once approved, Medicaid pays Medicare directly, so you do not receive money or pay a bill yourself.
- SLMB does not cover any services that regular Medicaid covers; it is a premium-payment program only.
What SLMB actually pays
SLMB pays the Medicare Part B premium, which is the monthly charge for doctor and outpatient services. In 2024, this premium ranges from around $164 to $560 per month depending on your income, but SLMB covers whatever amount you owe.
SLMB also pays the Medicare Part D premium, which is the monthly cost of prescription drug coverage. Part D premiums vary by plan and by state, typically ranging from $5 to $100 or more per month. SLMB covers your plan's premium.
For people with Medicare Part A (hospital insurance), SLMB may cover the premium if you do not have Part A for free. Most people over 65 get Part A free, but some do not, and SLMB can cover that cost if you meet the income limit.
SLMB does not pay for any medical services, copayments, coinsurance, deductibles, or anything else. It is strictly a premium-payment program. If you need help with copays or deductibles, you may be able to use a different Medicaid program, such as QMB (may have access to Medicare Beneficiary) or QDWI (may have access to Disabled and Working Individual), but those are separate programs with their own income limits and rules.
Income and asset limits by state
SLMB income limits are set by federal law at approximately 120 to 135 percent of the federal poverty line, but your state can set its own limit within that range. For 2024, the federal poverty line for a single person is $14,580, so SLMB income limits typically fall between $17,500 and $19,680 per year for one person. For a couple, the limit is higher.
Your state may count income differently. Some states count only your own income; others count a spouse's income even if you file taxes separately. Some states count Social Security; others do not. Some count pensions or retirement account withdrawals; others do not. You cannot know your state's exact rule without contacting your state Medicaid office.
Asset limits also vary. Some states have no asset limit for SLMB; others limit you to $7,500 or $10,000 in countable resources. Your home and car usually do not count. Again, your state Medicaid office can tell you the exact rule.
Because limits vary so much, the only way to know whether you meet your state's SLMB income and asset rules is to contact your state Medicaid office directly or use your state's online income calculator if one exists.
How to apply for SLMB in your state
You apply through your state Medicaid office, not through Medicare or the federal government. Your state may let you apply online, by mail, by phone, or in person. Some states have a single application for all Medicaid programs; others have a separate SLMB form.
To apply, you will need proof of your Medicare coverage (your Medicare card), proof of income (recent pay stubs, tax return, or Social Security statement), and proof of citizenship or immigration status. Some states also ask for proof of assets.
The application process and approval timeline differ by state. Some states approve SLMB in two to four weeks; others take two to three months. A few states have a backlog and take longer. If you are approved, Medicaid will contact Medicare directly to start paying your premiums. You do not have to do anything after approval; the payment happens automatically.
To find your state Medicaid office, search "[your state] Medicaid" or call 1-800-MEDICARE and ask for your state Medicaid contact information.
SLMB versus other Medicare savings programs
Three other Medicaid programs help people with Medicare pay costs, and they have different income limits and coverage:
| Program | What it covers | Income limit (approximate) |
|---|---|---|
| QMB (may have access to Medicare Beneficiary) | Premiums, copays, coinsurance, and deductibles | 100% of federal poverty line |
| SLMB (Specified Low-Income Medicare Beneficiary) | Part B and Part D premiums only | 120–135% of federal poverty line |
| QI (may have access to Individual) | Part B premium only | 135–175% of federal poverty line |
| QDWI (may have access to Disabled and Working Individual) | Part A premium only | 200% of federal poverty line (for working disabled people) |
QMB has the lowest income limit but covers the most: premiums and cost-sharing. SLMB has a higher income limit but covers only premiums. QI covers only the Part B premium and has the highest income limit of the three main programs. If your income is too high for SLMB, you may still be able to use QI.
You can only be enrolled in one of these programs at a time. If you are approved for QMB, you cannot also use SLMB. Your state will place you in the program you are most likely to meet the rules for.
What happens after you are approved
Once your state approves you for SLMB, Medicaid notifies Medicare and your insurance companies. Medicare stops billing you for the Part B premium; Medicaid pays it instead. Your Part D plan stops billing you for the premium; Medicaid pays it instead.
You will receive a notice from your state Medicaid office confirming your approval and the date coverage starts. Keep this notice. If you move to a different state, you will need to reapply in your new state because SLMB is a state program.
You must report changes in your income, household size, or address to your state Medicaid office. If your income rises above your state's SLMB limit, you will lose coverage. If you gain other insurance or lose Medicare, you must report that too.
Frequently Asked Questions
Does SLMB cover prescriptions?
SLMB covers the Part D premium (the monthly cost of prescription drug coverage), but it does not cover the cost of the prescriptions themselves. You still pay copays or coinsurance when you fill a prescription. If you need help with prescription costs, ask your doctor about patient assistance programs or generic alternatives.
Can I use SLMB if I do not have Medicare Part D?
SLMB can pay the Part D premium if you enroll in a Part D plan, but you are not required to have Part D. If you do not want prescription coverage, you do not need SLMB to cover it. SLMB will still cover your Part B premium if you meet the income limit.
What if my income goes up after I am approved?
You must report income changes to your state Medicaid office. If your income rises above your state's SLMB limit, your coverage will end. The exact date depends on your state, but usually coverage ends at the end of the month in which you report the change or the month after.
Do I have to reapply for SLMB every year?
Most states require annual renewal of SLMB, though some have moved to longer renewal periods. Your state Medicaid office will send you a renewal form or notice. If you do not respond, your coverage may end. Check your mail regularly for renewal notices.
Can I have SLMB and regular Medicaid at the same time?
Yes. SLMB is a Medicare-focused program that only pays premiums. Regular Medicaid covers medical services, hospital stays, and other costs. You can have both, and in fact, many people do. Having both gives you more complete coverage.