West Virginia residents on Medicare have access to four assistance programs that can reduce or eliminate out-of-pocket costs for premiums, deductibles, and prescription drugs. These are the Medicare Savings Programs (QMB, SLMB, and QI) plus Extra Help for Part D drug costs. Qualifying depends on your monthly income and, in most cases, the value of your countable assets. This guide covers the 2026 income limits for each program, what each one covers, and how to apply in West Virginia.
2026 Medicare Savings Program Income Limits in West Virginia
West Virginia uses the standard federal income thresholds for Medicare Savings Programs. Income is measured against the Federal Poverty Level (FPL), which is updated each year. The 2026 FPL for a single person is $15,960 per year ($1,330 per month), and $21,540 per year ($1,795 per month) for a two-person household.
The key rule on income: not everything counts. The first $20 of most monthly income and the first $65 of earned income are excluded before the calculation is made. That means your gross income can exceed the limit below and you may still qualify.
| Program | Individual Monthly Limit | Couple Monthly Limit | FPL % | What It Covers |
|---|
| QMB (Qualified Medicare Beneficiary) | $1,350 | $1,824 | 100% FPL | Part A and B premiums, deductibles, copays, coinsurance |
| SLMB (Specified Low-Income Medicare Beneficiary) | $1,616 | $2,184 | 120% FPL | Part B premium only |
| QI (Qualifying Individual) | $1,816 | $2,455 | 135% FPL | Part B premium only |
| Extra Help (Part D) | $1,995 | $2,705 | 150% FPL | Prescription drug costs under Part D |
Note: These are 2026 figures based on the current FPL. Limits are typically updated each spring when CMS publishes the annual MSP standards.
2026 Asset Limits for Medicare Savings Programs in West Virginia
West Virginia has not eliminated the asset test for Medicare Savings Programs. Countable assets include checking and savings accounts, stocks, bonds, and most retirement accounts. They do not include your primary home, one vehicle, personal belongings, or irrevocable burial trusts.
| Program | Individual Asset Limit | Couple Asset Limit |
|---|
| QMB | $9,660 | $14,470 |
| SLMB | $9,660 | $14,470 |
| QI | $9,950 | $14,910 |
| Extra Help (Part D) | $17,220 | $34,360 |
The Extra Help asset limits are higher because the program is administered by the Social Security Administration (SSA) rather than the state. Extra Help also allows you to exclude up to $1,500 per person for burial expenses from your countable resources.
Program Details: What Each Program Covers
QMB: The Most Comprehensive Program
QMB is the broadest of the three Medicare Savings Programs. If you qualify, Medicaid pays your Medicare Part B premium ($185 per month in 2026 for most enrollees), your Part A premium if you owe one, and your cost-sharing for all Medicare-covered services. That includes hospital deductibles, skilled nursing facility coinsurance, and the 20% coinsurance you normally pay under Part B.
Providers are prohibited by law from billing QMB enrollees for Medicare cost-sharing. If a provider tries to bill you after you show your QMB status, you can report it to 1-800-MEDICARE.
QMB enrollment also automatically qualifies you for Full Extra Help with Part D drug costs.
SLMB: Part B Premium Relief
SLMB pays your Part B premium only. At $185 per month in 2026, that is $2,220 per year returned to your Social Security check or billed directly to the state if you pay out of pocket. SLMB does not cover deductibles or coinsurance.
SLMB enrollment also qualifies you for Full Extra Help automatically.
QI: For Those Slightly Above SLMB
The Qualifying Individual (QI) program covers the same benefit as SLMB: the Part B premium. The income limit is slightly higher, at 135% FPL. One important difference: QI is funded by a federal block grant, and enrollment is first-come, first-served each year. If funding runs out before the calendar year ends, new applicants may be waitlisted. Apply early in the year if you are near this income range.
QI enrollment also triggers automatic Extra Help for Part D.
Extra Help (Low-Income Subsidy)
Extra Help reduces what you pay for prescription drugs under Medicare Part D. In 2026, Full Extra Help recipients pay no more than $4.90 for generics and $12.15 for brand-name drugs. People with partial Extra Help pay a sliding-scale copay based on income.
If you receive Medicaid, SSI, or any Medicare Savings Program, you are automatically enrolled in Full Extra Help. You do not need to apply separately. For everyone else, the income limit is 150% FPL, about $1,995 per month for a single person.
How to Apply for Medicare Savings Programs in West Virginia
West Virginia processes Medicare Savings Program (QMB, SLMB, and QI) applications through its Department of Human Services (DoHS). The state reorganized in January 2024, replacing the former DHHR structure with a new DoHS agency.
Step 1: Check your eligibility
Before applying, confirm your income and assets are within the limits for at least one program. Use the table above. Remember to subtract $20 from your monthly income before comparing to the limit, since the first $20 of most income is disregarded.
Step 2: Gather your documents
You will need:
- Proof of identity (driver's license, state ID, or passport)
- Proof of Medicare enrollment (your Medicare card)
- Income verification from the last 30 days (Social Security award letter, pay stubs, pension statement)
- Bank statements showing current account balances
- Proof of West Virginia residency (utility bill, lease, or official mail)
Step 3: Apply online through WV PATH
WV PATH (People's Access To Help) is West Virginia's online benefits portal at wvpath.wv.gov. It handles applications for Medicare Savings Programs along with Medicaid, SNAP, and other assistance programs. Create an account, select Medicare Premium Assistance, and complete the application.
After submitting, save your confirmation number. You can log back in at any time to check your status, upload additional documents, and read decision notices. Enable text or email alerts in the portal to get updates without logging in each time.
Step 4: Apply by phone or in person
If you prefer not to apply online, call West Virginia DoHS at 1-877-716-1212, Monday through Friday, 8 AM to 5 PM. You can complete the application by phone or ask for help finding a local DoHS office.
Step 5: Apply for Extra Help separately if needed
If you do not qualify for a Medicare Savings Program but your income is below 150% FPL, apply for Extra Help directly through the Social Security Administration. You can apply online at ssa.gov/medicare/part-d, call SSA at 1-800-772-1213, or visit your local SSA office. There is no deadline. You can apply any time of year.
When Coverage Starts
Once your Medicare Savings Program application is approved, your Part B premium is typically reimbursed back to the month you applied. If you overpaid for Part B in prior months, you may receive a credit to your Social Security payment or a reimbursement check.
QI applications can only be approved going back to January 1 of the current calendar year, regardless of when you apply. SLMB applications can go back up to three months before the application date.
West Virginia SHIP: Free Counseling
If you are unsure which program fits your situation or want help applying, contact the West Virginia State Health Insurance Assistance Program (SHIP) at 1-877-987-4463. SHIP counselors are trained volunteers who provide free, unbiased help with Medicare enrollment, plan comparisons, and benefits applications. They do not sell insurance.
SHIP can also help you identify whether you might qualify for other assistance programs in West Virginia, including Medicaid long-term care benefits and SNAP.
Do Medicare Savings Programs Affect Other Benefits?
Enrollment in QMB, SLMB, or QI does not reduce your Social Security benefit or count as income for other programs. It also does not affect your Medicare coverage itself. You keep your same doctors, plans, and prescription coverage. The programs only add financial assistance on top of existing coverage.
Being enrolled in a Medicare Savings Program does make you automatically eligible for Extra Help, which is significant if you pay for brand-name medications out of pocket.
Check Your Eligibility
If you are on Medicare in West Virginia and your income is below $2,000 per month as a single person, you likely qualify for at least one of these programs. Many eligible West Virginians do not apply because they do not know the programs exist or assume they earn too much. Income disregards, asset exclusions, and the $20 per month income deduction mean the actual qualifying income can be higher than the stated limits.
Use the free eligibility screener at BenefitsUSA to check your estimated eligibility for Medicare Savings Programs and other West Virginia assistance programs in about two minutes. You can also visit the West Virginia benefits page for a full overview of programs available in the state.
Frequently Asked Questions
What is the income limit for QMB in West Virginia in 2026?
The QMB income limit in West Virginia is $1,350 per month for an individual and $1,824 per month for a married couple in 2026. These limits reflect 100% of the Federal Poverty Level. The first $20 of most monthly income is not counted, so your gross income can be slightly higher and you may still qualify.
What is the income limit for Extra Help in West Virginia in 2026?
The Extra Help (Low-Income Subsidy) income limit is $1,995 per month for individuals and $2,705 per month for couples in 2026, which equals 150% of the Federal Poverty Level. The asset limit is $17,220 for a single person and $34,360 for a couple. If you already receive a Medicare Savings Program, SSI, or Medicaid, you are automatically enrolled in Full Extra Help.
Does West Virginia have an asset test for Medicare Savings Programs?
Yes. West Virginia uses the federal asset limits for QMB, SLMB, and QI. The limit is $9,660 for individuals and $14,470 for couples for QMB and SLMB, and $9,950 for individuals and $14,910 for couples for QI. Your home, one car, and personal belongings are not counted toward these limits.
How do I apply for a Medicare Savings Program in West Virginia?
Apply online through WV PATH at wvpath.wv.gov, call the West Virginia Department of Human Services at 1-877-716-1212, or visit a local DoHS office. You will need proof of identity, Medicare enrollment, income from the past 30 days, bank statements, and proof of West Virginia residency.
What does QMB cover that SLMB does not?
QMB covers your Part B premium, Part A premium if applicable, plus all Medicare cost-sharing including deductibles, coinsurance, and copays. SLMB and QI only cover the Part B premium. If you have significant medical expenses, qualifying for QMB rather than SLMB can mean thousands of dollars in additional savings per year.
Can I get help applying for Medicare Savings Programs in West Virginia?
Yes. Call the West Virginia SHIP at 1-877-987-4463 for free, unbiased help from a trained counselor. SHIP counselors do not sell insurance and can walk you through the application process at no cost.
What happens if my income is over the QMB limit but under the SLMB limit?
You may qualify for SLMB, which pays your Part B premium ($185 per month in 2026). While SLMB does not cover deductibles or coinsurance like QMB does, it still saves you $2,220 per year and automatically qualifies you for Full Extra Help with your Part D prescription drug costs.
