What SLMB Medicaid Covers and How It Works

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 the monthly premium for Medicare Part B on your behalf. It does not cover doctor visits, hospital stays, prescriptions, or any medical services—only the Part B premium itself, which is the cost to keep your Medicare coverage active.

If you have Medicare and your income is low enough, SLMB can remove the burden of paying that premium each month. Your Medicare coverage itself stays the same; SLMB just handles one bill. This matters because without Part B active, you lose access to doctor visits and outpatient care, even if you have Part A hospital coverage.

SLMB is run by your state Medicaid office, not Medicare. Each state sets its own income limits and processes applications differently, so what qualifies you in one state may not in another.

Key Takeaways

SLMB pays only your Medicare Part B premium each month; it does not cover medical care, prescriptions, or other costs.
You must be enrolled in Medicare Part A and have income below your state's SLMB limit, which varies by state and household size.
Your state Medicaid office handles SLMB, so you explore through them, not through Medicare.
Once approved, SLMB pays the premium directly to Medicare, and you see no bill for Part B.

What SLMB actually covers

SLMB covers only the Medicare Part B monthly premium. That premium changes each year. In 2024, the standard Part B premium was $164.90 per month for most people, though some pay higher amounts based on income. SLMB pays whatever your state's Medicare program bills you for that month.

SLMB does not cover Part B deductibles, copayments, or coinsurance. If you see a doctor, you still owe the copay. If you need a lab test, you still owe your share of the cost. SLMB only removes the monthly premium bill.

If you also need help with those out-of-pocket costs—deductibles, copays, and coinsurance—you may be able to get a different program called QMB (may have access to Medicare Beneficiary) instead of SLMB, or you may may have access to for both. QMB covers those costs that SLMB does not. Your state Medicaid office can tell you whether you may have access to for QMB based on your income and resources.

Income limits and who qualifies

To may have access to for SLMB, your income must fall below a certain threshold set by your state. The federal guideline is roughly 120 to 135 percent of the federal poverty level, but each state can set its own limit within federal rules. A single person's limit in one state might be $1,500 per month, while another state's limit could be $1,700. You need to check your specific state's current limit.

You must also be enrolled in Medicare Part A. SLMB is only for people who already have Medicare. If you do not have Medicare yet, you cannot use SLMB.

Your state also counts your resources—savings, investments, property other than your home. Most states allow you to have up to $7,560 in resources as a single person, though this limit varies. Your home and one car do not count.

To find your state's exact income and resource limits, contact your state Medicaid office directly or call 1-800-MEDICARE to ask for your state's SLMB rules.

how the process works through your state Medicaid office

You explore for SLMB through your state Medicaid office, not through Medicare. Each state runs its own process process. Some states let you explore online, some by mail, and some require you to visit an office in person.

To explore, you will typically need to provide proof of your income (recent pay stubs, tax returns, or a letter from Social Security), proof of your Medicare enrollment (your Medicare card), and proof of your citizenship or legal residency. Some states also ask for bank statements to verify your resources.

Your state Medicaid office will tell you exactly what documents to bring or mail. You can find your state office by searching "[your state] Medicaid" online or by calling 1-800-MEDICARE and asking for your state's contact information.

How long approval takes and what happens next

Processing time varies by state. Some states approve SLMB applications within two to four weeks; others take six to eight weeks or longer. During that time, you are still responsible for paying your Part B premium to Medicare. Once you are approved, your state Medicaid office sends approval notice to Medicare, and Medicare stops billing you for Part B.

After approval, your state Medicaid office handles the premium payment to Medicare each month. You do not receive a bill for Part B anymore. If your income or circumstances change, you must report that to your state Medicaid office, because changes can affect whether you still may have access to.

If your process is denied, your state will send you a notice explaining why. You have the right to request a hearing to appeal the decision. The notice will explain how to ask for a hearing and what important date you have to do so.

SLMB versus QMB and other Medicare savings programs

SLMB is one of four Medicare Savings Programs run by states. The others are QMB, QDWI, and QI. Each covers different costs and has different income limits.

QMB (may have access to Medicare Beneficiary) has a higher income limit than SLMB and covers Part B premiums plus deductibles, copayments, and coinsurance. If you may have access to for QMB, you get more help than SLMB offers, so your state will usually enroll you in QMB instead.

QDWI (may have access to Disabled and Working Individual) is for people under 65 who are disabled, still working, and lost Medicare because of work earnings. It covers only the Part A premium.

QI (may have access to Individual) has an income limit between SLMB and QMB and covers only the Part B premium, like SLMB, but the income cutoff is higher.

Your state will determine which program you may have access to for based on your income. You do not choose; the state assigns you to the program that fits your situation.

What to do if you are denied or your circumstances change

If your process is denied, the denial notice will explain the reason—usually income too high, resources too high, or not enrolled in Medicare Part A. You can request a hearing to appeal. The notice tells you the important date to request a hearing, which is usually 30 days from the date of the notice.

If your income drops after you are denied, you can reapply. If your income rises after you are approved, you must report it to your state Medicaid office. If your income goes above the limit, your SLMB coverage will end, and you will start receiving Part B bills again.

If you move to a different state, your SLMB coverage does not follow you. You will need to explore to your new state's Medicaid office using that state's rules and income limits.

Frequently Asked Questions

Does SLMB cover prescription drugs?

No. SLMB covers only the Medicare Part B premium. Prescription drug coverage comes through Medicare Part D, which is separate. If you need help paying for prescriptions, you may be able to get Extra Help (also called the Low-Income Subsidy), which is a different program run by Medicare, not Medicaid.

Can I have SLMB and Medicare Advantage at the same time?

Yes. SLMB pays your Part B premium regardless of whether you have Original Medicare or Medicare Advantage. Your Part B premium is the same either way, and SLMB covers it.

What if I turn 65 and enroll in Medicare—can I get SLMB right away?

You can explore for SLMB as soon as you enroll in Medicare Part A and Part B, but approval takes time. During the waiting period, you are responsible for paying the Part B premium yourself. Once approved, SLMB pays it retroactively in some states, but not all—ask your state Medicaid office whether they do.

Does SLMB cover my spouse's Medicare premiums?

No. SLMB is individual coverage. Your spouse must explore separately and meet the income and resource limits on their own. Your household income counts toward both applications, but each person must may have access to independently.

What happens to SLMB if I go into a nursing home?

SLMB continues as long as you remain enrolled in Medicare Part B and meet the income and resource limits. However, if you are in a nursing home and receiving Medicaid coverage for that care, your resource limit may change, which could affect your SLMB may be able to access. Contact your state Medicaid office to understand how nursing home placement affects your coverage.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.