Medicare Part B reimbursement is an arrangement in which a third party pays your monthly Part B premium instead of leaving you to cover it yourself. The standard premium in 2026 is $202.90, and for most enrollees that amount comes straight out of the Social Security check each month.1Centers for Medicare & Medicaid Services. 2026 Medicare Parts A and B Premiums and Deductibles Three routes can take that cost off your shoulders: a state Medicare Savings Program, a Medicare Advantage plan that offers a Part B “giveback,” or an employer-funded health reimbursement arrangement. Each works differently and each has its own eligibility rules.
Reimbursement Through a Medicare Savings Program
The most common route is a Medicare Savings Program (MSP). These are state-run but federally funded under Title XIX of the Social Security Act, and once you qualify, your state Medicaid agency pays the Part B premium directly to the federal government on your behalf.2Social Security Administration. Compilation of the Social Security Laws – Title XIX – Grants to States for Medical Assistance Programs The $202.90 deduction disappears from your Social Security check and you receive the full benefit amount instead.
Federal law requires every state to offer three MSPs, and which one you qualify for determines how much help you get.3Office of the Law Revision Counsel. 42 US Code 1396a – State Plans for Medical Assistance
- Qualified Medicare Beneficiary (QMB) is the most comprehensive. It pays your Part B premium, your Part A premium if you have one, and all Medicare deductibles, coinsurance, and copayments. Providers who accept Medicare cannot bill you for cost-sharing that QMB covers.4Medicare. Medicare Savings Programs
- Specified Low-Income Medicare Beneficiary (SLMB) covers only the Part B premium. You must be enrolled in both Part A and Part B.4Medicare. Medicare Savings Programs
- Qualifying Individual (QI) also covers only the Part B premium, with slightly higher income limits than SLMB. You need both Part A and Part B, and you cannot be enrolled in Medicaid.4Medicare. Medicare Savings Programs
The gap between QMB and the other two is substantial. If you qualify for QMB, your out-of-pocket costs for Medicare-covered services drop to essentially zero. SLMB and QI save you the monthly premium but leave you responsible for deductibles and copays.
2026 Income Limits
Each program ties eligibility to a percentage of the Federal Poverty Level. A $20 monthly general income exclusion is built into every threshold, so the actual dollar cutoffs run slightly above the raw poverty percentages. For 2026, the monthly income limits in most states are:5Social Security Administration. HI 00815.023 – Medicare Savings Programs Income and Resource Limits
- QMB: $1,350 individual / $1,824 couple
- SLMB: $1,616 individual / $2,184 couple
- QI: $1,816 individual / $2,455 couple
Those figures refer to countable income, not gross income. States ignore certain types of income when running the numbers, and the $20 exclusion is already baked in. Some earned income, certain disability payments, and specific government benefits may be partially or fully excluded. If your gross income is slightly above the threshold, do not assume you are disqualified before checking what your state actually counts.
Resource Limits
The federal resource limits for 2026 are $9,950 for individuals and $14,910 for couples. Resources include money in bank accounts, stocks, bonds, and mutual funds.5Social Security Administration. HI 00815.023 – Medicare Savings Programs Income and Resource Limits Your primary home, one vehicle, household goods, burial spaces, burial funds up to $1,500 per person, and life insurance with a cash value under $1,500 do not count.
Roughly a third of states and the District of Columbia have eliminated the asset test entirely for MSPs, and several others set higher limits than the federal floor. In those states only your income matters. Your state Medicaid office can tell you which rules apply where you live.4Medicare. Medicare Savings Programs
How to Apply
You apply through your state Medicaid agency, not through Medicare or Social Security. Forms are available on the website of your state’s department of human services or the agency that administers Medicaid.4Medicare. Medicare Savings Programs Your state decides which of the three programs you qualify for. Gather these documents before you start:
- Proof of identity and citizenship or immigration status, such as your Social Security card or a government-issued ID.
- Income documentation: Social Security award letters, recent pay stubs, or pension statements showing gross monthly amounts.
- Recent statements from bank, investment, and retirement accounts, in states that still apply the asset test.
Most states accept applications online, by mail, or in person at a local social services office. Free counseling is available through your State Health Insurance Assistance Program (SHIP) if you want help walking through the form.
What Happens After You Apply
Federal policy requires the state to decide within 45 days, though many states move faster. You will receive a Notice of Action telling you whether you were approved, denied, or asked for more information. Once you are approved, the state notifies Social Security to stop deducting the Part B premium from your check. Processing lag usually means one to several months pass between your eligibility date and the point when the deductions actually stop, and the agency typically issues a retroactive lump-sum reimbursement for premiums you paid in the meantime.
If your application is denied, you have the right to a fair hearing under federal Medicaid regulations, and the state must give you up to 90 days from the mailing date of the denial to request one.6eCFR. 42 CFR Part 431 Subpart E – Fair Hearings for Applicants and Beneficiaries A hearing officer will review evidence you present. Denials based on income miscalculations are among the most common errors, particularly when the state failed to apply an exclusion that would have lowered your countable income. Bring documentation of any income the state may have miscategorized.
Extra Help Comes Automatically
Qualifying for any MSP automatically qualifies you for Extra Help, the federal program that pays most Medicare Part D prescription drug costs, including premiums, deductibles, and copayments.7Medicare. Help With Drug Costs You do not apply separately. Once your MSP enrollment is confirmed, a notice arrives in the mail explaining the benefit and, if you do not already have a Part D plan, identifying the one you were assigned to. The combined value of an MSP plus Extra Help can save a beneficiary several thousand dollars a year, which makes even SLMB or QI worth pursuing.
Reimbursement Through a Medicare Advantage Plan
A separate route runs through certain Medicare Advantage plans. These private plans receive a fixed per-member payment from the federal government, and when that payment exceeds their costs, some plans return a portion to members by covering all or part of the monthly Part B premium. Medicare calls this a Part B premium reduction, sometimes marketed as a “giveback.”8Medicare.gov. Understanding Health Plan Costs
Not every Advantage plan offers this benefit, and availability varies by region. Plans that do offer it tend to advertise it during the annual enrollment period, October 15 through December 7. The reduction amount varies by plan and can change year to year, so check the current figure before you count on it in your budget.
Reimbursement Through an Employer ICHRA
If you or your spouse is still working and the employer offers health benefits, an Individual Coverage Health Reimbursement Arrangement (ICHRA) can reimburse your Part B premium. Under rules finalized in 2019, an employer can fund an ICHRA that reimburses employees for individual health insurance premiums, including Medicare Parts A and B.9CMS. Individual Coverage Health Reimbursement Arrangements – Policy and Application Overview There is no federal cap on employer contributions, so the amount depends entirely on what the employer decides to offer.
Two catches. You must be enrolled in Medicare Parts A and B (or Part C) to receive ICHRA reimbursements for Medicare costs. And an employer offering an ICHRA to a class of employees generally cannot also offer that same class a traditional group health plan.
ICHRA reimbursements for medical expenses, including premiums, are excluded from your gross income for federal tax purposes.10Internal Revenue Service. Publication 502 – Medical and Dental Expenses Because those premiums are effectively paid with pre-tax dollars, you cannot also claim them as a medical expense deduction. Premiums paid on your behalf through an MSP are similarly not deductible, since you did not bear the cost.
If You Pay More Than the Standard Premium
Reimbursement programs address the standard premium. If you pay a higher amount because of the Income-Related Monthly Adjustment Amount (IRMAA), that is a separate issue with a separate fix. Social Security bases IRMAA on your modified adjusted gross income from two years earlier, so 2026 premiums use 2024 income. The 2026 brackets for individual filers run from $202.90 at $109,000 or less up to $689.90 at $500,000 or above, with joint filers generally receiving doubled thresholds.11Medicare. 2026 Medicare Costs
If your income dropped after the tax year Social Security used, you can request a new determination on Form SSA-44 by pointing to a qualifying life-changing event:12Social Security Administration. Medicare Income-Related Monthly Adjustment Amount – Life-Changing Event
- Retirement or a significant reduction in work hours by you or your spouse.
- Marriage, divorce, or the death of a spouse.
- Loss of income-producing property through disaster, arson, or investment fraud (not a voluntary sale).
- Loss of pension income because the plan was terminated or reorganized.
- An employer settlement payment resulting from bankruptcy or reorganization.
SSA-44 is one of the most underused tools in Medicare planning. Newly retired beneficiaries frequently keep paying inflated premiums for months simply because they did not know the form existed. If you recently retired and have documentation of your reduced income, file it now rather than waiting for the two-year lookback to catch up.