Medicare Buy-In Program in Pennsylvania: Tiers and Income Limits

The Pennsylvania Medicare Buy-In program pays the Medicare premiums, and sometimes the deductibles and coinsurance, of state residents whose income and resources fall below set limits. It is run by the Department of Human Services through local County Assistance Offices, and it comes in four tiers, each with its own income cutoff and its own list of what the state will cover. Approval also opens the door to federal help with prescription drug costs.

The Four Tiers and What Each One Pays

Which tier you fall into depends on your monthly income measured against the Federal Poverty Level. The tier decides how much of your Medicare cost the state picks up.

Qualified Medicare Beneficiary (QMB). The most generous tier. The state pays your Part B premium, pays your Part A premium if you don’t get Part A free, and covers your Medicare deductibles and coinsurance. QMB enrollees receive a Pennsylvania ACCESS card that handles the cost-sharing.¹
Specified Low-Income Medicare Beneficiary (SLMB). The state pays your Part B premium only.¹
Qualifying Individual (QI-1). The state pays your Part B premium only. QI-1 recipients cannot also receive full Medicaid benefits through programs like Medical Assistance for Workers with Disabilities or a Home and Community-Based Services waiver.¹
Qualified Disabled Working Individual (QDWI). A narrow category for people under 65 who lost premium-free Part A after returning to work. The state pays the Part A premium only, and QDWI recipients are not eligible for other Medical Assistance benefits.²

Some people qualify for both a Medicare Savings Program and full Medicaid. Those enrollees are called “QMB Plus” or “SLMB Plus” and receive the MSP help alongside the full range of Medicaid-covered services.³

2026 Income and Resource Limits

The three main tiers share the same resource limits and differ only on income:

QMB (under 100% FPL): monthly income up to $1,330 for one person or $1,804 for a married couple; resources up to $9,950 for one person or $14,910 for a couple.¹
SLMB (under 120% FPL): monthly income up to $1,596 for one person or $2,164 for a couple; same resource limits.
QI-1 (under 135% FPL): monthly income up to $1,796 for one person or $2,435 for a couple; same resource limits.

QDWI is separate: family income up to 200% of the Federal Poverty Level, and resources up to twice the Supplemental Security Income limit.⁴

Income Disregards Can Put You Under the Line

Do not stop reading if your gross income exceeds the number above. Before the state compares your income to the limit, it applies disregards. On unearned income such as Social Security, the first $20 a month is ignored. On earned income, the first $65 a month is ignored, and then half of what remains is disregarded.¹ Someone whose gross income looks too high on paper may still qualify once the math is done.

What Counts as a Resource, and What Doesn’t

Countable resources include checking and savings accounts, cash, certificates of deposit, stocks, bonds, mutual funds, IRAs and 401(k)s, life insurance with a cash value, and real property other than your primary home. Excluded from the count: your home, one vehicle, burial plots, irrevocable burial reserves, and ABLE accounts.¹⁵ Pennsylvania has not eliminated the asset test, so resources are counted for every applicant.⁶

How to Apply

There are three ways to file:

By paper. Complete form PA 600M. You can request it by calling the DHS Customer Service Center at 1-877-395-8930 or pick one up at your local County Assistance Office. Mail or hand-deliver the completed form to the CAO.⁷
Online. Use the COMPASS system at compass.state.pa.us. The online form is longer than the PA 600M and asks for information the paper version does not.¹
In person. Take it to your County Assistance Office. Staff can answer questions and help you gather documents.⁷

You will need proof of identity, income, resources, and address. The application has a box you can check to ask the CAO to help gather documents such as bank records or pay stubs. Keep copies of everything you send, and never give the CAO original documents.¹

A decision usually takes 30 to 45 days. Call the Customer Service Center about a week after you file to confirm the CAO received it, and follow up at 1-877-395-8930 if nothing has arrived by day 30.⁸ Benefits can be made retroactive for up to three months before your application date, so if you were eligible earlier you may recover some of what you paid.⁹ If the decision goes against you, you have 30 days from the notice to request a hearing.⁷

What Approval Also Gets You

Enrollment in any tier automatically qualifies you for the Medicare Part D Low-Income Subsidy, known as Extra Help, which cuts your prescription drug premiums, deductibles, and copays.¹⁰ Medicare will send you a notice confirming Extra Help, and if you are not already in a Part D plan, Medicare will enroll you in one. The trigger works the other way as well: applying for Extra Help through Social Security automatically shares your information with the state to start an MSP application, unless you opt out.¹¹

MSP enrollees can also sign up for Part B at any point in the year rather than waiting for a designated enrollment period, and the Part B late enrollment penalty does not apply to them.⁵

QMB Billing Protection

If you are in the QMB tier, providers are barred by federal and state law from collecting Medicare Part A and Part B deductibles, coinsurance, or copays from you. They cannot start or threaten collection against you for covered services, and the protection applies to all Medicare Advantage providers whether or not the provider participates in Medicaid.¹²¹³ Providers who bill QMB members anyway face disciplinary action. If a bill shows up, call your managed care plan or the Pennsylvania Health Law Project helpline at 1-800-274-3258.

Part A When You Don’t Have Enough Work Credits

Pennsylvania has a Part A Buy-In agreement with the Centers for Medicare and Medicaid Services, and that arrangement helps people who don’t qualify for premium-free Part A on their own work record. You can be enrolled in Part A year-round, without waiting for Medicare’s General Enrollment Period, and the Part A late enrollment penalty is waived for people enrolled through the Buy-In.¹⁴

If you already have Part B, the CAO handles the Part A enrollment for you through a process called a “manual accretion,” and you do not need a separate trip to Social Security. Once it is processed, Medicare mails you a new card showing both parts.¹⁵¹⁶ If you have no Medicare coverage yet, you first need to contact Social Security for conditional Part A and Part B before the state can finish the Buy-In enrollment.

If You Work and Have a Disability: MAWD Instead of QI-1

Pennsylvania’s Medical Assistance for Workers with Disabilities program covers employed people with disabilities aged 16 through 64 whose income is below 250% of the Federal Poverty Level and whose countable resources are $10,000 or less. Enrollees pay a monthly premium to the state.¹⁷

MAWD covers the Part B premium for enrollees who meet SLMB financial limits and covers both Part A and Part B premiums for those who meet QMB limits. MAWD and QI-1 cannot both pay your Part B premium, so if you qualify for both you have to pick one. The County Assistance Office is required to walk you through the choice.¹⁷

Free Help With Your Application

You do not have to figure this out alone.

PA MEDI, the state’s Medicare counseling service, gives free, unbiased help with MSP applications and Medicare questions through the Department of Aging and local Area Agencies on Aging. Call 1-800-783-7067, Monday through Friday, 8 a.m. to 5 p.m.¹⁸
Pennsylvania Health Law Project offers free legal help to low-income Pennsylvanians on health coverage problems, including MSP denials. Helpline: 1-800-274-3258.¹
DHS Statewide Customer Service Center handles questions about a filed application or existing benefits: 1-877-395-8930, or 215-560-7226 for Philadelphia.¹

1
Pennsylvania Health Law Project. Medicare Savings Program Guide
2
PA Department of Human Services. Qualified Disabled Working Individual
3
MACPAC. Medicare Savings Programs
4
PA Department of Human Services. Buy-In of Medicare Part A
5
Pennsylvania Health Law Project. PHLP Medicare 2026 Webinar Slide Deck
6
PA Department of Human Services. Medicaid General Eligibility
7
PA Department of Human Services. Application for Payment of Medicare Premiums
8
Pennsylvania Health Law Project. Medicare Savings Program Guide
9
PA Department of Human Services. Buy-In General Policy
10
Medicare.gov. Medicare’s Extra Help Program
11
Medicare.gov. Get Help With Drug Costs
12
PA Health & Wellness. QMB Billing Protections
13
Center for Medicare Advocacy. Medicare Cost Sharing for Dual Eligibles
14
Justice in Aging. Building the Path to Medicare Part A Buy-In
15
CMS. State Buy-In Manual FAQs
16
Pennsylvania Health Law Project. Medicare Buy-In Program Helps With Part A Premium Costs
17
PA Department of Human Services. MAWD General Policy
18
PA Department of Aging. PA MEDI Medicare Counseling