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Washington Medicare cost help
Last updated: 20 September 2026
Washington Medicare Savings Programs (MSPs) can help people with limited income pay Medicare costs. Washington has four federal MSP levels: QMB, SLMB, QI-1, and QDWI. The state does not use an asset test for MSP-only eligibility, so money in a checking or savings account does not by itself disqualify you from an MSP.
Bottom Line
If you have Medicare and your monthly income is near the Washington limits, apply even if you have savings or think you are slightly over the chart. Washington uses countable-income rules and more than one budgeting method. The fastest starting point is Washington Connection or the Department of Social and Health Services (DSHS) at 1-877-501-2233.
The standard 2026 Medicare Part B premium is $202.90 a month, or $2,434.80 for 12 months. An MSP that pays Part B can therefore put more than $2,400 a year back into a household budget. See the official CMS 2026 costs.
Start Here
- Check the Washington numbers. Use the state’s current 2026 MSP flyer. Do not rely on a national chart because Washington’s rules are more favorable in important ways.
- Apply instead of self-denying. Call DSHS at 1-877-501-2233, apply online, or submit a paper form. Washington says an interview is not required for an MSP application or renewal.
- Get free Medicare help. Washington SHIBA counselors can explain MSPs, Extra Help, Medicare bills, and plan questions. If you want a broader overview first, use our national MSP guide.
| If you need to… | Start here | Why |
|---|---|---|
| Apply for MSP | DSHS, 1-877-501-2233 | DSHS handles MSP applications for Medicare households. |
| Use a shorter form | Short MSP form | Form HCA 13-691 is designed for Medicare Savings Programs. |
| Apply for broader Medicaid | Full Apple Health form | Form HCA 18-005 also screens for aged, blind, disabled, and long-term care coverage. |
| Understand Medicare choices | SHIBA, 1-800-562-6900 | SHIBA provides free, unbiased Medicare counseling. |
What Has Changed
- Part B amount corrected: The exact standard Part B premium for 2026 is $202.90 a month, not a rounded $203.
- Income screening clarified: Washington’s May 2026 flyer tells households to subtract $20 once from gross monthly income and then compare the result with the chart. The chart numbers below are therefore not simple gross-income cutoffs.
- SSA can start an MSP case: Under Washington’s rule effective January 19, 2026, a person who applies for Medicare Part D Extra Help through Social Security can consent to have SSA send the application information to Washington to initiate MSP screening without a separate MSP application.
- Important October 2026 change: Washington HCA says federal Medicaid eligibility changes beginning October 1, 2026 will affect some refugees, asylees, humanitarian parolees, trafficking survivors, VAWA self-petitioners, and other noncitizens. If you received a state notice about this change, ask DSHS whether your MSP is affected before assuming it will continue.
2026 Income Rules and No Asset Test
Washington’s MSP income standards are based on countable monthly income. The state’s Washington MSP rule sets QMB at 110% of the federal poverty level, SLMB above 110% through 120%, QI-1 above 120% through 138%, and QDWI above 138% through 200%, with additional program rules.
For a quick screen, the Washington flyer says to write down gross monthly household income, subtract $20 once per household, and compare the result with the chart. Other exclusions and spouse rules can also change countable income. This is why a person who looks a little over the chart should still apply.
| Program | Main help | Individual | Couple | Key caution |
|---|---|---|---|---|
| QMB | Part A and B premiums plus Medicare-covered cost sharing | $1,463 | $1,984 | Subtract the household $20 screen deduction before comparing. |
| SLMB | Part B premium | $1,596 | $2,165 | Countable income may differ from gross income. |
| QI-1 | Part B premium | $1,835 | $2,490 | QI-1 is not available with other Medicaid coverage. |
| QDWI | Part A premium | $2,660 | $3,608 | Special earned-income deductions apply; call DSHS for a real calculation. |
How to read the table: These are the state flyer’s comparison amounts, not hard gross-income ceilings. The flyer first tells you to subtract $20 once per household. Washington can also use spouse, dependent, earned-income, and other countable-income rules. Larger households can have higher standards.
No asset test: Washington expressly says federal MSPs do not require a resource test. For an MSP-only application, DSHS should not ask you to verify bank balances or other resources. Other Apple Health programs can have different asset rules.
If you want a rough first screen before applying, our MSP and Extra Help checker can organize the questions. It cannot decide eligibility; DSHS makes the final decision.
QMB, SLMB, QI-1, and QDWI
QMB: the strongest MSP protection
What it helps with: Qualified Medicare Beneficiary (QMB) pays Medicare Part A and Part B premiums and protects you from Medicare-covered deductibles, coinsurance, and copayments. Washington’s rule also addresses covered Part C cost sharing, subject to Medicaid payment rules.
Who may qualify: A person who meets Washington’s MSP eligibility and QMB income rules may qualify. QMB and full Medicaid can exist at the same time.
Reality check: QMB does not make every health expense free. It does not turn non-covered services into Medicare-covered care, and prescription drugs are handled through Part D. If a provider sends you a bill for covered Medicare cost sharing, use our QMB billing guide.
SLMB: Part B premium help
What it helps with: Specified Low-Income Medicare Beneficiary (SLMB) pays the Medicare Part B premium.
Who may qualify: It is generally for people whose countable income is above the QMB level but within the SLMB level. A person can receive SLMB and another Medicaid program at the same time.
Reality check: SLMB by itself does not provide QMB’s broad cost-sharing protection. If you also qualify for another Medicaid category, that other coverage may help with additional Medicare cost sharing.
QI-1: Part B help with funding rules
What it helps with: Qualified Individual (QI-1) pays the Part B premium.
Who may qualify: It is for people within the QI-1 income range who are not receiving other Medicaid coverage. Washington’s rule says QI-1 payments depend on the state’s federal allotment.
Reality check: Do not delay an application because you think you are too close to the line. DSHS uses the eligibility method that gives the applicant the highest level of MSP coverage available under the rule.
QDWI: Part A help for some workers
What it helps with: Qualified Disabled and Working Individual (QDWI) pays the Medicare Part A premium.
Who may qualify: Washington requires QDWI applicants to be under age 65, employed, and to meet disability and income rules. It is mainly relevant to some people who returned to work and lost premium-free Part A.
Reality check: The state flyer says special earned-income deductions apply to QDWI. A working person can have gross earnings above the simple table number and still deserve a full DSHS calculation.
Extra Help for Prescription Drugs
QMB, SLMB, and QI-1 recipients automatically qualify for Medicare Part D Extra Help. Social Security’s MSP guidance distinguishes QDWI, so a QDWI recipient should not assume automatic Extra Help. Medicare explains automatic qualification and 2026 drug-cost rules on its Medicare Extra Help page.
If prescriptions are a major cost, compare the separate drug-cost rules in our Extra Help guide. MSP and Extra Help are connected, but they are not the same benefit.
Who Should Apply Even If Unsure
Apply if your income is near the state chart, if only one spouse has Medicare, if your spouse still works, or if you have dependents in the home. Washington’s 2026 rule uses multiple income methods. It can consider a one-person or two-person SSI-related method, a family-size method, and information from an SSA Extra Help application. The agency uses the method that provides the highest MSP coverage available.
This matters for married seniors. A nonapplying spouse’s income is not always treated as if both spouses were applying. Earned-income deductions can also matter. Do not decide your own case from gross income alone.
If you have Medicare and full Apple Health, you may be “dual eligible.” Our dual eligible guide explains how Medicare and Medicaid work together.
How to Apply Without Wasting Time
Washington directs people age 65 or older, people on Medicare, and people seeking help with Medicare costs to DSHS and Washington Connection. The current DSHS MSP page lists five routes: online, phone, fax, mail, or in person.
- Pick the application. Use HCA 13-691 if you mainly want MSP. Use HCA 18-005 if you also want broader Apple Health screening.
- Submit it. Apply online, call 1-877-501-2233, fax 1-888-338-7410, mail it to DSHS, P.O. Box 11699, Tacoma, WA 98411, or visit a Community Services Office.
- Watch for a proof request. Washington normally has 45 calendar days to process an Apple Health application. A case needing a disability decision can take up to 60 days under the state processing rule.
- Do not wait for an interview. DSHS says no interview is required for MSP applications or renewals, but you still must submit the required form and proof.
- Use SSA if convenient. If you apply for Part D Extra Help through Social Security, Washington’s application rule allows SSA, with your consent, to send information that starts an MSP application.
For help choosing the right Washington portal, see our Washington benefits portals guide.
Phone script: applying
“I have Medicare and want to apply for a Medicare Savings Program. Can you tell me whether I should use the short MSP form or the full Apple Health form, and what income proof you need from me?”
What to Gather Before You Apply
- Your Medicare card or Medicare number.
- Social Security benefit information.
- Pension, retirement, VA, Railroad Retirement, unemployment, or other income records that apply to you.
- Recent pay stubs if you or a spouse works.
- Names, birth dates, and Social Security numbers for people included in the case.
- Your current mailing address and phone number.
- An authorized representative’s details if someone will help manage the case.
Do not over-collect asset papers for MSP only. Washington says MSPs have no resource test. If you also apply for a different Apple Health program, DSHS may request asset information for that separate program.
What Happens After Approval
Coverage start dates differ by program. Under Washington’s coverage-start rule, QMB begins on the first day of the month after QMB eligibility is determined. SLMB, QI-1, and QDWI can be approved for up to three earlier months when the person met the rules in those months.
Stopping the Part B deduction can take longer than getting the approval notice. HCA’s buy-in instructions say that if Part B is still being billed or deducted after 60 to 90 days, contact the Medicare Buy-In Unit at 1-800-562-3022, extension 16129. Keep your approval notice and watch your Social Security payment or Medicare bill for the change.
Phone script: premium still deducted
“I was approved for a Medicare Savings Program, but my Part B premium is still being deducted. Can you check my Medicare buy-in record and tell me whether anything needs to be corrected?”
If a Provider Bills You While You Have QMB
Medicare providers and suppliers are not allowed to bill a QMB enrollee for Medicare-covered deductibles, coinsurance, and copayments. The federal Medicare MSP page explains this protection.
- Do not assume the bill is correct just because it came from a medical office.
- Call the billing office and say you have QMB.
- Ask the office to recheck the payer information and remove Medicare-covered cost sharing from your patient balance.
- If the bill is not fixed, call Medicare at 1-800-MEDICARE (1-800-633-4227) and contact Apple Health.
- If you already paid, ask the provider whether a refund is due after the account is corrected.
Phone script: wrong QMB bill
“I am enrolled in QMB. This bill appears to include Medicare-covered cost sharing. Please review my QMB status, correct the claim if needed, and tell me whether I should have a zero patient balance for this covered service.”
Reality Checks and Common Mistakes
- Do not add $20 to the chart and call that the official limit. The state worksheet tells you to subtract $20 from household income before comparing. Other deductions may also apply.
- No asset test does not mean no paperwork. DSHS can still verify income, Medicare status, residence, household information, and other eligibility factors.
- Do not use federal QDWI numbers for Washington. Washington applies its own rules and special earned-income deductions.
- Do not pay a suspicious QMB bill first. Ask the provider to correct it before you pay Medicare-covered cost sharing.
- Do not ignore state mail. Proof requests, renewal forms, or immigration-status notices can affect coverage.
- MSP is not every kind of Medicaid. Full Apple Health, long-term care Medicaid, spenddown, and MSP can have different financial rules.
Denied, Delayed, or Overwhelmed
If 45 days have passed without a decision, call DSHS and ask for the application date, what proof is still needed, and whether the case has a documented reason for delay. If the denial looks wrong, ask which income method DSHS used and whether the family-size method was considered.
You can request an Apple Health administrative hearing if you disagree with the decision. HCA’s current hearing guidance says the request should be made within 90 days of the decision and may be verbal or written. Follow the instructions on your notice.
If you need plain-language legal information, the nonprofit Washington LawHelp MSP guide can help you understand the program and next steps.
Phone script: denial
“I was denied for a Medicare Savings Program. Please tell me what income was counted, which eligibility method was used, and what I need to do to request a hearing if I still disagree.”
Backup Options if MSP Is Not Enough
- Extra Help: If prescription costs are the problem and you do not automatically get Extra Help, apply through Social Security or ask SHIBA for help.
- Broader Apple Health: Ask DSHS to screen you for other Medicaid categories if you need more than Medicare premium help.
- Free Medicare counseling: Our SHIP and SMP guide explains how counseling and fraud-help programs work.
- Other Washington benefits: If food, housing, utilities, or other bills are also difficult, use our Washington senior benefits guide.
Washington Help and Official Contacts
| Resource | Best for | Contact |
|---|---|---|
| DSHS | Apply, renew, report changes, check status, ask about denial | 1-877-501-2233; DSHS office finder |
| HCA Buy-In Unit | Part B still billed or deducted 60–90 days after MSP approval | 1-800-562-3022, ext. 16129 |
| SHIBA | Free Medicare counseling, Extra Help, plan questions | 1-800-562-6900; SHIBA program |
| Local aging network | Benefits navigation, caregiver and community-service referrals | Use our Washington AAA guide |
Resumen en Español
En Washington, los Programas de Ahorro de Medicare (MSP) pueden ayudar con las primas y algunos costos de Medicare. Washington no usa una prueba de bienes o ahorros para una solicitud de MSP solamente. La tabla estatal de 2026 indica que primero se restan $20 una vez por hogar antes de comparar los ingresos con los límites de la tabla.
Para solicitar, use Washington Connection o llame a DSHS al 1-877-501-2233. No se requiere entrevista para solicitar o renovar un MSP, pero sí debe entregar la solicitud y los documentos necesarios. Si ya tiene QMB y recibe una factura por costos compartidos de un servicio cubierto por Medicare, pida al proveedor que revise su estado QMB antes de pagar.
Desde el 1 de octubre de 2026, algunos cambios federales de Medicaid pueden afectar a ciertos no ciudadanos. Si recibió una carta del estado, llame a DSHS y pregunte específicamente si cambia su MSP.
Frequently Asked Questions
What are Washington’s 2026 MSP income amounts?
Effective April 1, 2026, Washington’s flyer lists individual/couple comparison amounts of $1,463/$1,984 for QMB, $1,596/$2,165 for SLMB, $1,835/$2,490 for QI-1, and $2,660/$3,608 for QDWI. The state tells households to subtract $20 once from gross monthly income before comparing, and other income rules can also apply.
Does Washington have an MSP asset limit?
No. Washington says federal Medicare Savings Programs do not have a resource test. An MSP-only applicant should not have to prove bank balances, although other Apple Health programs can have different asset rules.
How do I apply for an MSP in Washington?
Apply through Washington Connection, call DSHS at 1-877-501-2233, fax 1-888-338-7410, mail an application to DSHS, or visit a Community Services Office. You can use the short MSP form HCA 13-691 or form HCA 18-005 when seeking broader Apple Health coverage.
Can Social Security start my Washington MSP application?
Yes. Effective January 19, 2026, Washington can use information sent by Social Security, with your consent, when you complete a Medicare Part D Extra Help application to initiate MSP screening without requiring a separate MSP application.
How long can an MSP application take?
Washington generally processes Apple Health applications within 45 calendar days. A case that requires a disability decision can take up to 60 days. The agency must act as quickly as possible and should not use the maximum time as a waiting period.
What if Part B is still deducted after approval?
HCA says Medicare buy-in matching can take time. If Part B is still billed or deducted after 60 to 90 days, contact the HCA Medicare Buy-In Unit at 1-800-562-3022, extension 16129.
Can a doctor bill me if I have QMB?
Providers and suppliers cannot bill a QMB enrollee for Medicare-covered deductibles, coinsurance, or copayments. If you receive such a bill, ask the provider to correct it before paying and contact Medicare if the problem continues.
What can I do if Washington denies my MSP?
Ask DSHS for the exact reason, income calculation, and proof used. If you disagree, Washington says you may request an administrative hearing, generally within 90 days of the decision. Follow the instructions on your notice.
About This Guide
Sources: This guide uses official federal, state, local, and other high-trust nonprofit and community sources linked in the article.
Editorial note
This guide is produced under the GFS Editorial Standards using official and other high-trust sources. GFS is not affiliated with a government agency and is not a substitute for official agency guidance. Individual eligibility outcomes cannot be guaranteed.
Corrections
Despite careful verification, errors may occur. Readers may email info@grantsforseniors.org with corrections.
Disclaimer
This article is for informational purposes only and is not legal, financial, medical, tax, disability-rights, immigration, or government-agency advice. Program rules, policies, funding, and availability can change. Readers should confirm current details directly with the responsible official program before acting.
Last updated: 20 September 2026 · Next review: 20 January 2027
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