Does QMB Pay the Medicare Part A Premium in 2026? ($565 and $311 Rates)

Yes. If you do not qualify for premium-free Medicare Part A, the Qualified Medicare Beneficiary (QMB) program pays your entire monthly Medicare Part A premium in full, in addition to paying your $202.90 monthly Part B premium and Medicare cost-sharing. In 2026, according to CMS 2026 Medicare cost figures, that saves $565 per month ($6,780 per year) if you have fewer than 30 work quarters or $311 per month ($3,732 per year) if you have 30 to 39 quarters of Medicare-taxed employment.

Critically, QMB is the only broad senior MSP tier that pays the Part A monthly premium (aside from QDWI, which applies narrowly to disabled adults under 65 who returned to work). Neither SLMB nor QI pays a dime toward Part A premiums, making QMB approval make-or-break for retirees lacking 10 years of U.S. Social Security work credits.

Who owes a monthly Medicare Part A premium in 2026

Around 99% of Medicare enrollees receive Part A with a $0 monthly premium because they, a current spouse, an ex-spouse (from a marriage lasting at least 10 years), or a deceased spouse paid Medicare payroll taxes for at least 40 calendar quarters (10 years). The remaining 1% who face steep 2026 Part A premiums typically include:

• Older legal permanent residents (green card holders) who immigrated to the U.S. later in life and lived here at least five continuous years before enrolling in Medicare.
• Former state, county, municipal, or school employees hired before April 1986 under older non-Medicare-taxed government pension systems, if they also lack a qualifying spouse's 40 quarters.
• Self-employed workers or homemakers with gaps in reported Medicare payroll taxes who finished with fewer than 40 quarters.

Exact 2026 Part A premium savings under QMB vs. SLMB and QI

Compare what happens across MSP tiers in 2026 if you owe Part A premiums:

• Zero to 29 work quarters: Standard 2026 Part A premium is $565/month. Combined with the $202.90 Part B premium, unsubsidized Medicare costs $767.90 every month ($9,214.80/year) before seeing a single doctor. QMB pays both premiums ($0 monthly premium), saving $9,214.80 a year.
• 30 to 39 work quarters: Reduced 2026 Part A premium is $311/month. Combined with $202.90 Part B, premiums total $513.90/month ($6,166.80/year). QMB reduces monthly premiums to $0.
• If you qualify only for SLMB or QI: SLMB and QI pay ONLY the $202.90 Part B premium and do not cover Part A. Worse, in most states you cannot even enroll in Part B without already having Part A unless your state permits Part B-only enrollment or QMB Part A Buy-In.

What happens if your income sits $50 over QMB while owing $565 for Part A

Because SLMB and QI never cover the $565 or $311 Part A premium, sitting $40 above the 2026 federal QMB income limit ($1,350 single / $1,824 couple) creates a painful cliff for someone without premium-free Part A. Check three ways to cross back under QMB before giving up:

• Count earned-wage and tax exclusions carefully: Working even 4 hours a week counts at less than half after the $65 earned-income disregard, and checking non-countable income exceptions (such as SNAP, LIHEAP, or VA Aid and Attendance) can drop countable income below $1,330.
• Check spousal work quarters again: Many retirees assume they need 40 quarters personally, forgetting that a living or deceased spouse (age 62+ or qualifying widow/widower) or a divorced spouse from a 10-year marriage grants premium-free Part A at $0, allowing you to use SLMB or QI solely for Part B.
• Check higher state MSP ceilings: In states with expanded QMB caps (such as Connecticut, New York, Massachusetts, Maine, Indiana, or Washington), you may qualify for QMB Part A Buy-In with Social Security well above $1,350.

Wait: do you already have to be enrolled in Part A before applying for QMB?

This is the single most important procedural trap for people who owe Part A premiums. In ordinary circumstances, Medicare requires you to have Part A in order to qualify for QMB, yet you cannot afford $565/month just to apply and hope state Medicaid approves QMB months later.

To solve that catch-22, Social Security and CMS created Conditional Part A Enrollment (documented in SSA POMS HI 00801.140). Conditional enrollment lets you sign up for Part A on the condition that you will only keep and start Part A if the state approves QMB to pay the $565 or $311 monthly bill. If the state denies QMB, your Part A enrollment cancels cleanly with zero premium debt.

Important state distinction: roughly 37 states plus D.C. (now including California as of January 1, 2025) operate under federal Part A Buy-In agreements allowing year-round conditional applications with late penalties waived, while about 13 Group Payer states (such as Arizona, Illinois, New Jersey, and Virginia) restrict conditional filing to specific enrollment periods such as the January 1 to March 31 General Enrollment Period. Read our detailed conditional QMB without premium-free Part A guide before walking into a Social Security office.

Does QMB also waive Part A late-enrollment penalties?

Yes. If you delayed Part A past age 65 because $500+ a month was unaffordable, Medicare normally assesses a 10% Part A late-enrollment penalty for twice the number of years you could have enrolled but did not. Once QMB pays your Part A premium through state Buy-In or Group Payer enrollment, you owe $0 on both the base Part A premium and the Part A late penalty.

Step-by-step checklist before filing

1. Check whether you can claim premium-free Part A through a current, deceased, or 10-year divorced spouse's Social Security record before applying to pay for Part A.
2. Verify your income falls under your state's QMB threshold (federal baseline: $1,350 single / $1,824 couple in 2026) using our free MSP eligibility screener. Remember that five-year lawful permanent resident status also governs non-citizen Medicare and MSP access.
3. Verify whether your state is a year-round Part A Buy-In state or a Group Payer state via CMS Part A Buy-In guidance or your state Medicaid office, and ask a local SHIP counselor to help schedule your conditional Part A filing with Medicare.gov / SSA.