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Version 4 Updated 07/13/2026

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VPharm Ranges for premiums, effective 4/1/26

Eligibility maximums for Medicare savings programs, effective 4/1/26

Household Size Coverage Groups Rule % FPL 1 2 Qualified Medicare Beneficiaries (QMB)* § 8.07b1 150% 1,995* 2,707 Qualified Disabled and Working Individuals (QDWI) § 8.07b4 200% 2,660* 3,609 Qualified Individuals - 1 (QI-1) § 8.07b3 202% 2,687* 3,645 *SLMB at 120% FPL has been subsumed into QMB SSI/AABD payment levels Living Arrangement

Effective 1/1/26 Effective 1/1/25 – 12/31/25 Independent Living Individual Couple 1049.68 1596.80 1,022.68 1,555.80 Another’s Household Individual Couple 704.72 1,045.69 686.72 1,018.36 Residential Care Home w/ Assistive Community Care Level III Individual Couple 1,045.77 1,594.54 1,018.77 1,553.54 Res. Care Home w/ Limited Nursing Care Level III Individual Couple 1,261.13 2,094.69 1,234.13 2,053.69 Residential Care Home Level IV Individual Couple 1,233.62 2,092.40 1,206.62 2,051.40 Custodial Care Family Home Individual Couple 1,099.60 1,847.12 1,072.60 1,806.12 Long-term Care Individual Couple 79.93 159.85 79.93 159.85

Household Size Coverage Groups Rule % FPL 1 2 3 4 5 6 7 8 VPharm 1 - VD, VG, VJ, VM $15/person/month § 5441 > 0 < 150% 1,995* 2,707 3,419 4,132 4,844 5,557 6,269 6,982 VPharm 2 - VE, VH, VK, VN $20/person/month § 5441 > 150 < 175% 2,328* 3,158 3,989 4,820 5,652 6,483 7,314 8,145 VPharm 3 - VF, VI, VL, VO $50/person/month § 5441 > 175 < 225% 2,993* 4,060 5,129 6,197 7,266 8,335 9,404 10,472