The Qualified Medicare Beneficiary (QMB) program is a federal and state-sponsored Medicare Savings Program (MPS) that helps low-income individuals and married couples pay their Original Medicare premiums and Part B deductibles, copayments, and coinsurance. In 2019, over 16% of all Medicare enrollees received financial assistance through the QMB program.
The QMB is one of four MSPs, and while each assists low-income seniors and disabled workers in meeting either their Part A or Part B monthly premiums, only the QMB program reduces or eliminates Part B cost-sharing. The QMB program has the strictest financial requirements of the four MSPs available.
Table of Contents
Understanding the Qualified Medicare Beneficiary Program
To access the Medicare QMB program, your income and resources must meet a specific limit. While these numbers rise every year, 2024 QMB thresholds are as follows:
Marital Status | Monthly Income Limit | Resource Limit |
|---|---|---|
Individual | $1,275 | $9,430 |
Married | $1,724 | $14,130 |
Resources include available funds in checking, savings, retirement accounts, stocks, and bonds.
Eligibility
To access the QMB program, you must qualify for Medicare Part A and have a monthly income and resources at or below the listed limits. Alaska and Hawaii allow seniors with slightly higher incomes to enroll in their QMB programs. Similarly, Connecticut and several other states do not count a person’s assets against eligibility.
Benefits
Once you qualify for the QMB program, Medicare providers no longer bill you for Medicare-approved items and services. This coverage extends to Original Medicare premiums and Part B deductibles, coinsurance, and copayments. QMB beneficiaries can also receive Extra Help, a financial aid program that lowers Medicare drug plan costs.
Coverage and Limitations
QMB beneficiaries have no legal obligation to pay their Part A and Part B deductibles, coinsurance, and copayments. Furthermore, with Extra Help, beneficiaries may pay no more than $11.20 for each Medicare-covered drug.
While thresholds vary by state, QMB benefits are similar across the country. To remain in the program, you must renew your application annually and submit updated financial records to your local Medicaid office.
How to Enroll in the Qualified Medicare Beneficiary Program
Because each state determines QMB eligibility, enrollment differs among states. However, following these general guidelines will help ensure you secure the benefits you deserve:
- Verify your eligibility for Medicare Part A: While you can access QMB coverage while unenrolled in Part A, you must still meet the typical age or disability criteria.
- Verify your financial eligibility: Contact your state Medicaid office to guarantee you meet their specific resource and income limit.
- Compile documents: QMB programs always ask for financial records like bank statements, tax paperwork, share certificates, and similar forms of evidence.
- Apply through your individual Medicaid program: Most states allow Qualified Medicare Beneficiaries to enroll online, over the phone, or in person.
What To Do If Denied
After submitting your QMB application, you should receive a notification of benefits within 45 days. You can directly appeal with your state Medicaid office if denied coverage. While each state has a different appeals process, most allow multiple opportunities to appeal.
Alternative Medicare Savings Programs
Those who cannot access the QMB program can still reduce Medicare premium expenses through any other MSP. Financial criteria are as follows:
Medicare Savings Program | Marital Status | Monthly Income Limit | Resource Limit |
|---|---|---|---|
SLMB | Individual | $1,526 | $9,430 |
SLMB | Married | $2,064 | $14,130 |
QI | Individual | $1,715 | $9,430 |
QI | Married | $2,320 | $14,130 |
QDWI | Individual | $5,105 | $4,000 |
QDWI | Married | $6,899 | $6,000 |
Specified Low-Income Medicare Beneficiary (SLMB) Program
While the SLMB program limits are slightly higher, beneficiaries must have Part A and Part B coverage. This program only absorbs Part B premiums and provides members with Extra Help for prescription drugs.
Qualifying Individual Program (QI)
The QI program also requires Part A and Part B enrollment and only covers Part B premiums and prescription drugs. However, people eligible for Medicaid cannot access QI benefits, and enrollment is first-come, first-serve to prioritize active beneficiaries.
Qualified Disabled & Working Individual (QDWI) Program
To access the QDWI program, you must meet the following criteria:
- Have a disability
- Have a job
- Have lost your Social Security Disability Insurance (SSDI) and premium-free Part A benefits because you returned to work
Unlike all the other MSPs, the QDWI program only covers Medicare Part A premiums.
All in All
To reduce out-of-pocket expenses for low-income or disabled Medicare beneficiaries, the state-sponsored Qualified Medicare Beneficiary program provides coverage for Original Medicare premiums and deductibles. While not every MSP offers equivalent access and coverage, they can all help eliminate your Medicare premiums and prescription drug costs. For more information, contact your local Medicaid office or call 1-800-MEDICARE.