If you find yourself in need of additional assistance in paying for health care costs, you may find the Qualified Medicare Beneficiary Program to be the right avenue for you to pursue. The QMB proves to be an excellent resource for millions throughout the United States.
What’s the QMB Program for Medicare
The Qualified Medicare Beneficiary (QMB) program is a savings program through Medicare. The Qualified Medicare Beneficiary Program allows beneficiaries to receive help from the state they reside in to help cover the costs of Medicare premiums. A Qualified Medicare Beneficiary gets government help to cover healthcare costs like deductibles, premiums, and copays. Recipients must meet all criteria to qualify for the program assistance.
The program provides:
Qualified Medicare Beneficiary Application
Anyone interested in beginning the Qualified Medicare Beneficiary application process needs to contact the state’s Medicaid program. If your income looks higher than the income requirements, still reach out to determine eligibility. Each state’s Medicaid program pays the Medicare cost-sharing for the QMB member. Anyone who qualifies for QMB doesn’t have to pay for Medicare cost-sharing and cannot be charged by their healthcare providers.
The state is responsible for these costs, meaning Medicaid is responsible for these costs. If an individual is considered a QMB Plus, they meet all criteria for the QMB program but also meet all requirements financially to receive full Medicaid services. These enrollees can receive benefits through the QMB program as well as their state’s health plan.
What’s the Income Limit for the QMB Program?
The Qualified Medicare Beneficiary program has a set of specific requirements regarding income. For an individual household, the income limit is $1,060 per month and a resource limit of $7,730. A married couple’s income limit is $1,430 per month and a resource limit of $11,600.
These limits may change from one year to the next, so it’s always best to check and make sure you have the most accurate income information available. Further information about the Medicare Savings Programs can is on Medicare’s website.
How to Enroll in a Qualified Medicare Beneficiary Program
The first step in enrollment for the Qualified Medicare Beneficiary program is to find out if you qualify. A super quick and easy way to do this would be to call your local Medicare program.The next enrollment process step is completing an application. You can locate a QMB program application on Medicare’s website.
To be Qualified Medicare Beneficiary eligible, you must follow the criteria below:
- You must qualify for Part A
- Monthly income must be at or fall below 100% of the annual Federal Poverty Level (FPL).
- The FPL announces its updated income restrictions every year. The income requirements for the QMB can change depending on the income changes with the FPL.
- Resources for an individual must be below $7,730, and funds per couple must be below $11,600, as of 2019. This resource limit is the same in place for the Part D Low Income Subsidy program.
- Individual states may choose to either decrease or increase the resource amounts listed above.
- Each year, members must go through a redetermination to continue receiving benefits for the following year. This process includes providing your local state’s Medicaid office with updated resources and income information.
If a person doesn’t have Part A but is eligible, they can choose to join anytime throughout the year. Once they’ve joined, they can then proceed to apply for the QMB program. The QMB can then cover the Part A premium.
Billing Requirements for the Qualified Medicare Beneficiary Program
Qualified Medicare Beneficiary and Medicare Advantage
If you’re currently in the Qualified Medicare Beneficiary program, you can enroll in a Medicare Advantage plan. There are even unique plans for those with Medicare and Medicaid. A Medicare Advantage Special Needs Plan for dual-eligible individuals could be a fantastic option. Generally, there is a premium for the plan; however, the Medicaid program will pay that premium.
Many people choose this extra coverage because it provides routine dental, vision, and some have a gym membership. While not every policy has these benefits, there may be one available in your area!