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Qualified Medicare Beneficiary (QMB) Program


If you’re a Medicare beneficiary, you know that health care costs can quickly add up. These costs are especially noticeable when you’re on a fixed income. If your monthly income and total assets are under the limit, you might be eligible for a Qualified Medicare Beneficiary program, or QMB. Below, we’ll explain all you need to know about what the QMB program pays for, who’s eligible, and how to sign up.

Qualified Medicare Beneficiary Program

The Qualified Medicare Beneficiary program is a type of Medicare Savings Program (MSP). The QMB program allows beneficiaries to receive financial help from their state of residence with the costs of Medicare premiums and more.

A Qualified Medicare Beneficiary gets government help to cover health care costs like deductibles, premiums, and copays. Recipients must meet all criteria to qualify for the program assistance.

Qualified Medicare Beneficiary Program (QMB)

The QMB program pays:

  • The Part A monthly premium (if applicable)
  • The Part B monthly premium and annual deductible
  • Coinsurance and deductibles for health care services through Parts A and B

If you’re in a QMB program, you’re also automatically eligible for the Extra Help program, which helps pay for prescription drugs.

Who is Eligible for a Qualified Medicare Beneficiary Program in 2020

To be eligible for a QMB program, you must qualify for Part A. Your monthly income must be at or below $1,084 as an individual and $1,457 as a married couple. Your resources (money in checking and/or savings accounts, stocks, and bonds) must not total more than $7,860 as an individual or $11,800 as a married couple.

Income Limits for Qualified Medicare Beneficiaries

Keep in mind that income and resource requirements for the QMB program are subject to increase each year. Thus, members must go through a redetermination to continue receiving benefits for the following year. This process includes providing your local Medicaid office with updated information about your monthly income and total resources.

If someone doesn’t have Part A but is eligible, they can choose to sign up anytime throughout the year. Once they’ve signed up for Part A, they can proceed to apply for the QMB program. If they need to pay a premium for Part A, the QMB program can cover it.

State-Specific Name Conventions for QMBs

In North Carolina QMB is called MQB. If you live in Nebraska, Federal QMB is replaced with full Medicaid.

How to Apply for a Qualified Medicare Beneficiary Program

Anyone interested in applying for a QMB program must contact their state’s Medicaid office. If your income is higher than the QMB requirements, you should still reach out to determine eligibility.

Each state’s Medicaid program pays the Medicare cost-sharing for QMB program members. Anyone who qualifies for the QMB program doesn’t have to pay for Medicare cost-sharing and can’t be charged by their health care providers.

If an individual is considered a QMB Plus, they meet all criteria for the QMB program but also meet all financial requirements to receive full Medicaid services. These enrollees can receive benefits through the QMB program as well as their state’s health plan.

The first step in enrollment for the QMB program is to find out if you’re eligible. A quick and easy way to do this is to call your local Medicaid office. The next step is to complete an application. You can request Medicaid to provide you with an application form or locate a QMB program application from your state online.

Billing Requirements for the Qualified Medicare Beneficiary Program

Providers can’t bill QMB members for their deductibles, coinsurance, and copayments because the state Medicaid programs cover these costs. There are instances in which states may limit the amount they pay health care providers for Medicare cost-sharing. Even if a state limits the amount they’ll pay a provider, QMB members still don’t have to pay Medicare providers for their health care costs and it’s against the law for a provider to ask them to pay.

If Your Provider Charges You and You’re in the QMB Program

Inform who is requesting payment that you’re in the QMB program. If you’ve already paid, you’re entitled to a refund.

To ensure this does not happen, show your QMB card or Medicare and Medicaid card to your providers each time you receive care. Your Medicare Summary Notice (MSN) can also serve as proof that you’re in the QMB program. You can access your MSN electronically through your MyMedicare.gov account.

If a provider continues to bill you, call Medicare’s toll-free number. They will confirm your QMB status and request cessation of billing and/or refunds from your provider(s). In the case that debt collectors wrongly pursue payment, you can submit a complaint to the Consumer Financial Protection Bureau (CFPB) online or via telephone.

Qualified Medicare Beneficiary Programs and Medicare Advantage

If you’re currently in the QMB program, you can enroll in a Medicare Advantage plan. There are 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, but the Medicaid program will pay that premium.

Many people choose this extra coverage because it provides routine dental and vision care, and some come with a gym membership. While not every policy has these benefits, there may be one available in your area!

Do I Need to Enroll in a QMB Program if I Have Medigap

Medigap coverage isn’t necessary for anyone on the QMB program. This program helps you avoid the need for a Medigap plan by assisting in coverage for copays, premiums, and deductibles. Those that don’t qualify for the QMB program may find that a Medigap plan helps make their health care costs much more predictable.

How to Get Additional Coverage with Your QMB Program

If you qualify for a QMB program, you’ll save money on out-of-pocket Medicare costs. For further savings, you can add supplemental coverage to your Original Medicare.

Pairing an Advantage Special Needs Plan with your QMB is a great way to protect yourself from unexpected health costs. It also provides extra benefits at an affordable price.

Call the number above to get rate quotes for plans in your area. Another option is to fill out our form to compare rates. An agent will reach out to you with quotes from top-rated carriers.

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Lindsay Engle

Lindsay Engle is the Medicare expert for MedicareFAQ. She has been working in the Medicare industry since 2017. She is featured in many publications as well as writes regularly for other expert columns regarding Medicare. You can also find her over on our Medicare Channel on YouTube as well as contributing to our Medicare Community on Facebook.

6 thoughts on “Qualified Medicare Beneficiary (QMB) Program

  1. If my son earns $944 per month SSDisability, how much can he earn per month in a part-time job? I know the limit is $1084. IS there a formula to use or is it strictly !084-944=140 dollars.

    Also, he is on a Medicare Advantage plan, and he usually pays $25 per visit but he is a QMB. Should he not be paying that office visit amount? I know that I had shown his Medicaid card at one point, but was unaware that it may pay that $25.

    1. Hi Nancy! Anything over the income limit earned from a part-time job would most likely make him ineligible for QMB. However, there are other Medicare Savings Programs he may still be eligible for as long as his income does not go over the limit set in place by his state for that program. Regarding paying a copay, no, your son should not have to pay a copay if he has QMB. Inform his physician that he has QMB and that you’re entitled to a refund. If they continue to bill you, call Medicare directly. You can file a complaint.

  2. My dad had QMB with help for prescriptions he did not use and Humana Advantage plan. From my understanding Medicaid paid for the Medicare cost each month for part A or B ( not sure which or both).
    I was curious about a bill after reviewing the Humana Advantage plan EOB for an ambulance service and share of cost. I called and was told they sent the bill to Medicaid for payment. My dad passed away. Do I need to be concerned about the ambulance bill that Medicaid paid and also the monthly payments Medicaid paid each month for his Medicare A or B ? Will they ask for recovery of what was paid?
    Note: He was hospitalized and I see payments by his Humana Advantage Plan EOB and everything being paid by his plan.

    Thanks

  3. Hi Lindsay:

    If a patient has Ohio QMB, are they eligible for Medicaid Room and Board for Hospice?

    Thanks

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