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.
The Medicare QMB Program
The Qualified Medicare Beneficiary (QMB) program is a savings program through Medicare. The QMB program allows beneficiaries to receive help from the state they reside in to help cover the costs of Medicare premiums.
The program provides:
- Part A monthly premium payments
- Part B monthly premium payments and the annual deductible
- Coinsurance and deductibles for health care services through Parts A and B
Anyone interested in beginning the QMB 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.
Qualified Medicare Beneficiaries
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.
What is the Income Limit for the QMB Program
The QMB 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.
Enrolling in the QMB Program
The first step in enrollment for the QMB 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 QMB 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 in Part A anytime throughout the year and then proceed to apply for the QMB program.
The QMB can then cover the Part A premium.
Since traditional Medicare doesn’t cover dental or vision care, it’s likely; you won’t get all Medicaid benefits that include vision and dental.
QMB members can get assistance for prescription drug coverage through Medicaid. Dual-eligible people have automatic enrollment in the Extra Help program.
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.
QMB and Medicare Advantage
If you’re currently in the QMB 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!
Billing Requirements for the QMB Program
Providers cannot 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 in which they’ll pay a provider, QMB members still don’t have to pay Medicare providers for the health care costs they’ve incurred through Part A and B.
Medigap and QBM
Medigap coverage isn’t necessary for anyone on the QMB program. Since this program assists in coverage for copays, premiums, and deductibles, it completely avoids the need for Medigap plans.
Those that don’t qualify for the QMB program may find that a Medigap plan helps make your health care costs much more predictable.
If you’d like to receive more information on Medigap plans, or if you need assistance with navigating the Qualified Medicare Beneficiary Program, please give our team of Medicare experts a call at the number above.
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