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Qualified Medicare Beneficiary (QMB) Program


If you’re a Medicare beneficiary, you know that healthcare costs can quickly add up. These costs are especially noticeable when you’re on a fixed income. If you are a senior with a monthly income and total assets that 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.

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What Is QMB?

The Qualified Medicare Beneficiary (QMB) 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 healthcare costs like deductibles, premiums, and copays. Recipients must meet all criteria to qualify for the program assistance.

Qualified Medicare Beneficiary Program (QMB)

  • The Medicare Part A monthly premium (if applicable)
  • The Medicare Part B monthly premium and annual deductible
  • Coinsurance and deductibles for healthcare services through Medicare Part A and Part B

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

QMB Income Limits 2022

To be eligible for a QMB program, you must qualify for Medicare Part A. Your monthly income must be at or below $1,153 as an individual and $1,526 as a married couple. Your resources (money in checking and/or savings accounts, stocks, and bonds) must not total more than $8,400 as an individual or $12,600 as a married couple.

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 Medicare Part A but is eligible, they can choose to sign up anytime throughout the year. Once they sign up for Medicare Part A, they can proceed to apply for the QMB program. If they need to pay a premium for Medicare Part A, the QMB program can cover it.

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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 QMB Program

Seniors submitting a QMB application 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 healthcare providers.

QMB Plus

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 for Medicaid to provide you with an application form or locate a QMB program application from your state online.

Billing Requirements for QMB

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 healthcare 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 healthcare 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.

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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 prove 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.

Is QMB Full Medicaid?

No, QMB and Medicaid are two different programs. If you are part of a QMB program, you will not receive regular Medicaid benefits. The Medicaid program covers out-of-pocket Medicare costs for beneficiaries of the QMB program. Deductible or coinsurance payments for services covered by your State Plan are not limited by Medicaid.

How Does QMB Work With Medicare Advantage Plans?

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 in 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 healthcare costs much more predictable.

Can a Medicare Provider Refuse a QMB Patient?

According to the regulations set out by the Centers for Medicare & Medicaid Services (CMS), Medicare providers cannot discriminate against patients based on source of payment, which includes QMB and other assistance programs.

Does Social Security Count as Income for QMB?

Your Social Security Income (SSI) payments will count as income when applying for QMB. Seniors must take this into consideration and fall within the appropriate thresholds in order to qualify for the program.

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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 a QMB and Medicare Advantage Special Needs Plan 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 that work with your QMB eligibility. 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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Jagger Esch

Jagger Esch is the Medicare expert for MedicareFAQ and the founder, president, and CEO of Elite Insurance Partners and MedicareFAQ.com. Since the inception of his first company in 2012, he has been dedicated to helping those eligible for Medicare by providing them with resources to educate themselves on all their Medicare options. He is featured in many publications as well as writes regularly for other expert columns regarding Medicare.

28 thoughts on “Qualified Medicare Beneficiary (QMB) Program

  1. 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

    1. Hi JM. So sorry to hear about the passing of your father. As long as Social Security has been notified of his passing, there is nothing you need to do regarding Medicaid or Medicare for him. His Medicare Advantage plan & Medicaid should’ve taken care of any ambulance bills. You are not responsible for any medical bills left unpaid. Please don’t hesitate to reach out if you have any additional questions.

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