The Qualified Medicare Beneficiary (QMB) program is one of four Medicare Savings Programs that assist low-income beneficiaries with their costs in Original Medicare, including premiums, deductibles, and copayments. Qualification is based on annual income.
Key Takeaways
- The Qualified Medicare Beneficiary (QMB) program pays a qualifying beneficiary’s Medicare Part A and Part B premiums, deductibles, and copayments or coinsurances.
- Qualifying QMB Plus beneficiaries receive all of the benefits of the QMB program as well as the benefits of their state Medicaid program.
- Beneficiaries must be enrolled in Medicare and have an income at or below the federal poverty level.
- Qualifying beneficiaries can call their state’s Medicare Program to apply for the QMB.
- QMB beneficiaries qualify for prescription drug assistance through the Social Security Extra Help program.
How Does QMB Assist with Medicare Costs?
The QMB program provides assistance with Medicare Part A and Part B premiums, deductibles, and copayments/coinsurance. QMB program beneficiaries cannot be charged by Medicare providers for Medicare Part B cost-sharing amounts, such as deductibles, coinsurance and, copays. If a beneficiary receives a charge or a bill for these costs, they can request a refund.1Medicare.gov, “Medicare Savings Program“, Accessed October 27, 2021
QMB and Medicaid (QMB Plus)
A Medicare beneficiary that qualifies for both Medicare and Medicaid (dual-eligible) receives QMB Plus. QMB Plus beneficiaries do not pay Medicare Part A or Part B premiums, deductibles, or copayments. Plus, they receive all of the benefits available through their state’s Medicaid program, which often includes routine vision, dental, and hearing benefits not covered by Medicare.2CMS.gov, “Dually Eligible Individuals – Categories“, Accessed October 27, 2021
How to Qualify for QMB
To qualify for the QMB program, beneficiaries must be enrolled in Medicare Part A and/or Part B and have a monthly income that falls below the Federal Poverty Level (FPL). Beneficiaries must also demonstrate that their financial resources do not exceed the FPL. These resources include:1Medicare.gov, “Medicare Savings Program“, Accessed October 27, 2021
- Money in a checking or savings account
- Stocks
- Bonds
How to Apply for the QMB
To apply for the QMB program, beneficiaries should call their state Medicare Program at 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.3Medicare.gov, “Talk to someone“, Accessed October 27, 2021
Extra Help for Prescription Drugs
Beneficiaries that qualify for Medicaid, QMB, or another Medicare Savings Program, also qualify for the Social Security Extra Help program. Extra Help assists with Medicare Part D plan prescription drug coverage costs.1Medicare.gov, “Medicare Savings Program“, Accessed October 27, 2021
Citations
- 1Medicare.gov, “Medicare Savings Program“, Accessed October 27, 2021
- 2CMS.gov, “Dually Eligible Individuals – Categories“, Accessed October 27, 2021
- 3Medicare.gov, “Talk to someone“, Accessed October 27, 2021