How-to Qualify for Dual Eligibility (Medicare + Medicaid)
- You must be enrolled in Medicare Part A.
- You must prove your income is at or below the national poverty level.
- You must prove that you do not have cash value resources above a certain value.
- You must apply at your local Medicaid office.
Qualified Medicare Beneficiary (QMB) Program Details
For those who qualify, the federal QMB program pays the cost of their Medicare premiums, deductibles and co-insurance. These costs are typically paid by the Medicare beneficiary. Beneficiaries qualify based on their monthly income and cash value assets.
If you’re enrolled in Medicare Part A, for your hospital insurance, and your income and resources meet the federal poverty threshold, you are most likely eligible to enroll in the QMB program. When you’re enrolled, your state’s Medicaid program pays some or all of your Medicare Part B premium, Part A and Part B deductibles, and co-insurances. This is a significant financial relief for anyone qualified to receive the benefits. Some people call QMB the full benefit for dual-eligible beneficiaries.
QMB Eligibility Requirements
The rules are somewhat different for each state. The general federal guideline is that you must meet these basic requirements:
- You must be enrolled in Medicare Part A.
- Your normal monthly income must be at or below the national poverty level (updated annually).
- Excluding exempt property, you may not have cash resources that exceed a certain value. Your home, one car, and certain other personal items are not typically counted as resources.
Does the QMB Program Supplement Medicare?
QMB pays the beneficiary’s premiums, deductibles, and co-insurance through their state’s Medicaid program. In essence, it acts like a free Medigap plan for the beneficiary, covering all Medicare-approved costs that most beneficiaries pay out-of-pocket. Some states require you to pay a small co-payment when you see a doctor.
Other Dual Eligible Programs
There are two other related programs:
- Specified Low-Income Medicare Beneficiary (SLMB); and
- Qualifying Individual (QI).
These programs help if your income is too high for QMB, but is within 20 percent above the federal income poverty level.
SLMB coverage helps people with their Medicare Part B monthly premium. If you qualify, you continue to pay your deductibles and co-insurance costs. Eligibility is the same as those for QMB, with the exception of monthly income, which cannot exceed 120 percent of the national poverty level.
If your income is more than 120 percent of the federal poverty level, you may qualify under the QI program. If your income is less than 135 percent of the national poverty level, your state may pay your Medicare Part B premium if funds are available. This is a first first-come, first-served program, with a limited pool of funds. You must apply annually.
How-to Apply
If you’re enrolled in Medicare Part A and think you qualify for assistance, visit your local state Medicaid office.
