What is the Qualified Medicare Beneficiary Program?
The Qualified Medicare BeneficiaryA person who has health care insurance through the Medicare or Medicaid programs.... (QMB) program is one of four Medicare Savings Programs that assist low-income beneficiaries with their costs in Original MedicareOriginal Medicare is private fee-for-service health insurance for people on Medicare. It has two parts. Part A is hospital coverage. Part B is medical coverage...., including premiumsA premium is an amount that an insurance policyholder must pay for coverage. Premiums are typically paid on a monthly basis. In the federal Medicare program, there are four different types of premiums. ..., deductiblesA deductible is an amount a beneficiary must pay for their health care expenses before the health insurance policy begins to pay its share...., and copaymentsA copayment, also known as a copay, is a set dollar amount you are required to pay for a medical service..... Qualification is based on annual income.
Key Takeaways
- The Qualified Medicare Beneficiary (QMB) program pays a qualifying beneficiary’s Medicare Part AMedicare Part A is hospital coverage for Medicare beneficiaries. It covers inpatient care in hospitals and skilled nursing facilities. It also covers limited home healthcare services and hospice care.... 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 MedicaidMedicaid is a public health insurance program that provides health care coverage to low-income families and individuals in the United States.... 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 also qualify for prescription drug assistance through the Social Security Extra HelpSocial Security's Low-Income Subsidy (LIS) program helps Medicare beneficiaries pay for their Medicare Part D prescription drugs by paying some of the costs. Also known as "Extra Help", beneficiaries who qualify for LIS receive premium... 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 BMedicare Part B is medical coverage for people with Original Medicare benefits. It covers doctor visits, preventative care, tests, durable medical equipment, and supplies. Medicare Part B pays 80 percent of most medically necessary healthcare... cost-sharing amounts, such as deductibles, coinsuranceCoinsurance is a percentage of the total you are required to pay for a medical service. ... 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-eligibleDual-eligible beneficiaries are those who receive both Medicare and Medicaid benefits. It includes beneficiaries enrolled in Medicare Part A and/or Part B while receiving full Medicaid and/or financial assistance through a Medicare Savings Program....) 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 DMedicare Part D plans are an option Medicare beneficiaries can use to get prescription drug coverage. Part D plans provide cost-sharing on covered medications in four different phases: deductible, initial coverage, coverage gap, and catastrophic. Each... 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