- If you can’t afford your Medicare premiums, the Qualified Medicare Beneficiary (QMB) program might be able to help.
- To qualify for the QMB program, your assets and monthly income must fall below certain limits.
Medicare offers healthcare services to people ages 65 and over, as well as those with certain health conditions or disabilities. Though the goal is to keep these services generally affordable, you may still need help paying your share of costs.
Four Medicare savings programs (MSPs) were created to help people who find themselves unable to pay for their share of Medicare. These programs include:
- Qualified Medicare Beneficiary (QMB) program
- Specified Low-Income Medicare Beneficiary (SLMB) program
- Qualified Individual (QI) program
- Qualified Disabled and Working Individuals (QDWI) program
This article will focus on the QMB program, what it covers, and the guidelines for eligibility. Like other Medicare savings programs, the QMB sets limits on your income and resources in order for you to participate.
The four MSPs cover certain Medicare premiums and other costs that might fall to participants. As of 2017, 7.7 million people — about 1 in 8 Medicare beneficiaries — were enrolled in the QMB program.
The QMB program is available to anyone who falls under certain income and resource limits. It covers:
- Medicare Part A premiums
- Medicare Part B premiums
- coinsurances associated with Medicare parts A or B
- copayments associated with Medicare parts A or B
- deductibles associated with Medicare parts A or B
The other three MSPs pay for less or are restricted to individuals with certain qualifications or disabilities.
Since the QMB program aims to help low-income individuals, it places limits on the monthly income and financial resources you have available to you. If you exceed these limits, you may not be eligible for the program.
Generally, participation is limited to individuals who meet the federal poverty level. For 2020, the federal poverty level is $12,760 per year for individuals in Washington, D.C., and 48 states. Limits are higher in Alaska ($15,950) and Hawaii ($14,680).
Specific financial requirements for the QMB for individuals are:
- a monthly income limit of $1,084
- an asset limit of $7,860
Specific financial requirements for the QMB for married couples are:
- a monthly income limit of $1,457
- an asset limit of $11,800
If you think your income and assets are too high to make you eligible for this program, try applying anyway. Several exceptions and considerations are made when calculating income and assets.
Income that isn’t counted toward QMB eligibility includes:
- the first $20 of your income for the month
- the first $65 of any wages you earn for the month
- half of any wages you earn after the initial $65 is deducted
- food stamps
The program does allow you to have $20 in income each month above the federal poverty limit.
Income limits may also vary slightly by state. You must be a resident of the state in which you’re applying for the QMB program, and you must already be enrolled in Medicare Part A.
Assets that aren’t counted when you apply for the QMB program include:
- your primary home
- one vehicle
- household items
- engagement and wedding rings
- burial plots
- burial expenses of up to $1,500
- life insurance that has a cash value below $1,500
Tips for finding help paying for Medicare
Medicare was created to offer healthcare services for people ages 65 and over as well as those with certain health conditions. But out-of-pocket costs like premiums, copayments, and deductibles can add up. If you’re having trouble paying for your share of Medicare costs, you can take several actions or look into programs that can help:
- Dual eligibility. If you have significant need or disability, you may qualify for both Medicare and Medicaid. This is called dual eligibility, and it could offer you additional health coverage and services.
- Extra Help. This program offers savings on prescription medication costs, but you have to be enrolled in a Medicare Part D prescription plan to participate. If you qualify for a QMB, you should also qualify for the Extra Help program.
- Medicare Advantage (Part C) plans. Medicare parts A and B cover inpatient and outpatient care, respectively. Medicare Part D is an optional program that covers prescription medications. Medicare Part C, or Medicare Advantage, allows you to tailor a Medicare plan that best suits your healthcare and financial needs. Bundling Medicare services through an Advantage plan may help you save money.
- Medicare savings programs. These programs — including the QMB — help cover a share of your Medicare costs. Participation is limited to particular needs and income limits.
- Sign up on time and plan ahead. A variety of penalties may be applied to your share of Medicare costs. Sign up for initial coverage on time. Add additional services you think you might need within designated time frames to avoid late fees and penalties.
- Update your income. A number of Medicare programs use income to determine eligibility. If your income drops, be sure to update Medicare.
To enroll in the QMB program, you first need to be enrolled in Medicare Part A.
The next step is to review your income and assets to see if you fall below the limits set by Medicare. But remember there are exceptions to those limits, and you’re encouraged to apply even if your income or assets exceed them.
To apply, you’ll need to contact your state Medicaid office. Check online to find your state’s office locations, or call Medicare at 800-MEDICARE. The documentation you’ll need varies by state, but your application process will likely include submissions of identification, proof of Medicare coverage, and financial information.
Once you submit your application, you should receive a confirmation or denial within about 45 days. If you’re denied, you can request an appeal. Enrollment in any of the MSPs must be renewed each year.
Even when your QMB is active, you may at times be wrongfully billed for items or services that it covers. Contact Medicare for any billing problems. Be sure to carry documentation of your participation in the QMB program and show it to your providers.
- Medicare is meant to provide affordable healthcare coverage for older adults and other individuals in need. Even so, out-of-pocket costs can add up.
- A number of programs can help you pay for your share of Medicare costs. The QMB program is just one way to get help paying your premiums, deductibles, and other costs.
- You must fall below income and asset limits to participate in the QMB program. If you think you make or own too much, try applying anyway. Many assets and income sources aren’t included when calculating your eligibility.