- 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.
Four Medicare savings programs (MSPs) were created to help people who have difficulty affording Medicare costs. These programs include:
- Qualified Medicare Beneficiary (QMB) program
- Specified Low-Income Medicare Beneficiary (SLMB) program
- Qualified Individuals (QI) program
- Qualified Disabled and Working Individuals (QDWI) program
This article will focus on the QMB program and, more specifically, the guidelines for eligibility. Like other Medicare savings programs, the QMB has set limits on income and resources 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 covers:
Since the QMB program aims to help individuals with low income, it places limits on the monthly income and financial resources 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 2021, the federal poverty level is $12,880 per year for individuals in Washington, D.C., and 48 states. Limits are higher in Alaska ($16,090) and Hawaii ($14,820).
Specific financial requirements for the QMB for individuals are:
- a monthly income limit of $1,094
- an asset limit of $7,970
Specific financial requirements for the QMB for married couples are:
- a monthly income limit of $1,472
- an asset limit of $11,960
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
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 for the QMB program, you’ll need to contact your state Medicaid office. You can 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.