- The Qualified Medicare Beneficiary (QMB) program is one of the four Medicare savings programs.
- The QMB program helps those with limited income and resources pay for costs associated with Medicare parts A and B (original Medicare).
- To enroll in the QMB program, you must be eligible for Medicare Part A and meet certain income and resource limits.
- You can contact your state’s Medicaid office to get specific information on your eligibility and the application process.
Medicare savings programs (MSPs) help people with limited income and resources pay for the costs of Medicare. There are four different MSPs available. The Qualified Medicare Beneficiary (QMB) program is one of them.
The QMB program can help pay for Medicare costs including premiums, deductibles, coinsurance, and copays.
Despite these benefits, it’s estimated that only 33 percent of people who are eligible for the QMB program are enrolled in it. Continue reading to explore the QMB program, who’s eligible, and how you can enroll.
Specifically, the program pays for:
- your Medicare Part A deductible
- your Medicare Part B deductible and monthly premiums
- other coinsurance and copay costs associated with Medicare Part A and Part B coverage
If you qualify for the QMB program, you’ll also qualify for Extra Help. This is a program that helps to pay for the costs associated with a Medicare prescription drug plan (Medicare Part D). Extra Help covers things like:
- monthly premiums
- copays for prescriptions
Some pharmacies may still charge a small copay for prescriptions that are covered under Part D. For 2021, this copay is no more than $3.70 for a generic drug and $9.20 for each brand-name drug that is covered.
Additional tips for coverage
If you’re enrolled in the QMB program, the following tips will help ensure that your healthcare costs are covered:
- Let a healthcare professional know that you’re enrolled in the QMB program. Show both your Medicare and Medicaid cards or QMB program card any time you seek care.
- If you receive a bill that should be covered by the QMB program, contact the healthcare professional. Let them know that you’re in the QMB program and cannot be billed for things like deductibles, coinsurance, and copays.
- If the healthcare professional continues to bill you, contact Medicare directly at 800-MEDICARE. They can help confirm with your healthcare provider that you’re in the QMB program and refund any payments you’ve already made.
There are three different eligibility criteria for the QMB program. These include Medicare Part A eligibility, income limits, and resource limits. You can receive QMB benefits whether you have original Medicare (parts A and B) or a Medicare Advantage plan.
MSPs, including the QMB program, are administered through your state’s Medicaid program. That means that your state will determine whether or not you qualify. For example, different states may have different ways to calculate your income and resources.
Let’s examine each of the QMB program eligibility criteria in more detail below.
Medicare Part A eligibility
To enroll in the QMB program, you also need to be eligible for Medicare Part A. Generally, to be eligible for Part A you must be:
- 65 years or older
- any age and have a qualifying disability
- any age and have end stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease)
If you would like to enroll in the QMB program, you must meet certain monthly income limits. These limits depend on whether you’re married or not. For 2021, the monthly income limits for the QMB program are:
- Individual: $1,094 per month
- Married: $1,472 per month
Monthly income limits are higher in Alaska and Hawaii. Because of this, people living in these states may still be eligible for the QMB program, even if their monthly incomes are higher.
The monthly income limit for the QMB program increases each year. That means you should still apply for the program, even if your income goes up slightly.
In addition to a monthly income limit, there is also a resource limit for the QMB program. Items that are counted toward this limit include:
- money you have in checking and savings accounts
Some resources don’t count toward the resource limit. These include things like your house, car, and furniture.
Like income limits, the resource limits for the QMB program are different depending on whether or not you’re married. For 2021, the resource limits for the QMB program are:
- Individual: $7,970
- Married: $11,960
Resource limits also increase every year. As with income limits, you should still apply for the QMB program if your resources have slightly increased.
To see if you qualify and to get information on the application process, contact your state’s Medicaid office. Your State Health Insurance Assistance Program (SHIP) may also be able to help if you have additional questions or concerns.
The enrollment process requires you to fill out a short application form. The Social Security Administration (SSA) has a model form that can be found here. However, the form that you’ll actually fill out may be slightly different, depending on your state.
You may be asked to provide additional documentation as a part of your application process. This may include things like pay stubs, bank statements, or income tax return information.
If you’re enrolled in the QMB program, you’ll have to reapply for it each year. This is because your income and resources may change from one year to the next. Your state’s Medicaid office can give you information about when and how to reapply.
Applying for Extra Help
If you qualify for the QMB program, you automatically qualify for Extra Help. You can enroll in the Extra Help program on the SSA website.
Once you’re enrolled in Extra Help, the SSA will review your income and resource status each year, typically at the end of August. Based on this review, your Extra Help benefits for the upcoming year may stay the same, be adjusted, or be terminated.
The QMB program is one of four MSPs. These programs are aimed at helping those with limited income and resources pay their Medicare out-of-pocket costs.
These covered costs include premiums, deductibles, coinsurance, and copays associated with Medicare parts A and B. If you qualify for the QMB program, you’ll also qualify for Extra Help.
There are a few different eligibility requirements for the QMB program. You must be eligible for Medicare Part A and also meet specified income and resource limits.
For more information about the QMB program in your state, contact your state’s Medicaid office. They can help you determine if you’re eligible and give you all the information needed to apply.