Qualified Medicare Beneficiary Program

The Qualified Medicare Beneficiary (QMB) program is one of four Medicare Savings Programs that assist low-income beneficiaries with their costs in Original Medicare, including premiums, deductibles, and copayments. Qualification is based on annual income.

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• The Qualified Medicare Beneficiary (QMB) program pays a qualifying beneficiary’s Medicare Part A 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 Medicaid 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 qualify for prescription drug assistance through the Social Security Extra Help program.

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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 B cost-sharing amounts, such as deductibles, coinsurance and, copays. If a beneficiary receives a charge or a bill for these costs, they can request a refund.[mfn referencenumber=1]Medicare.gov, “Medicare Savings Program“, Accessed October 27, 2021[/mfn]

QMB and Medicaid (QMB Plus)

A Medicare beneficiary that qualifies for both Medicare and Medicaid (dual-eligible) 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.[mfn referencenumber=2]CMS.gov, “Dually Eligible Individuals – Categories“, Accessed October 27, 2021[/mfn]

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:[mfn referencenumber=1]Medicare.gov, “Medicare Savings Program“, Accessed October 27, 2021[/mfn]

• 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.[mfn referencenumber=3]Medicare.gov, “Talk to someone“, Accessed October 27, 2021[/mfn]

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 D plan prescription drug coverage costs.[mfn referencenumber=1]Medicare.gov, “Medicare Savings Program“, Accessed October 27, 2021[/mfn]