What Is the Qualified Medicare Beneficiary (QMB) Program?

In this article...
  • The Qualified Medicare Beneficiary (QMB) program pays for Medicare Part A and B coverage. Find out if you're eligible for the QMB, how it works and where to apply.

If you're a low-income senior or person with disabilities, you may be eligible to have your Medicare Part A and B coverage paid for through the Qualified Medicare Beneficiary (QMB) Program.

The QMB program makes Medicare more accessible by paying for premiums, deductibles and cost-sharing of Medicare-covered expenses. About 7.7 million people, or 12.5% of people with Medicare coverage, receive assistance through the QMB program. 

What Medicare Costs Are Paid For by QMB?

QMB is one is of four Medicare Savings Programs designed to assist those with limited financial resources to more easily access Medicare coverage. These programs are federally funded and administered through state-run Medicaid agencies.

Under the Qualified Medicare Beneficiary Program, health care providers are not permitted to bill you for Medicare services. QMB pays for:

  • Part A premiums
  • Part B premiums
  • Deductibles 
  • Coinsurance 
  • Co-payments 

Are Prescription Drugs Covered Through QMB?

Beneficiaries who qualify for the QMB program automatically receive assistance with the costs of their prescription drugs through Extra Help. Also known as the Part D Low Income Subsidy, this program limits the costs you pay out of pocket to a few dollars per prescription.

You may be able to find a Part D prescription drug plan or a Medicare Advantage (Medicare Part C) prescription drug plan available in your area. Get started by comparing plans online and find out everything about each plan offered where you live, such as their costs and whether your pharmacy is part of the plan network.

Does QMB Pay for Dental Care?

Because standard dental care such as cleanings, fillings, extractions and dentures aren't typically covered by Medicare, unless required during a hospital stay, these expenses aren't covered by the QMB program.

Qualifying for the QMB Program

You may be eligible for the Qualified Medicare Beneficiary program if you:

  • Qualify for Medicare Part A
  • Are at or below the income limits established for the program
  • Are below the resource limits established for the program. This includes bank accounts, stocks and bonds.

For 2020, these limits are:

  • Income (Individual): $1,084 per month
  • Income (Married Couple): $1,457 per month
  • Resources (Individual): $7,860
  • Resources (Married Couple): $11,800

Because limits may change, visit the Medicare website for current eligibility information.

How Does the Program Work?

Once you're enrolled in the QMB program, you're no longer legally obligated to pay for deductibles, coinsurance or co-payments for any services or items covered by Medicare Part A or B.

Always show your QMB card before receiving services from Medicare providers, suppliers and pharmacies to ensure they don't bill you. You can also show a copy of your Medicare Summary Notice.

If you're charged, advise the provider that you're enrolled in the QMB program. If you've made a payment while enrolled in the program, you're entitled to a refund.

Is QMB a Medicaid Program?

While QMB is administered by your state Medicaid agency, it's a separate program from Medicaid and provides different coverage. For example, Medicaid covers vision and dental, but QMB doesn't. Qualifying for QMB does not mean you automatically qualify for Medicaid. 

How to Apply for QMB

To apply for the Qualified Medicare Beneficiary program, contact your state Medicaid agency. Medicare encourages you to fill out an application if you think you might be eligible, even if your resources exceed the limits posted on their website.

For more information about this program, call Medicare at 1-800-633-4227.

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