Qualified Medicare Beneficiary
(QMB) Program
What is the QMB Program?
The Qualified Medicare Beneficiary (QMB) Program is one of four Medicare Savings Programs. These programs assist individuals with the costs of Medicare. Medicare Savings Programs are run through each state’s Medicaid program.
Who is Eligible for the QMB Program?
Medicare beneficiaries who meet certain income and resource limits are eligible for the QMB program. The eligibility limits change a little every year, but monthly income of around $2000 or less should be near the eligibility limit, depending on the year, your resident state, whether you’re working, and whether you’re filing as an individual or married couple.
What is Covered by the QMB Program?
The QMB program covers Medicare Parts A and B premiums, deductibles, copayments, and coinsurance. In short, almost all your Medicare bills will be covered if you’re eligible for this program. You will receive a QMB card that you will show providers alongside your Medicare card, or you will show them both your Medicare and Medicaid cards to let them know that you are part of the Qualified Medicare Beneficiary Program.
Extra Help
If you qualify for the QMB Program, you will also automatically qualify for Extra Help, a program that assists with prescription drug costs. Extra Help may pay your Prescription Drug Plan premium and deductible, as well as set a maximum cost for each prescription, usually between $4-10. Extra Help is run through the Social Security Administration.
QMB Example Scenario
You have Medicare Parts A and B, plus a Part D prescription drug plan. You don’t pay a premium for Part A, but you do have premiums for Parts B and D. While on the Qualified Medicare Beneficiary Program:
· You do not pay a monthly Part B premium
· You do not pay a monthly Part D premium
· Because deductibles are covered, your full Medicare coverage starts January 1.
· When you go to the doctor for a Medicare-covered service, the doctor’s office will not bill you and you will not pay the typical 20% copayment.
· You pay less for your prescriptions, just around $4 for the generic ones and around $10 for the name-brand prescriptions.
What About Medicare Advantage (Part C) Plans?
The Qualified Medicare Beneficiary Program works with Medicare Advantage (Part C) Plans as well. Because you continue to pay your Part A and/or B premiums while enrolled in a Part C Plan, those costs will be covered, as well as any deductible, coinsurance, or copay for the services covered by Original Medicare. The savings on prescription drugs will also carry over to a Medicare Advantage Prescription Drug Plan (MAPD).
However, you may still pay a premium for the Medicare Advantage Plan, as well as coinsurance or copays for additional benefits that Original Medicare doesn’t cover.
How Do I Enroll in the QMB Program?
Contact your state’s Medicaid offices. It’s worth applying for the program even if you’re not sure whether you qualify. Due to differences in eligibility by state—based on your income, savings, properties, and your working situation—calculating your own eligibility can be difficult.
Enrollment Eligibility
Annual Enrollment Period (AEP)
Medicare Annual Enrollment Period runs each year from October 15 to December 7. What is the Annual Enrollment Period vs. Open Enrollment Period?
Initial Enrollment Period (IEP)
Your Initial Enrollment Period generally surrounds your 65th birthday but may occur if you otherwise become eligible for Medicare for the first time.
Special Enrollment Period (SEP)
You may be eligible if you experience a qualifying life event such as moving to a new zip code, losing employer coverage, or change in Medicaid status.
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Further Reading:
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Last Updated: October 13, 2023 MULTIPLAN_ETQEZMwebsite_2024_M