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What is QMB and QMB+? Do I qualify for it?

Health care costs can add up quickly, but there are other options for individuals who are struggling to pay for their Medicare coverage. Medicare Savings Programs (MSP) are designed to help qualified individuals by covering some of the costs of Medicare Parts A and B, deductibles, coinsurance, and copayments.

Today, we’re talking about QMB programs in particular, which is for individuals who are at or below the national poverty line.

What are QMB and QMB+?

QMB, or the Qualified Medicare Beneficiary Program, is a Medicare Savings Program for people who have Medicare, but need help paying for some Medicare costs. It typically covers the Medicare Part A (hospital insurance) premium and the Medicare Part B (medical insurance) premium. The program also helps cover Medicare expenses, such as deductibles, coinsurance, and copayments. This means that you should not be billed for any approved Medicare Parts A and B care you receive from an approved facility by an approved provider. If you qualify for QMB, you also automatically qualify for the Extra Help prescription drug program, which aids in paying for your medications.

There are two types of Qualified Medicare programs: QMB Only and QMB Plus.

  • QMB Only provides assistance for specific Medicare costs, but does not cover any additional costs. As stated above, this program covers Medicare Part A and Part B premiums, deductibles, copays, and coinsurance. QMB Only cannot be used to receive benefits outside of what is covered by Medicare.
  • QMB Plus covers the same costs as QMB Only, plus allows recipients to receive full Medicaid benefits. Not every state offers this program, however, and you will need to speak to a Medicare agent to determine your options.

Both programs provide individuals with an alternative way to pay for their medical bills. One thing to note, however, is that QMB programs are specifically for very low-income individuals and certain limits on income and resources must be met in order to qualify.

Do I qualify for QMB?

To qualify for QMB, you must first meet the requirements for Medicare. Medicare is available to individuals 65 years of age or older and individuals with certain disabilities. Medicare is specifically for low-income individuals, and as with all MSPs, QMB programs have limits on income and resources in order to qualify. If you are under these limits you may qualify for QMB Medicare:

  • Individual monthly income limit: $1,084
  • Married couple monthly income limit: $1,457
  • Individual resource limit: $7,860
  • Married couple resource limit: $11,800

This program provides unparalleled assistance for its enrollees and can make a huge difference in the care individuals receive. If you think you are eligible for the QMB Medicare program, you should speak with a qualified Medicare agent to maximize your health benefits and apply for coverage.

The Medicare Policy Center is here to help you get the Medicare coverage you need.

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