People can apply for the Qualified Medicare Beneficiary (QMB) program if they have Original Medicare or a Medicare Advantage (Part C) plan. They may also be eligible if they meet specific criteria.
Medicare helps people with limited income and savings pay for their healthcare costs through Medicare Savings programs (MSPs). The Qualified Medicare Beneficiary (QMB) program is one of four MSPs.
This article looks at the QMB program, what it covers, and the income and resource limits. It also explains eligibility and enrollment limits.
Glossary of Medicare terms
We may use a few terms in this article that can be helpful to understand when selecting the best insurance plan:
- Out-of-pocket costs: An out-of-pocket cost is the amount a person must pay for medical care when Medicare does not pay the total cost or offer coverage. These costs can include deductibles, coinsurance, copayments, and premiums.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before an insurer starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, this is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
The QMB program is one of four Medicare Savings Programs (MSPs). The other three programs are:
Medicare developed these programs to help Medicare beneficiaries with low income pay their healthcare costs.
A person can apply through their state, which decides which MSP a person may qualify for. Medicare encourages people to apply even if they do not think they qualify. More than 6 million adults who are not yet enrolled may be eligible for an MSP.
The QMB program covers Medicare Part A and Part B premiums and some out-of-pocket costs, such as deductibles, copays, and coinsurance.
When a person gets medical care, they should tell their healthcare provider they have QMB program coverage and show their Medicare and QMB program cards.
What if I get a bill?
Generally, if a person gets a bill they believe the QMB program should cover, they can get a refund. There are 3 ways a person can get help:
- Contact Medicare at 1-800-MEDICARE. Medicare will contact the healthcare provider, confirm that the QMB program covers the individual, and refund any payments already made.
- Show their Medicare Summary Notice (MSN) to the provider. The notice confirms a person is in the program. A person can get their MSN by logging in to their MyMedicare.gov account.
- Contact the Consumer Financial Protection Bureau (CFPB). If a debt collector contacts someone, they can call the CFPB at no cost at 1-855 411-2372 or reach the CFPB online.
Someone can enroll in a QMB program providing they meet the monthly income limits.
In 2024, the limit for an individual is $1,275 per month. For a married couple, the combined income must be less than $1,724 per month. The income limits are slightly higher in Alaska and Hawaii.
The income limit increases annually to allow for general inflation and the cost of living.
Other financial resources count toward the QMB resource limit. These items include:
- money in checking accounts
- money in savings accounts
- stocks
- bonds
Some parts of an individual’s property do not count toward the resource limit, such as:
- a primary home where the individual lives
- a primary vehicle
- furniture
- personal items
- a pre-paid burial plot
- a limited burial plan
In 2024, the resource limits are $9,430 for an individual and $14,130 for a married couple.
As with income limits, the resource limits also increase annually.
People with Original Medicare (parts A and B) or a Medicare Advantage plan (Part C) can apply for the QMB program.
Individuals must fulfill the following eligibility criteria:
- have or be eligible for Medicare Part A
- live in the state where they are applying for the QMB program
- have limited income, savings, and resources
The individual state’s Medicaid program administers all Medicare MSPs, including the QMB program, and decides if an individual is eligible for the QMB program.
Typically, states use the Federal Poverty Level (FPL) for income and resources, but the calculations may differ between states.
If an individual wants to apply for the QMB program, they should contact their state Medicare office. This online tool can help a person find the right contact information. A Medicare representative can confirm their eligibility and explain the application process.
Typically, the person making the application must complete a form and provide supporting documentation.
If someone needs more assistance, they can contact their local State Health Insurance Assistance Program (SHIP).
Because a person’s financial situation can change, they must reapply each year to continue receiving the QMB program benefits. An individual’s state Medicaid office can provide information about the reapplication process.
An individual who qualifies for the QMB program automatically qualifies for Medicare Extra Help.
Medicare established this program to help people pay for their Medicare Part D prescription drug coverage. It offers financial assistance for premiums, deductibles, and other associated prescription drug costs.
In 2024, the copay is a maximum of $4.50 for generic drugs and $11.20 for brand-name drugs.
Extra Help does not apply to any Medicare Advantage plans or Medigap plans.
How to apply for Extra Help
After the QMB program accepts an individual’s application, the individual automatically qualifies for the Extra Help program. Individuals can enroll online on the Social Security Administration (SSA) website.
In August each year, the SSA reviews an individual’s income. Depending on the decision, a person’s Extra Help benefits may remain the same, increase, decrease, or end.
If an individual does not meet the QMB program’s qualifying requirements, they can check if another MSP could help them.
The table below compares the four MSPs. The income limit is shown as a percentage of the FPL.
| MSP | Income limit | Benefits |
|---|---|---|
| Qualified Medicare Beneficiary (QMB) | 100% of FPL | Medicare Part A and Part B premiums, deductibles, coinsurance, and co-payments |
| Specified Low-Income Medicare Beneficiary (SLMB) | 100 to 120% of FPL | Medicare Part B premiums |
| Qualifying Individual (QI) | 120 to 135% of FPL | Medicare Part B premiums |
| Qualified Disabled and Working Individuals (QDWI) | under 200% of FPL | Medicare Part A premiums |
Read more about qualifying for MSPs.
Medicare resources
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.
Medicare offers MSPs, including the QMB program. The QMB program provides financial assistance to people who meet specific income and resource limits. It helps pay Medicare premiums and out-of-pocket costs.
If someone qualifies for the QMB program, they automatically qualify for Extra Help, which helps with prescription drug costs.
People should contact their state’s Medicare office for more information and to apply.