What Is the Medicare QMB Program?

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Do you have trouble paying your Medicare bills? Is your income too high to qualify for Medicaid? Consider applying for the Qualified Medicare Beneficiary (QMB), a Medicare program that helps you get assistance from your state in paying for Medicare costs.

If you’re curious about the QMB program, this article will go over the basics of the QMB program, including what it is, how it works, what it covers, the eligibility requirements and how to apply to participate in the program. This way, you can start accessing affordable healthcare even if you have higher Medicare costs. 

What Is the Medicare QMB Program?

The Qualified Medicare Beneficiary program is a federal assistance program that helps certain low-income Medicare beneficiaries pay for their Medicare Part A and Part B premiums, deductibles coinsurance, and copays for Medicare-covered items and services. The Medicare QMB program is frequently used by people whose income is considered too high to qualify for Medicaid. It’s one of several Medicare savings programs funded by the federal government but administered by each state’s Medicaid system.

Enrolling in the QMB program in your state of residence can reduce your Medicare costs and copays. This is done through Medicaid, directly paying healthcare providers for your medical care. Also, if you qualify for the QMB program, you automatically qualify for the Extra Help program that covers some prescription drug costs.

According to the Centers for Medicare & Medicaid Services, it’s against federal law for healthcare providers, including Medicare suppliers and pharmacies, to bill Medicare QMB program beneficiaries. Therefore, if you are enrolled in the Medicare QMB program, healthcare providers should not bill you for Medicare-covered items and services.

If this happens, you can notify Medicare and request a refund. To avoid such scenarios, however, always show your Medicare and Medicaid cards (or QMB cards) to your healthcare provider every time you receive medical care.

What Does the QMB Program Cover?

It’s important to note the items and services covered by the QMB program so that you know which items and services you should not pay for when receiving medical care. The following are the items and services covered by the QMB program:

  • Medicare Part A premiums
  • Medicare Part B premiums
  • Prescription drug costs of over certain amounts covered by Medicare Part D
  • Medicare deductibles, co-payments and coinsurance for Medicare-covered items and services

What Are the Eligibility Requirements?

To be eligible for Medicare, you must meet a few criteria, so make sure to go through this checklist to see if you qualify for the QMB Program. You’re eligible for the QMB Program if you:

  • Are entitled to Medicare Part A premiums
  • Have an individual resource limit of $8,400
  • Are a married couple with a resource limit of $12,600
  • Have an individual monthly income of at most $1,153
  • Are a married couple with a monthly income of at most $1,546

Keep in mind that these income and resource limits frequently change from year to year. As a result, you should always double-check the Medicare Savings Programs page for any changes to the income requirements.

What Does the QMB Program Resource Limit Include?

The QMB program resource limit is a federally mandated limit on the amount of resources a Medicaid beneficiary can have to qualify for the program. According to Medicare, the resources they consider include the following:

  • Bonds
  • Stocks
  • Savings or checking account

However, resources do not include either of the following:

  • Furniture
  • Burial plot
  • Your house
  • One vehicle
  • Up to $1,500 for burial expenses
  • Other household and personal items

How to Apply for the QMB Program

The QMB program is awarded based on your state of residence. To apply, contact the Medicare program and let them know you’d like to apply to the program.

Before you begin the application process, ensure you are familiar with the criteria and questions that Medicaid will ask. You can begin collecting supporting documents such as bank statements, proof of home address, citizenship, Medicare cards, Social Security cards, tax returns and any other documents required by the application form. Also, verify your income and resource limits to see if you qualify for the QMB program.

Once your application is approved, it may take several months to receive your benefits. This can take between one and three months. After your application is approved, Medicaid will typically start paying your Medicare expenses on the first day of the month. You will notice an increase in your Social Security payments. The Social Security Administration can also refund payments you made after enrolling in the program.

Medicare requires that you re-apply for the program every year. In the event of any clarification questions, always feel free to contact Medicare support for additional help.