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What is the Qualified Medicare Beneficiary (QMB) program and how can it save me money?

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Question: What is the Qualified Medicare Beneficiary (QMB) program and how can it save me money?

Answer: The Qualified Medicare Beneficiary (QMB) program is one of four Medicare Savings Programs (QMB, SLMB, QI, and QDWI) established by Medicare to help low-income Medicare beneficiaries pay their Medicare Part A premiums, Medicare Part B premiums and a portion of Medicare coverage costs such as deductibles and co-insurance.

A Medicare beneficiary who qualifies for the QMB program will automatically qualify for the Medicare Part D Extra Help program that provides financial assistance with Medicare Part D prescription drug coverage (monthly premiums, deductibles, and drug costs).

What costs does the QMB program cover?

For those who qualify for the QMB program, this Medicaid program pays:
  • Medicare Part A premiums,
  • Medicare Part B premiums,
  • Medicare deductibles, and
  • Medicare coinsurance amounts for Medicare services.
  • Medicare Part D prescription drug plan premiums (depending on the chosen plan)
  • A portion of your Medicare drug costs
Bottom line: If you qualify for the QMB Medicare Savings Program, you could save a substantial amount of money on Medicare Part A, Medicare Part B, and Medicare Part D prescription drug coverage.

Who is eligible for the QMB program?

To be qualified for the QMB program, you must be a Medicare beneficiary and:
  • Be enrolled in Medicare Part A (Hospital or In-patient insurance),
  • Be a resident of the state where you are applying for your QMB benefits, and
  • Have limited income and assets or financial resources.
  • Specifically, to qualify for the QMB program you must have income and assets meeting 100% of the Federal Poverty Level (FPL).  (You can click here to read more about the current Federal Poverty Level.)
    • As an example, in 2015 the income limits are $981 for a single person or $1,328 for a couple and
    • The 2015 asset or allowed financial resource limit is: $7,280 per individual or $10,930 per couple.
    • Your financial resources or assets that count toward QMB eligibility include: your checking accounts, savings accounts, and investments such as stocks, bonds, and mutual funds.
    • Some of your property will not count as assets when qualifying for the QMB program, such as:
      • Your primary home where you or your spouse lives,
      • Your primary car,
      • Furniture / personal items,
      • A pre-paid burial plot, and
      • A limited burial plan.
Please note: The Federal Poverty Level can (and usually does) change each year so the income and resource limits for the QMB program can change each year.

Important:  Annual changes in the FPL mean that, even if you might not have qualified for QMB last year, under the new FPL, you may be able to qualify this year.

How do you apply for the QMB program?

To apply for the QMB program, you will need to contact your local state Medicaid office.  For more assistance, you may wish to contact your local State Health Insurance Assistance Program (SHIP).

As a note:  You may also wish to see if your state has a State Pharmacy Assistance Program (SPAP).  SPAPs are state-funded programs that provide low-income and medically needy senior citizens and individuals with disabilities financial assistance for prescription drugs.  We have SPAP information online here (note that the SPAP information is subject to change without notice):  http://www.q1medicare.com/PartD-State-PharmacyAssistancePrograms.php

What are the other related Medicare Savings Programs?

If you do not meet the low-income financial requirements to qualify for the QMB program, you still may have some of your Medicare costs covered by one of the other Medicare Savings Programs.  The four Medicare Savings Programs include:

Limits *
Qualified Medicare Beneficiary (QMB) Program 100% of FPL
QMB helps pay Medicare Part A premiums, Medicare Part B premiums, deductibles, coinsurance, and co-payments 
Specified Low-Income Medicare Beneficiary (SLMB) Program
100-120% of FPL
SLMB helps pay Medicare Part B premiums
Qualifying Individual (QI) Program 120-135% of FPL QI helps pay Medicare Part B premiums
Qualified Disabled and Working Individuals (QDWI) Program under 200% of FPL  QDWI helps pay Medicare Part A premiums

You can click here to learn more about Medicare Savings Programs:  http://www.q1medicare.com/q1group/MedicareAdvantagePartDQA/faq/What-is-a-Medicare-Savings-Program-/184/11.html

(primary source: Medicare.gov)

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