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
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.
In 2016, the income limits are $1,010 for a single person or $1,355 for a 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): https://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:
The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
Medicare has neither reviewed nor endorsed the information on our site.
We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information.
However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist.
For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
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Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year.
Our PDP-Compare.com and MA-Compare.com provide highlights of annual plan benefit changes.
The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
Limitations, copayments, and restrictions may apply.
We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area.
However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service
area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048),
24 hours a day/7 days a week or consult www.medicare.gov.
Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare.
Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits
money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible.
The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll
during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the
Beneficiaries can appoint a representative by submitting CMS Form-1696.