A may have access to Medicare Beneficiary is someone Medicare covers who also meets income and asset limits set by your state
A may have access to Medicare Beneficiary (QMB) is a person enrolled in Medicare whose income and assets fall below thresholds your state sets each year. If you are a QMB, your state pays your Medicare premiums, deductibles, and copayments — the out-of-pocket costs that come with Parts A and B coverage.
QMB is one of four Medicare Savings Programs, all run by states but funded partly by federal money. The other three — Specified Low-Income Medicare Beneficiary (SLMB), may have access to Individual (QI), and may have access to Disabled and Working Individual (QDWI) — cover different income ranges and different costs. QMB covers the most: it pays everything Medicare charges you directly.
You do not automatically become a QMB when you turn 65 or enroll in Medicare. You must contact your state Medicaid office and go through a separate process. Many people who could be QMBs never find out, so the program goes underused.
Key Takeaways
- QMB status means your state pays your Medicare Part A and Part B premiums, deductibles, and copayments if your income and assets are below your state's limits.
- Income limits vary by state and change yearly, but generally fall between 100 and 135 percent of the federal poverty line.
- You must contact your state Medicaid office to request QMB status — Medicare will not tell you that you may be may be able to access.
- Once approved, QMB coverage is retroactive to the first day of the month you requested it, so explore as soon as you think you may have access to saves money.
- QMB does not cover prescription drugs, vision, dental, or hearing — those require separate coverage or programs.
Income and Asset Limits Vary by State and Year
Each state sets its own income ceiling for QMB status. The federal government provides a floor — roughly 100 percent of the federal poverty line — but most states allow income up to 135 percent of poverty. A few allow higher. Because poverty thresholds change each year, so do QMB limits.
For 2024, the federal poverty line for a single person was about $15,060 per year. A state allowing 135 percent of that would set a QMB income limit around $20,331 annually. But your state may be different, and the number will shift in 2025. You need to check your specific state's current limit, not a national average.
Asset limits also matter. Most states allow you to own up to $7,500 in countable assets as a single person, or $11,250 as a couple. Countable assets typically include bank accounts, stocks, and bonds — but not your home, car, or personal belongings. Again, your state may differ.
The fastest way to learn your state's exact limits is to call your state Medicaid office or visit its website. You can also call 1-800-MEDICARE and ask them to connect you to your state program.
How QMB Differs from Other Medicare Savings Programs
Medicare Savings Programs come in four tiers. QMB is the most generous, but only if your income qualifies. If your income is slightly higher, you might fit into SLMB, QI, or QDWI instead, each of which covers fewer costs.
| Program | Income Limit (Approximate) | What It Covers |
|---|---|---|
| QMB | 100–135% of poverty | Part A and B premiums, deductibles, copayments |
| SLMB | 135–150% of poverty | Part B premium only |
| QI | 150–175% of poverty | Part B premium only (limited funding) |
| QDWDI | Up to 200% of poverty | Part A premium only (for working disabled people) |
If your income is above your state's QMB limit but below SLMB, you still have a path to help. SLMB covers your Part B premium, which is the largest recurring cost. QI covers the same thing but has less funding, so it may have a waiting list. QDWDI is only for people under 65 who are disabled and still working.
How to Request QMB Status
You request QMB through your state Medicaid office, not through Medicare or Social Security. The process and timeline vary by state, but the basic steps are the same everywhere.
Start by contacting your state Medicaid office directly. You can find the phone number on your state's health department website, or call 1-800-MEDICARE and ask for the referral. Have your Social Security number, Medicare number, and recent income information ready. Some states let you request QMB online; others require a phone call or a paper form mailed in.
You will need to show proof of income — usually recent pay stubs, tax returns, or a Social Security statement. If you are retired, bring documentation of your pension or investment income. You may also need to show proof of citizenship or legal residency, depending on your state.
Once you submit your request, approval typically takes two to four weeks. The key: QMB coverage is retroactive to the first day of the month you requested it. If you request it on March 15, coverage starts March 1. This means you should explore as soon as you think your income qualifies, because you will recoup costs from earlier in that month.
What QMB Covers and What It Does Not
QMB pays the costs Medicare charges you directly: your Part A premium (if you have one), your Part B premium, your Part A deductible, your Part B deductible, and your copayments for Medicare-covered services. If you see a doctor who accepts Medicare, QMB eliminates your out-of-pocket cost for that visit.
QMB does not cover prescription drugs. You still need Part D coverage or another drug plan. It does not cover vision, dental, hearing aids, or long-term care. It does not cover services Medicare itself does not cover. And it does not cover costs charged by doctors who do not accept Medicare assignment.
If you are in a Medicare Advantage plan (Part C) rather than Original Medicare, QMB still applies — it pays your plan premium and your cost-sharing. But the exact amounts depend on your plan's structure.
Common Mistakes and How to Avoid Them
The biggest mistake is not requesting QMB at all. Many people assume Medicare will tell them if they may have access to, or that they will be enrolled automatically. Neither is true. You have to initiate the request yourself, and thousands of may be able to access people never do.
A second mistake is using outdated income limits. If you were denied QMB two years ago because your income was too high, your situation may have changed — or the state limit may have risen. Reapply if your income has dropped or if you have not checked in over a year.
A third mistake is not gathering the right documents before you call. Have your Medicare number, Social Security number, and proof of income ready. If you are missing something, the process stalls. Some states will mail you a form to complete; others will not move forward until you provide everything on the first call.
Finally, do not assume your state's limit is the federal minimum. Some states are more generous. Call your state Medicaid office and ask what the current year's limit is for your household size. Do not rely on a website that may not have been updated.
What Happens After You Are Approved
Once your state approves you for QMB, you will receive a letter confirming your status and the effective date. Your state will send this information to Medicare. From that point forward, when you see a Medicare provider, your cost-sharing should be zero — the provider bills Medicare, Medicare bills your state, and your state pays.
In practice, some providers' billing systems lag. You may still receive a bill even though you are a QMB. If this happens, contact your state Medicaid office with a copy of the bill and your QMB approval letter. They can follow up with the provider or reimburse you directly.
Your QMB status is not permanent. You must recertify each year, usually by mail or online. Your state will send you a renewal form. If your income or assets change, or if you move to a different state, you must report it. Failing to recertify can end your coverage without warning.
Frequently Asked Questions
Can I have QMB and Medicaid at the same time?
Yes. QMB is a Medicare program that helps with Medicare costs. Medicaid is a separate program that covers other services. Many people have both. In fact, if you are a QMB, you usually may have access to for Medicaid as well, since the income limits are similar. Ask your state Medicaid office about full Medicaid coverage when you request QMB.
What if my income goes over the limit after I am approved?
You must report the change to your state Medicaid office. If your income exceeds the QMB limit, your coverage will end. However, you may still may have access to for SLMB or QI, which have higher income thresholds. Your state will tell you which program you now fit into.
Does QMB work with Medicare Advantage plans?
Yes. QMB pays your Medicare Advantage plan premium and your cost-sharing (copayments and coinsurance). However, the amount varies depending on your plan. Some Advantage plans have zero premium; others charge a monthly fee that QMB will cover.
Can I request QMB retroactively if I did not know about it?
You can request it at any time, and coverage will be retroactive to the first of the month you request it — but not before. If you may have access to for QMB three years ago and did not know, you cannot recover those past costs. This is why explore as soon as you suspect you may have access to matters.
What if my state denies my QMB request?
You have the right to appeal. Your state will send you a denial letter explaining why. Common reasons are income or assets above the limit, or failure to provide required documents. You can request a hearing and present additional information. Contact your state Medicaid office for the appeal process.