A may have access to Medicare Beneficiary is someone Medicare recognizes as needing help paying premiums and cost-sharing

A may have access to Medicare Beneficiary (QMB) is a person whose income and resources fall below certain limits set by Medicare. If you are a QMB, your state pays your Part B premium, and Medicare covers your copayments, coinsurance, and deductibles for services that Original Medicare covers. You do not pay these costs out of pocket — the state program handles them.

The key word is "may have access to." You must meet income and resource thresholds that vary by state and change each year. Being on Medicare alone does not make you a QMB. Neither does having low income. You have to be both on Medicare and fall within the specific financial limits your state sets.

QMB is one of four Medicaid programs for people on Medicare, often called "Medicare Savings Programs." The others are Specified Low-Income Medicare Beneficiary (SLMB), may have access to Individual (QI), and may have access to Disabled and Working Individual (QDWI). Each covers different costs and has different income limits. QMB covers the most.

Key Takeaways

  • QMB status means your state pays your Part B premium and covers your copayments, coinsurance, and deductibles for Original Medicare services.
  • Income and resource limits vary by state and are updated each year, so you must check your state's current thresholds to know if you may be may be able to access.
  • You must be enrolled in Medicare Part A and Part B to be a QMB; Part B enrollment is required even if you do not use it.
  • Your state Medicaid office handles QMB enrollment, not Medicare, and the process and timeline differ by state.
  • If your income rises above the QMB limit, you may still may have access to for SLMB or QI, which cover fewer costs but have higher income thresholds.

Income and Resource Limits Vary by State

QMB income limits are set at 135% of the federal poverty level, but your state Medicaid program applies this to your specific situation. The federal poverty level changes each year, so the QMB income limit also changes. In 2024, for example, the limit for a single person was around $1,550 per month, but this varies by state and will be different in 2025.

You also have a resource limit — the total amount of money and assets you can own and still be a QMB. This limit is usually around $8,000 for a single person and $12,000 for a married couple, but again, your state sets the exact number. Resources include savings accounts, stocks, and property you own, but typically do not include your home or one car.

Because limits change and vary, you need to contact your state Medicaid office directly to learn the current thresholds. The Medicaid website has a state-by-state directory. Your local Area Agency on Aging can also tell you the limits and help you understand whether your income and resources fall within them.

Who Can Become a QMB

You must be a U.S. citizen or may have access to immigrant, a resident of the state where you are explore, and enrolled in Medicare Part A. You must also be enrolled in Medicare Part B — even if you have not used it and do not plan to — because QMB covers your Part B premium and cost-sharing.

You do not have to be retired. You do not have to be a certain age. You do not have to be disabled. The only requirements are citizenship or may have access to immigrant status, state residency, Medicare Part A and Part B enrollment, and income and resources below your state's QMB limits.

If you are still working and earning income, you can still be a QMB as long as your total income stays below the limit. If you receive Social Security, a pension, investment income, or wages, all of it counts toward your income total.

What QMB Covers and What It Does Not

QMB covers your Medicare Part B premium (the monthly fee for doctor visits and outpatient services). It also covers your Part B deductible, copayments for doctor visits and outpatient services, and coinsurance for hospital stays covered by Part A. If you need a blood transfusion, QMB covers the first three pints of blood.

QMB does not cover prescription drugs. That is what Part D is for. QMB does not cover services that Original Medicare does not cover — things like dental, vision, hearing aids, or long-term care. If you are in a Medicare Advantage plan instead of Original Medicare, QMB works differently and may not cover the same costs.

QMB also does not cover your Part A premium if you have to pay one (most people do not, because they or their spouse paid Medicare taxes for 40 quarters). If you do owe a Part A premium, you would need a different program to cover it.

How to Enroll in QMB

You do not enroll in QMB through Medicare. You enroll through your state Medicaid office. Contact your state Medicaid program directly — the phone number and website are on the Medicaid.gov state directory. Some states also let you explore online or by mail.

When you contact your state Medicaid office, tell them you want to know about QMB. They will tell you the current income and resource limits, ask you questions about your income and assets, and tell you what documents to bring or send. You will typically need proof of income (pay stubs, Social Security statement, pension letter), proof of resources (bank statements), proof of citizenship, and proof of Medicare enrollment.

Processing time varies by state. Some states decide within two to four weeks. Others take longer. Once you are approved, your state Medicaid program sends you a QMB card or letter, and the state begins paying your Part B premium and covering your cost-sharing. You keep your Medicare card — you use both cards when you see a doctor.

What Happens If Your Income Changes

If your income rises above the QMB limit, you lose QMB status. Your state Medicaid office will tell you when this happens, usually after you report a change or during an annual review. Once QMB ends, you are responsible for your Part B premium and cost-sharing again.

If your income is slightly above the QMB limit, you may still be able to get help through SLMB or QI. SLMB covers your Part B premium only (not copayments or deductibles) and has an income limit of 150% of poverty. QI covers your Part B premium and has an income limit of 175% of poverty. Both have lower income thresholds than QMB but cover fewer costs.

If your income drops back below the QMB limit, you can reapply. There is no waiting period. Contact your state Medicaid office to restart your QMB coverage.

QMB and Medicare Advantage Plans

If you are enrolled in a Medicare Advantage plan (Part C) instead of Original Medicare, QMB works differently. Your state still pays your Part B premium, but the copayments and coinsurance you owe depend on your plan's cost-sharing structure, not on Original Medicare's structure. Some Medicare Advantage plans have lower copayments than Original Medicare, so QMB may cover less of your out-of-pocket costs.

Before you enroll in a Medicare Advantage plan, check with your state Medicaid office to understand how QMB will work with that specific plan. Some people on QMB stay in Original Medicare because the cost-sharing is more predictable and QMB covers all of it.

Frequently Asked Questions

Do I have to tell Medicare I am a QMB?

No. Your state Medicaid office tells Medicare that you are a QMB. Once you are approved, your state sends the information to Medicare automatically. You do not need to contact Medicare yourself. When you see a doctor, show both your Medicare card and your QMB card or letter.

Can I be a QMB if I have a Medicare Supplement plan?

No. QMB and Medigap (Medicare Supplement) plans serve the same purpose — they both help pay your cost-sharing. You cannot have both. If you are approved for QMB, you must drop your Medigap plan. If you want to keep Medigap, you cannot be a QMB.

What if I am not a citizen but I am a may have access to immigrant?

may have access to immigrants can be QMBs, but the rules are strict. You must have been a may have access to immigrant for at least five years. Bring your immigration documents when you explore to your state Medicaid office. They will tell you whether your immigration status meets the requirement.

Does QMB cover my spouse?

No. QMB is individual. Your spouse must have their own Medicare enrollment and their own income and resources below the QMB limit to be a QMB. You can both be QMBs, but you each have to meet the requirements and enroll separately.

What if my state Medicaid office says I do not meet the income limit by a small amount?

Ask about SLMB or QI. These programs have higher income limits and may cover at least your Part B premium. If you do not meet any of the four Medicare Savings Programs, ask about other Medicaid programs your state offers for people on Medicare. Rules vary widely by state.