QMB pays your Medicare costs when your income is low
QMB stands for may have access to Medicare Beneficiary. It is a program run by your state that pays some or all of your Medicare premiums, deductibles, and copayments if your income and savings fall below certain limits. You do not pay QMB directly — the program sends the money to Medicare or your provider on your behalf.
QMB is one of four state programs called Medicare Savings Programs. Each one covers different costs and has different income limits. If you are on Medicare and struggling to pay your share of medical bills, QMB may cover those costs without you having to pay anything upfront.
Key Takeaways
- QMB pays your Part B premium, Part A deductible, Part B deductible, and copayments for most Medicare services if your income is below your state's limit.
- Income limits vary by state and change each year, but generally QMB serves people with income between 100 and 120 percent of the federal poverty level.
- You must be enrolled in Medicare Part A and Part B to use QMB, and you explore through your state Medicaid office, not through Medicare.
- Once approved, QMB works automatically — providers bill Medicare, Medicare pays QMB's share, and you pay nothing.
- QMB does not cover prescription drugs, but you may also be on a separate program called Extra Help that does.
What QMB actually pays for
QMB covers the costs you owe to Medicare, not the costs Medicare does not cover. Specifically, it pays your Part B monthly premium (the amount you pay to have Part B coverage), your Part A hospital deductible (the amount you pay before hospital insurance kicks in), your Part B deductible (the amount you pay before doctor visit insurance kicks in), and your copayments for most services Medicare covers.
QMB does not pay for services Medicare does not cover, such as dental, vision, or hearing aids. It also does not pay for prescription drugs — that is handled by a separate program called Extra Help, which you may also be on. If you need both programs, you explore to each one separately through your state.
Income and savings limits for QMB
To be on QMB, your monthly income must be below a certain amount set by your state each year. That amount is usually between 100 and 120 percent of the federal poverty level. For 2024, the federal poverty level for a single person is about $1,145 per month, so QMB income limits typically range from roughly $1,145 to $1,374 per month depending on your state. These numbers change every year.
Your state also sets a limit on how much money you can have in savings or investments. That limit is usually between $8,000 and $10,000 for a single person, though it varies by state. Money in your home, your car, and your life insurance does not count toward this limit.
Because limits vary by state and change yearly, the best way to find your state's current numbers is to call your state Medicaid office or visit your state's Medicaid website. You can also call 1-800-MEDICARE and ask them to connect you to your state program.
how the process works for QMB
You explore for QMB through your state Medicaid office, not through Medicare. Your state Medicaid office may be called the Department of Human Services, Department of Social Services, or Department of Medical information — the name varies by state. You can find your state office by calling 1-800-MEDICARE or searching online for "[your state] Medicaid office."
When you contact your state office, they will tell you whether to explore by mail, phone, or in person. You will need to provide proof of your income (such as recent pay stubs, tax returns, or a letter from Social Security), proof of your savings and investments, and proof that you are enrolled in Medicare Part A and Part B. Some states let you explore online through their website.
Your state will tell you how long approval takes. Some states decide within two weeks; others take longer. Once you are approved, your state sends a notice to Medicare, and QMB begins paying your costs automatically.
How QMB works once you are approved
After your state approves you, you do not need to do anything special when you go to the doctor or hospital. Your provider bills Medicare as usual. Medicare pays its share, then sends the bill to QMB for your share. QMB pays the provider directly, and you receive no bill.
You will receive a QMB card or notice from your state showing that you are on the program. Bring this with you when you see a doctor, along with your Medicare card. Some providers may not know about QMB, so if you receive a bill you think QMB should have paid, contact your state Medicaid office to report it.
QMB compared to other Medicare Savings Programs
Your state runs four Medicare Savings Programs, and they differ in what they cover and who they serve. QMB covers the most costs — premiums, deductibles, and copayments — but has the lowest income limit. The other three programs (SLMB, QI-1, and QI-2) cover fewer costs but allow higher income. If your income is too high for QMB, you may still be on one of the others.
| Program | What It Covers | Income Limit (Approximate) |
|---|---|---|
| QMB | Part B premium, Part A deductible, Part B deductible, copayments | 100–120% of poverty level |
| SLMB | Part B premium only | 120–135% of poverty level |
| QI-1 | Part B premium only | 135–175% of poverty level |
| QI-2 | Part B premium only | 175–200% of poverty level |
If you are not sure which program you might be on, your state Medicaid office can tell you based on your income. You can only be on one program at a time.
What to ask your doctor or state office
Before you explore, ask your state Medicaid office what the current income and savings limits are for your state, because they change every year. Ask whether you can explore online or if you must explore by mail or phone. Ask how long approval usually takes so you know when to expect a decision.
If you are already on QMB and receive a bill you think should have been paid, ask your provider's billing office to resubmit the claim to QMB. If the bill is still not paid after 30 days, contact your state Medicaid office and give them the date of service, the provider's name, and the amount owed.
Frequently Asked Questions
Do I have to be on Medicaid to be on QMB?
No. QMB is separate from Medicaid. You can be on QMB without being on your state's Medicaid program for other services. However, your state runs both programs, so you explore to the same office.
What happens to QMB if I move to a different state?
QMB ends when you move. You must explore to your new state's program, and approval may take several weeks. Contact your new state's Medicaid office as soon as you move so there is no gap in coverage.
Does QMB cover prescription drugs?
No. Prescription drug coverage is handled by a separate program called Extra Help. You explore for Extra Help through Social Security, and you can be on both QMB and Extra Help at the same time.
Can I be on QMB if I have other health insurance?
Yes. QMB works alongside other insurance. If you have employer coverage or a Medigap plan, QMB still pays your Medicare costs. Tell your state Medicaid office about any other insurance you have when you explore.
What if my income goes up after I am approved?
Your state will review your income periodically, usually once a year. If your income rises above the limit, QMB will end. Your state will send you a notice before this happens, giving you time to plan for other coverage options.