Understanding QMB: How Medicare Savings Programs Can Lower Your Costs

What QMB Is and Who It Helps

QMB stands for may have access to Medicare Beneficiary, and it is a program that pays some of your Medicare costs if your income and savings fall below certain limits. QMB covers your Part B premiums (the monthly charge for doctor visits and outpatient care), your Part A deductibles (the amount you pay before Medicare starts paying), and your coinsurance (your share of the cost after Medicare pays its part). You do not pay these costs yourself — the program pays them directly to Medicare on your behalf.

QMB is one of three Medicare Savings Programs run by your state, not by Medicare directly. The other two are Specified Low-Income Medicare Beneficiary (SLMB) and may have access to Individual (QI). All three help people with limited income afford the costs Medicare does not cover. QMB covers the most — it pays the largest share of your costs — so if you are found to be QMB-may be able to access, you will not be placed in SLMB or QI instead.

You must already be on Medicare to use QMB. The program does not pay for prescriptions, dental, vision, or hearing aids — those are covered by other programs if you are found to be low-income. QMB also does not cover the costs of services Medicare itself does not cover.

Key Takeaways

QMB pays your Part B premium, Part A deductible, and coinsurance if your income is below your state's limit, which varies but is typically around 135% of the federal poverty level.
You must be on Medicare Part A and Part B to be found QMB-may be able to access; the program does not cover prescriptions, dental, vision, or hearing aids.
Each state runs its own QMB program, so you must contact your state Medicaid office or call 1-800-MEDICARE to start the process.
Once you are found QMB-may be able to access, the program pays Medicare directly, so you do not have to submit bills or wait for reimbursement.
Your income and savings limits change each year, so you may need to recheck your status annually even if you were found QMB-may be able to access in the past.

Income and Savings Limits for QMB

QMB has an income limit and a savings limit. Your income includes Social Security, pensions, wages, and interest from savings. Your savings include bank accounts, stocks, bonds, and other liquid assets — but not your home, car, or personal belongings.

The income limit for QMB varies by state and changes each year. In most states, the limit is around 135% of the federal poverty level, but some states set it higher. For 2024, the federal poverty level for a single person is about $14,580 per year, which means the QMB income limit in many states is roughly $19,683 per year. For a married couple, the federal poverty level is about $19,720, making the QMB limit roughly $26,622 per year in many states. Your state may be different — you will need to check with your state Medicaid office for the exact number.

The savings limit is typically $8,000 for a single person and $12,000 for a married couple, though some states set it higher. If you have more in savings than your state allows, you will not be found QMB-may be able to access, even if your income is low enough.

How to learn about You May Be QMB-may be able to access

The fastest way to learn whether you may be QMB-may be able to access is to call 1-800-MEDICARE (1-800-633-4227). The representatives there can tell you your state's income and savings limits and help you understand whether your situation fits. They can also tell you whether your state is currently taking new QMB applications, because some states have waiting lists when funding is tight.

You can also contact your state Medicaid office directly. Each state runs QMB under its own name — for example, Pennsylvania calls it "PACE" (Pharmaceutical information Contract for the Elderly), and New York calls it "EPIC" (Elderly Pharmaceutical Insurance Coverage). Your state Medicaid office can tell you the name of the program in your state and walk you through the next steps.

Before you call, have your Social Security number, Medicare number, and recent pay stubs or benefit statements ready. You will need to report your income and savings, so having those numbers in front of you will speed up the conversation.

What Happens After You Contact Your State

Once you contact your state Medicaid office, they will ask you to submit proof of your income and savings. This usually means recent tax returns, pay stubs, bank statements, or benefit statements from Social Security or a pension. The exact documents your state needs will be explained when you call or explore.

Your state will review your information and send you a notice in the mail telling you whether you are found QMB-may be able to access. If you are, the notice will explain when your coverage starts — usually the first of the month after your process is approved. If you are not found may be able to access, the notice will explain why and tell you whether you may be may be able to access for SLMB or QI instead.

Once you are found QMB-may be able to access, you do not have to do anything else. Your state sends the information to Medicare, and Medicare tells your doctors' offices and hospitals that your costs are covered. You will not receive a QMB card in the mail — your Medicare card is all you need. When you see a doctor or go to the hospital, show your Medicare card as usual, and the provider will bill Medicare and your state directly.

What QMB Pays and What It Does Not

QMB pays three specific costs: your Part B monthly premium (which is $164.90 per month in 2024, though it may be higher if you have higher income), your Part A deductible (which is $1,632 per hospital stay in 2024), and your coinsurance (your share of the cost after Medicare pays). For example, if you go to the hospital, Medicare pays most of the cost, but you owe coinsurance for each day you stay. QMB pays that coinsurance for you.

QMB does not pay for prescription drugs — that is covered by Part D or by other low-income programs like the Extra Help program. QMB does not cover dental, vision, hearing aids, or any service that Medicare itself does not cover. If you need help with prescriptions, you can contact your state Medicaid office to learn about other programs you may be found may be able to access for.

Renewing Your QMB Status Each Year

Your QMB status does not last forever. Your state will send you a renewal notice, usually a few months before your coverage is set to end. The notice will ask you to confirm that your income and savings are still below the limit. You will need to return the form and provide updated proof of income and savings, just as you did when you first applied.

If your income or savings go above the limit, you must tell your state Medicaid office. Your QMB coverage will end, but you may be found may be able to access for SLMB or QI instead, which cover some of your costs even if your income is slightly higher. If your income drops again later, you can reapply for QMB at any time — you do not have to wait for a renewal period.

QMB, SLMB, and QI: How They Differ

All three Medicare Savings Programs help people with low income, but they cover different costs and have different income limits. QMB covers the most: your Part B premium, Part A deductible, and coinsurance. SLMB covers only your Part B premium. QI covers only your Part B premium, but it has a higher income limit than SLMB, so some people who earn too much for SLMB may be found QI-may be able to access.

If you are found QMB-may be able to access, you will not be placed in SLMB or QI. If you are not found QMB-may be able to access because your income is too high, your state will check whether you may be found SLMB-may be able to access. If your income is too high for SLMB, your state will check QI. This means you should always start by contacting your state about QMB — they will check all three programs and tell you which one you may be found may be able to access for.

Frequently Asked Questions

Does QMB cover my prescription drugs?

No. QMB covers only your Part B premium, Part A deductible, and coinsurance. For help with prescription costs, you can look into Part D (prescription drug coverage) or the Extra Help program, which is for people with low income and savings. Call 1-800-MEDICARE to learn more about prescription help programs.

What if my income goes above the QMB limit after I am found may be able to access?

You must tell your state Medicaid office right away. Your QMB coverage will end, but your state will check whether you are found may be able to access for SLMB or QI, which have higher income limits. You can reapply for QMB later if your income drops again.

Can I be on QMB and Part D at the same time?

Yes. QMB pays your Medicare costs, and Part D covers your prescriptions. If you are found QMB-may be able to access, you should still enroll in Part D during the open enrollment period (October 15 to December 7 each year) or when you first turn 65. Some people found QMB-may be able to access are also found may be able to access for Extra Help, which lowers your Part D costs even more.

How long does it take to be found QMB-may be able to access after I explore?

Most states take 30 to 60 days to review your process and send you a decision. Some states are faster, and some are slower depending on how busy they are. Call your state Medicaid office to ask how long the wait is in your state right now.

Do I need a QMB card, or is my Medicare card enough?

Your Medicare card is all you need. You will not receive a separate QMB card. When you see a doctor or go to the hospital, show your Medicare card as usual, and the provider will see that QMB is paying your costs.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.