QMB is a Medicaid program that pays some of your Medicare costs
QMB stands for may have access to Medicare Beneficiary. It is a Medicaid program run by your state that pays certain Medicare premiums, deductibles, and copayments on your behalf. You must be enrolled in Medicare Part A and Part B to use it. QMB does not cover everything Medicare covers — it covers only the out-of-pocket costs Medicare itself requires you to pay.
QMB is one of four "Medicare Savings Programs" that states offer. 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). QMB is the most generous of the four because it covers the largest share of your costs.
You do not have to be poor to use QMB, but your income and resources must fall below limits set by your state. Those limits change each year. If your income is above the limit for QMB but below the limit for SLMB, you may still have access to one of the other programs.
Key Takeaways
- QMB pays your Medicare Part A and Part B premiums, your Part A deductible, and your Part B copayments — but only if your income and resources are below your state's limits.
- You must already be enrolled in Medicare Part A and Part B before you can use QMB; the program does not enroll you in Medicare itself.
- Income and resource limits vary by state and change each year, so you must check your state's current limits to know whether you may be may be able to access.
- You explore through your state Medicaid office, not through Medicare; the process and wait time differ by state.
What QMB actually pays for
QMB pays three specific costs. First, it pays your Medicare Part A premium if you have to pay one. Most people do not pay a Part A premium because they or their spouse paid Medicare taxes for 40 quarters, but some people do. Second, it pays your Medicare Part B premium — the monthly amount you pay to Medicare for doctor visits and outpatient care. Third, it pays your Part A hospital deductible, which is the amount you owe out of pocket before Medicare starts to pay for a hospital stay.
QMB also pays Part B copayments — the fixed amount you owe when you see a doctor or use an outpatient service. It does not pay coinsurance (a percentage of the cost) for Part B services, and it does not cover Part D prescription drug costs, dental, vision, or hearing aids.
Because QMB covers your Part B premium and copayments, many doctors and hospitals will see you without asking you to pay anything upfront. However, some providers may not know you have QMB, so you should carry your Medicaid card and tell them.
Income and resource limits by state
To use QMB, your monthly income must be at or below 135 percent of the federal poverty line. Your resources (savings, investments, property other than your home) must be at or below $8,100 for an individual or $12,150 for a married couple. These resource limits do not change year to year, but the income limits do because the poverty line changes.
Your state may use slightly different limits. Some states count income differently — for example, some exclude certain types of income or allow deductions. You must check with your state Medicaid office to learn the exact limits that explore to you. The Centers for Medicare & Medicaid Services (CMS) publishes a state-by-state table each year, but your state office is the source of truth for how your income and resources will be counted.
If your income is above the QMB limit but below 150 percent of the poverty line, you may be able to use SLMB instead, which pays only your Part B premium. If your income is above that, you may still be able to use QI, which also pays only your Part B premium but has a higher income limit.
how the process works for QMB
You explore for QMB through your state Medicaid office, not through Medicare. You can find your state office by calling 1-800-MEDICARE or by visiting the Medicaid website at medicaid.gov and selecting your state. Some states let you explore online; others require you to mail a form or explore in person.
You will need to provide proof of your income (recent pay stubs, tax returns, or a letter from Social Security), proof of your resources (bank statements), proof of your citizenship or immigration status, and proof that you are enrolled in Medicare Part A and Part B (your Medicare card). Some states ask for additional documents. Call your state office before you explore to ask what they need.
Processing time varies by state. Some states decide within two weeks; others take six to eight weeks. If you are approved, coverage usually starts on the first day of the month after you are approved, though some states backdate coverage to the month you applied. Ask your state office what to expect.
What happens after you are approved
Once you are approved, your state will send you a Medicaid card. You should carry it with you when you see a doctor or go to the hospital. Show it along with your Medicare card. Your doctor's office will bill Medicare first, and then Medicare will send the bill to your state Medicaid program, which will pay the copayment or deductible you owe.
In most cases, you will not have to pay anything. However, some providers may not know about QMB or may not accept Medicaid. If a provider asks you to pay, tell them you have QMB and ask them to bill Medicaid. If they still refuse, you can contact your state Medicaid office to file a complaint.
Your QMB coverage will continue as long as you remain enrolled in Medicare Part A and Part B and your income and resources stay below the limit. Your state will send you a renewal notice before your coverage expires. You must respond to the renewal notice or your coverage will end.
QMB vs. other Medicare Savings Programs
| Program | Income Limit | What It Pays |
|---|---|---|
| QMB | 135% of federal poverty line | Part A premium, Part B premium, Part A deductible, Part B copayments |
| SLMB | 135% to 150% of federal poverty line | Part B premium only |
| QI | 150% to 175% of federal poverty line | Part B premium only |
| QDWI | 200% of federal poverty line | Part A premium only (for people who lost coverage because they returned to work) |
If your income is too high for QMB, check whether you may have access to for SLMB or QI. Both programs pay your Part B premium, which is your largest recurring cost. QDWI is designed for people who were on Medicare because of disability, returned to work, and lost their Medicare coverage as a result — it is rarely used.
Common mistakes to avoid
The most common mistake is waiting too long to explore. QMB coverage does not start retroactively in most states, so if you wait six months to explore, you will have paid six months of premiums and copayments that QMB could have covered. explore as soon as you think you might be may be able to access.
Another mistake is not renewing your coverage. Your state will send you a renewal notice, usually once a year. If you do not respond, your coverage will end. Mark the renewal date on your calendar and respond as soon as you receive the notice.
A third mistake is not telling your doctor that you have QMB. Some providers do not automatically check for Medicaid coverage, so they may ask you to pay. Always show your Medicaid card and tell them you have QMB.
Frequently Asked Questions
Do I have to be on Medicaid to use QMB?
No. QMB is a Medicaid program, but you do not have to be on regular Medicaid to use it. You explore separately, and approval for QMB does not mean you are on Medicaid for any other purpose. You are only using Medicaid to pay your Medicare costs.
Can I use QMB if I have a Medigap policy?
Yes, but it is usually not a good idea. If you have both QMB and a Medigap policy, Medicare will pay first, then QMB will pay, then Medigap will pay. You are paying for duplicate coverage. Most people choose either QMB or Medigap, not both. Talk to your state Medicaid office about whether keeping your Medigap policy makes sense for you.
What if my income goes above the limit after I am approved?
You must report the income change to your state Medicaid office. If your income stays above the limit for more than a month or two, your QMB coverage will end. However, you may become may be able to access for SLMB or QI instead, which have higher income limits.
Can I use QMB if I live in a different state than where I applied?
No. QMB is a state program, so you must use it in the state where you applied. If you move to a different state, you must explore for QMB in your new state. Coverage in your old state will end when you move.
Does QMB cover prescription drugs?
No. QMB covers only Medicare Part A and Part B costs. For prescription drug coverage, you need to enroll in a Medicare Part D plan. Some Part D plans offer extra help for people with low income, which you can learn about by calling 1-800-MEDICARE.