QMB is a program that helps pay your Medicare premiums, deductibles, and copayments if your income is low
QMB stands for may have access to Medicare Beneficiary. It is a Medicaid program run by your state that pays some or all of your Medicare costs — specifically your Part B premium, your Part A deductible, and your copayments and coinsurance amounts. You do not pay QMB directly; instead, QMB pays Medicare on your behalf.
QMB is one of several programs called Medicare Savings Programs, or MSPs. Each one covers different costs and has different income limits. QMB is the broadest: it covers the most costs and has the highest income limit of the three main programs.
The key difference between QMB and regular Medicare is that QMB reduces what you owe out of pocket. Medicare itself does not change — you still have the same coverage. QMB just fills in some of the gaps that Medicare leaves.
Key Takeaways
- QMB pays your Medicare Part B premium, Part A deductible, and your copayments and coinsurance if your income falls within your state's limit.
- Income limits vary by state but are roughly $1,500 to $1,900 per month for an individual, depending on where you live.
- You must already be enrolled in Medicare Part A and Part B to use QMB.
- You contact your state Medicaid office to request QMB, not Medicare itself.
- Once QMB is approved, you show your Medicaid card when you see a doctor or go to the hospital, and QMB pays the costs it covers.
Who QMB is for and income limits
QMB is for people who are already on Medicare and whose income is low enough to meet your state's threshold. You must be a U.S. citizen or may have access to immigrant, and you must have Medicare Part A (hospital insurance).
Income limits are set by each state and change yearly. In most states, the limit is around 135% to 150% of the federal poverty line. For 2024, that means roughly $1,500 to $1,900 per month for a single person, though your state may be higher or lower. Some states also count your assets — usually allowing up to $7,500 for an individual or $11,250 for a couple — but many do not.
Because limits vary, the best way to find your state's exact numbers is to call your state Medicaid office or visit your state health department website. You can also call 1-800-MEDICARE to ask for your state's QMB contact information.
What QMB covers and what it does not
QMB covers three main costs: your Medicare Part B premium (usually around $165 per month in 2024, though it varies by income), your Part A hospital deductible (the amount you owe before Medicare starts paying for a hospital stay), and your copayments and coinsurance for Medicare-covered services.
QMB does not cover Medicare Part D (prescription drugs), dental, vision, hearing aids, or long-term care. It does not cover services that Medicare itself does not cover. And it does not cover costs from providers who do not accept Medicare.
If you need help with prescription drug costs, you may be able to use a different program called SLMB (Specified Low-Income Medicare Beneficiary) or QI (may have access to Individual) at the same time as QMB. Your state Medicaid office can tell you whether you meet the income limits for those programs too.
How to request QMB
You do not request QMB from Medicare. Instead, you contact your state Medicaid office. Each state runs its own QMB program, so the process and timeline vary.
To start, call your state Medicaid office or visit its website. You can find the phone number by calling 1-800-MEDICARE or by searching "[your state] Medicaid office" online. When you call, tell them you want to request QMB. They will ask for your Medicare number, your income, your assets (if your state counts them), and proof of citizenship or immigration status.
You will usually need to provide documents such as recent pay stubs or tax returns to prove your income, a birth certificate or passport to prove citizenship, and your Social Security card. Some states let you mail these in; others require you to visit an office in person. Ask what your state accepts.
Timeline and what happens after approval
Processing time varies by state. Some states approve QMB in a few weeks; others take two to three months. A few states have waiting lists if funding runs low. Ask your state Medicaid office how long approval usually takes and whether there is currently a waiting list.
Once you are approved, your state will send you a Medicaid card. You show this card along with your Medicare card when you see a doctor, go to a hospital, or use any Medicare-covered service. The provider will bill Medicare first, then bill Medicaid (QMB) for the remaining cost that QMB covers.
You do not pay anything upfront if the provider accepts both Medicare and Medicaid. If a provider does not accept Medicaid, you may have to pay and then request reimbursement from your state, though this is rare.
QMB compared to other Medicare Savings Programs
There are three main Medicare Savings Programs. QMB is the most generous, but it also has the highest income limit. The other two are SLMB and QI.
| Program | What it covers | Income limit (roughly) |
|---|---|---|
| QMB | Part B premium, Part A deductible, copayments and coinsurance | 135–150% of poverty line |
| SLMB | Part B premium only | 120–135% of poverty line |
| QI | Part B premium only (limited to 5 years) | 150–175% of poverty line |
If your income is too high for QMB, you may still be able to use SLMB or QI. If your income is too high for all three, you might be able to use other Medicaid programs that help with Medicare costs, depending on your state. Your state Medicaid office can tell you which programs you may be able to use.
What to do if your income or situation changes
If your income goes up, you may no longer meet QMB's income limit and your coverage could end. If your income goes down, you may become newly may be able to access. You should report any major change — a new job, a job loss, a change in benefits, or a change in household size — to your state Medicaid office as soon as possible.
QMB coverage is usually approved for one year at a time. Your state will send you a notice before your coverage ends, telling you whether you have been approved for another year. Read this notice carefully. If your coverage ends and you want to reapply, contact your state Medicaid office again.
If you move to a different state, your QMB coverage does not follow you. You will need to request QMB from your new state's Medicaid office. Call your new state's office right away so there is no gap in coverage.
Frequently Asked Questions
Do I have to be on Medicaid to use QMB?
QMB is a Medicaid program, so yes — when you are approved for QMB, you are also approved for Medicaid. However, you do not have to use Medicaid for anything else. You are only using it to pay your Medicare costs.
Can I use QMB if I have a Medicare Advantage plan?
Yes. QMB works with both Original Medicare (Part A and Part B) and Medicare Advantage plans. If you have a Medicare Advantage plan, QMB will pay your plan's premium and your copayments and coinsurance, just as it does with Original Medicare.
What if my state says I make too much money for QMB?
Ask whether you meet the income limit for SLMB or QI instead. These programs have higher income limits and cover at least your Part B premium. Your state Medicaid office can tell you right away whether you may have access to for either one.
Do I have to reapply for QMB every year?
Your state will usually send you a renewal notice before your coverage ends. You may be able to renew by mail or phone, or you may need to provide updated income information. Check the notice your state sends you for instructions.
What happens if a doctor's office says they do not accept QMB?
Most doctors and hospitals accept Medicaid, but some do not. If a provider does not accept Medicaid, you can ask them to bill you and then you can request reimbursement from your state Medicaid office. You can also ask your state Medicaid office for a list of providers in your area who accept QMB.