What It Means to Be a Qualified Medicare Beneficiary

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 with Medicare whose income and resources fall below certain limits set by the federal government. If you are a QMB, your state pays your Medicare Part B premiums, deductibles, and coinsurance on your behalf. You do not pay these costs yourself — the state sends the money directly to Medicare or your provider.

This is different from regular Medicare. With regular Medicare, you pay the Part B premium every month and you pay a share of costs when you see a doctor or get care. As a QMB, those payments are covered. You still have Medicare; the program just covers more of what it costs to use it.

QMB is one of four programs called Medicaid Savings Programs, or MSPs. Each one covers different costs and has different income limits. QMB is the most generous of the four — it covers the most costs — but it also has the lowest income limit.

Key Takeaways

Your state pays your Medicare Part B premium, deductible, and coinsurance if you are a QMB, but you must meet income and resource limits that vary by state.
QMB is a Medicaid program, not a Medicare program, even though it pays Medicare costs.
You must have Medicare Part A to be a QMB; Part B is not required but you must enroll in it to receive QMB help.
Income limits for QMB are roughly 100 percent of the federal poverty line, which changes each year and differs by state.
You must explore through your state Medicaid office, not through Medicare or Social Security.

Income and resource limits for QMB

To be a QMB, your monthly income must be at or below a certain amount. That amount is set at roughly 100 percent of the federal poverty line. The federal poverty line changes each year, and each state sets its own limit based on that line. In 2024, the limit for a single person was around $1,550 per month in most states, but this varies — some states use a slightly higher or lower percentage, and a few states have their own rules.

Your resources — money in the bank, investments, property you own — also matter. The resource limit is usually around $8,000 for a single person and $12,000 for a married couple, but again, this varies by state. Your home does not count toward the resource limit, and neither does one car.

Because these limits change every year and differ by state, the best way to find your state's current numbers is to call your state Medicaid office or visit its website. You can also call 1-800-MEDICARE and ask them to connect you with your state program.

How QMB differs from other Medicaid Savings Programs

There are four Medicaid Savings Programs total: QMB, Specified Low-Income Medicare Beneficiary (SLMB), may have access to Individual (QI), and Medicare Savings Program (MSP). Each covers different costs and has different income limits.

QMB covers the most: your Part B premium, your Part B deductible, and your Part B coinsurance. It has the lowest income limit — roughly 100 percent of poverty. SLMB covers only your Part B premium and has a slightly higher income limit, around 120 percent of poverty. QI covers only your Part B premium and has an even higher limit, around 135 percent of poverty. MSP is a catch-all name some states use for programs that cover Part A costs.

If your income is too high for QMB, you may still be able to get help through SLMB or QI. If you do not meet any of these programs' limits, you may be able to get help through the Low-Income Subsidy program, which helps with prescription drug costs instead of Medicare premiums.

What QMB covers and what it does not

QMB pays three specific Medicare costs: your Part B monthly premium, your Part B annual deductible, and your Part B coinsurance (the percentage of the cost you would normally pay after you meet your deductible). It does not cover your Part A deductible, Part A coinsurance, or any costs related to Part D prescription drug coverage.

QMB also does not cover costs that Medicare itself does not cover — things like dental, vision, hearing aids, or long-term care. If Medicare does not pay for it, QMB will not either. QMB also does not pay for care you receive outside the United States.

When you see a doctor or get care as a QMB, you should not be asked to pay anything at the time of service. The provider bills Medicare, Medicare pays its share, and your state's Medicaid program pays the rest. If a provider asks you to pay, tell them you are a QMB and ask them to bill Medicaid.

how the process works for QMB

You explore for QMB through your state Medicaid office, not through Medicare or Social Security. Each state runs its own program and has its own process form. Some states let you explore online, some by mail, and some require you to explore in person.

To explore, you will need to show proof of income (recent pay stubs, tax returns, or a letter from Social Security showing your benefit amount), proof of resources (bank statements), and proof that you have Medicare Part A. You will also need to provide your Social Security number and citizenship or immigration status.

The fastest way to find your state's process is to search "[your state] Medicaid Savings Program" online, or call your state Medicaid office directly. You can also call 1-800-MEDICARE and ask them to send you to your state program. Processing usually takes two to four weeks, though some states are faster.

What happens after you are approved

Once you are approved, your state sends Medicare and your providers a notice that you are a QMB. You will receive a letter in the mail confirming your approval and the date it starts. You do not need to do anything else — your providers will see the notice and will know not to bill you for the costs QMB covers.

Your QMB status is usually approved for one year. Before it expires, your state will send you a renewal notice. You will need to send back proof of income and resources again. If your income or resources change during the year, you should report it to your state Medicaid office, because it may affect whether you stay a QMB.

If you move to a different state, your QMB status does not move with you. You will need to explore to your new state's Medicaid program. If you lose QMB status for any reason, you can explore again if your circumstances change.

When to contact your state Medicaid office

Contact your state Medicaid office if your income changes, your resources change, you move, or your Medicare coverage changes. Also contact them if you receive a notice that your QMB status is ending or if a provider tells you they cannot find your QMB information in the system.

If you have questions about what QMB covers or whether a specific service is covered, you can also call 1-800-MEDICARE. They can tell you whether Medicare covers the service; if it does, QMB should cover your share of the cost.

Frequently Asked Questions

Do I need to have Medicare Part B to be a QMB?

You must be enrolled in Medicare Part B to receive QMB help, but you do not have to have it before you explore. If you are not yet enrolled in Part B, you can enroll at the same time you explore for QMB. You must have Part A, but Part B is optional for Medicare — QMB requires it because QMB pays Part B costs.

If I am a QMB, do I still have to pay for doctor visits?

No. QMB covers your Part B coinsurance, which is the percentage of the cost you would normally pay after you meet your deductible. Your provider bills Medicare and Medicaid, and you should not owe anything. If you are asked to pay, tell the provider you are a QMB and ask them to verify your status with Medicaid.

What is the difference between QMB and Medicaid?

QMB is a Medicaid program, but it only pays Medicare costs — premiums and cost-sharing. It does not cover medical services the way regular Medicaid does. You can have both QMB and regular Medicaid at the same time, but they serve different purposes.

Can I have QMB and a Medigap or Medicare Advantage plan at the same time?

You can have QMB and a Medigap plan, but it is usually not necessary — QMB covers most of what Medigap covers. You cannot have QMB and Medicare Advantage at the same time. If you enroll in Medicare Advantage, you lose QMB status, though you may be able to get SLMB or QI instead.

How long does it take to hear back after I explore for QMB?

Most states process QMB applications within two to four weeks. Some states are faster. You should receive a letter in the mail telling you whether you were approved and when your coverage starts. If you do not hear back within a month, call your state Medicaid office to check on your process.

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.