Need help affording Medicare? Check out the QMB Program!

While Medicare offers an affordable way for people to gain much-needed health insurance, there are still some out there who struggle to meet the costs of staying healthy. Especially now that the COVID-19 pandemic is affecting the health and livelihoods of millions, it may be a good idea to look into the QMB program if you have found yourself struggling to pay premiums or co-pays.

By applying, you could find yourself not having to worry about Medicare premiums, even as the coronavirus threatens your sources of income.

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What is the Medicare QMB Program?

The Medicare Qualified Medicare Beneficiary Program (QMB) is one of four Medicare Savings Programs (sometimes called Medicare Cost Sharing) designed to assist low-income Medicare beneficiaries. Technically, QMB is a Medicaid benefit, given that it seeks to lighten the financial load for individuals that would otherwise have a difficult time paying for a variety of healthcare costs.

While there are a number of requirements that you’ll need to meet to qualify as a QMB, those who qualify need not worry about paying for certain aspects of their Medicare coverage. The Medicare QMB Program will pay for:

  • Medicare Part A premiums
  • Medicare Part B premiums
  • Medicare Deductibles
  • Coinsurance costs for Medicare and Medicaid services
  • Co-payments for Medicare services

If you prefer to use Medicare Advantage, you can qualify for a Special Needs Plan tailored to dual-eligible Medicare beneficiaries. SNPs work with a single Medicare provider. You’ll work within that provider’s network. These plans are especially useful for people treating a chronic illness like heart disease or HIV.

For those seeking help in paying for Medicare Part D prescription drug plans, the Extra Help program is a great resource. Those who qualify for QMB usually qualify for Extra Help.

If you are experiencing financial hardship and struggling to cover your monthly Medicare costs, Medicare QMB could be a great option and enable you to save a considerable amount of money. However, not just anyone can qualify for this medical assistance program, and you’ll have to meet some financial and policy requirements. 

There are three other types of Medicare Savings Programs that you might qualify for:

  • Specified Low-Income Medicare Beneficiaries (SLMB): People who qualify for this program have an income between 100 and 120 percent of the Federal Poverty Level and an asset total that does not exceed twice the limit for Social Security eligibility. Under this program, Medicaid will cover Part B premiums only.
  • Qualified Disabled and Working Individuals (QDWI): This program applies to individuals who have lost their Medicare Part A coverage due to returning to work and covers their Medicare Part A premiums.
  • Qualifying Individuals (QI): This program operates on a “first-come, first-served” basis and receives applications yearly. It can help individuals enrolled in Medicare Part A plans to pay for Medicare Part B premiums. While this program can definitely assist you in paying for Part B premiums, it’s important to note that you will need to reapply each year.

Who qualifies for QMB Medicaid?

Generally speaking, anyone who earns a low amount of income each month can be eligible for QMB assistance. In order to gain eligibility, you must:

  • Have an enrollment in Medicare Part A,
  • Have residence in the state in which you are applying for QMB benefits, and
  • Have a limited amount of income, assets, or financial resources (to be more specific, you must meet 100 percent of the Federal Poverty Level)
    • In order to meet 100 percent of the FPL, a qualifying individual must make less than $12,760 per year in Washington, D.C., and the 48 contiguous states. In Hawaii, individuals must make less than $14,680 per year, while in Alaska individuals must make less than $15,950.

Because Medicaid is regulated by each state, it’s a good idea to contact your state Medicaid program if you have any questions about your eligibility.

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What Is the Income Limit for the QMB Program?

To verify that individuals are in need of extra help, the program has income limitations on those seeking QMB eligibility. These limits shake out into two areas: monthly income and assets.

Monthly income is just as it sounds, the amount of money that you earn each month. Assets, on the other hand, include the money in your checking accounts, savings accounts, and investments.

Monthly Income Limits

  • Individuals have an income limit of $1,084 per month.
  • Married couples have a combined income limit of $1,457 per month.
  • There are some bits of income that do not count toward your QMB eligibility. These include:
    • The first $20 of income you receive in a given month
    • The first $65 of wages you gain in a given month
    • Half of any wages you receive during a given month (after you deduct the initial $65 of wages)
    • Any food stamps
  • In addition to income that does not count toward your QMB eligibility, the program allows for you to gain an extra $20 of income above the federal poverty level.

Resource Limits

  • Individuals have an asset limit of $7,860.
  • Married couples have a combined asset limit of $11,800.
  • As with monthly income, some assets will not count toward your QMB eligibility. These assets include:
    • Your primary home
    • One vehicle
    • Any household items
    • Engagement and wedding rings
    • Burial plots, as well as burial expenses of up to $1,500
    • Life insurance policies valued below $1,500

If you are concerned that you might have income or asset levels high enough to just barely disqualify you from the QMB program, you should still make an effort to apply. Various exceptions can come up, and consideration for your financial situation may result in an approved application.

Who Can Be a Medicare Beneficiary?

In most cases, people who turn 65 can enroll in Original Medicare or Medicare Advantage plans. This occurs during the Initial Enrollment Period, which begins three months prior to a person’s 65th birthday month and ends three months after their 65th birthday month. During this time, most people are required to enroll in Original Medicare (Part A and Part B) plans, lest they face late-enrollment penalties.

Those under 65 can enroll in Medicare during a Special Enrollment Period, which is for people who have experienced any number of extenuating or life-changing circumstances. To see a list of circumstances that qualify you for Special Enrollment, or for additional information, visit Medicare.gov. (To see if you are eligible for special enrollment, you can also call Medicare at 1-800-MEDICARE. TTY users can call 1-877-486-2048.)

 

 

FAQ: Qualified Medicare Beneficiaries

Is QMB the same as Medicaid?

QMB is a Medicaid program/benefit but is not necessarily Medicaid itself. The QMB program, as with Medicaid, is largely funded by states, not the federal government. Medicaid can often work in conjunction with Medicare if an individual qualifies for both. Individuals 65 and older, as well as those who qualify for Special Enrollment, qualify for Medicare. Individuals with low income, including children, pregnant women, parents, seniors, and individuals with disabilities, can qualify for Medicaid. Individuals who qualify for both Medicaid and Medicare are “dual-eligible beneficiaries.”  These individuals can then apply for cost-sharing programs, including QMB.

Is QMB full Medicaid?

Again, QMB is a Medicaid program/benefit, but it is possible to qualify for the QMB program without qualifying for full Medicaid. This category of beneficiaries is called “QMB Only.” Others, however, can qualify for the QMB program while having full Medicaid. This category of beneficiaries is called “QMB Plus.”  Individuals who are part of QMB Only get the same financial assistance as those who are part of QMB Plus; however, those under QMB Plus have access to various other Medicaid benefits.

What does Medicaid QMB pay for?

Medicaid QMB pays for Medicare Part A and Part B premiums. Also, depending on the plan provided by an individual’s home state, Medicaid QMB can pay for coinsurance and deductible costs.

Conclusion: It Doesn’t Hurt to See If You Qualify

Medicaid is a program that can help seniors with low income afford their Medicare plans. If you’re having trouble affording your healthcare, you should consider taking advantage of this program if you can—even if you don’t think you qualify. Talk to a representative at your state’s Medicaid program to uncover your options.

Finally, don’t forget to use the Insurify Medicare plan comparison tool. Simply enter your ZIP code to find the resources you need to get the best healthcare at the best price. Could it get any easier than that?

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Updated April 13, 2021

Originally from Los Angeles, California, Adrian Coto is a writer living in Brooklyn, New York. A graduate of the NYU Creative Writing MFA program, he's worked as a legal assistant, a law school administrator, and now as a copywriter and editor.