From monthly premiums to copayments, the out-of-pocket (OOP) expenses of Medicare can add up fast. Medicare Savings Programs (MSPs) are state Medicaid-sponsored programs that help relieve some OOP Medicare costs for people living on a low or fixed income. There are four programs in total, including the Qualified Medicare Beneficiary (QMB) program.

What is the Qualified Medicare Beneficiary (QMB) program?

The QMB program covers Medicare Part A and Part B premiums, deductibles, copayments, and coinsurance for people with limited income and assets.

  • A premium is a fixed monthly amount you pay for Medicare coverage, regardless of whether you receive services.
  • A deductible is the dollar amount you must pay for Medicare-covered services and items annually before Medicare coverage kicks in.
  • A copayment is a fixed amount you pay for a Medicare-covered service ($30, for example).
  • Coinsurance is a portion of the cost of a health care service that you are responsible for. With Medicare Part B, you generally pay 20% of the cost for each Medicare-covered service.

If you’re enrolled in the QMB program, you should not be billed for any Medicare-covered services you receive from approved providers—or providers in your plan’s network if you have Medicare Advantage. In fact, it’s against the law for Medicare providers to bill you for services if you have QMB.

As a QMB enrollee, you may have to pay a small copayment when you receive health care services. However, this bill will come from Medicaid, not Medicare.

What are the benefits of the Qualified Medicare Beneficiary (QMB)?

The biggest advantage of having QMB is saving money on doctor visits, hospital stays, and medical procedures. This program is one of the three MSPs that cover the entire Medicare Part B premium ($164.90 a month for most beneficiaries in 2023). This alone adds up to an annual savings of $1,978.80. Since this premium is normally taken out of your Social Security check, having QMB means more money in your check every month.

Plus, the QMB program also covers deductibles, coinsurance, and copayments for Medicare Part A and Part B covered services. As a result, you don’t have to let financial worries stop you from getting the health care services you need. The money you save can be applied to other areas of your budget, such as food and utility bills.

Below is an overview of what QMB covers for Medicare cost sharing:

Part A

Part B
  • Part A hospital deductible ($1,600/per benefit period)
  • Part A hospital copays: Days 61-90 ($400 daily), days 91-150 ($800 daily)
  • Part A SNF copays: Days 21-100 ($200 daily)
  • Part A monthly premium (up to $506)
  • Part B annual deductible ($226)
  • Part B monthly premium ($164.90)
  • Part B 20% coinsurance (amount varies)

Lastly, if you have QMB, you automatically qualify for the Medicare Part D Low Income Subsidy (LIS/Extra Help) program. Extra Help is a federal program that helps you pay your prescription drug costs. The Social Security Administration estimates the value of this benefit to be $5,300 a year for each beneficiary.

What is QMB Plus?

If you qualify for QMB but also meet the requirements for full Medicaid benefits, you are considered dual-eligible—also known as QMB Plus. You’ll receive benefits from the QMB program as well as your state Medicaid program. Having coverage through both programs may allow you to receive services not covered by Medicare, such as vision, hearing, and dental care.

Who qualifies for QMB?

To be enrolled in the QMB program, you must qualify for or be enrolled in Medicare Part A at a minimum. You must also meet strict income and asset limits. Most U.S. states use the general guidelines below, but some may set higher income limits or waive the asset guidelines altogether. These limits are based on the Federal Poverty Guidelines (FPG) and change each year. New limits are released each January.

Note: Your state Medicaid agency may not start to use the current year's guidelines until March or April, after the Centers for Medicare & Medicaid Services have formally published these figures.

Below is general eligibility information for 2023:

Monthly Income Limit

Asset Limit
(at or below 100% FPG/+ $20 income disregard per household) (e.g., real estate, retirement accounts, and savings and checking accounts)
  • $1,215/$1,235 if single
  • $1,643/$1,663 if married
  • $9,090 if single
  • $13,630 if married

Alaska

  • $1,518/$1,538 if single
  • $2,053/$2,073 if married
  

Hawaii

  • $1,398/$1,418 if single
  • $1,890/$1,910 if married
  

In all states, all of the MSPs include a $20 general income disregard. This means the first $20 of your monthly income is not counted toward the income limit. If you receive Supplemental Nutrition Assistance Program (SNAP) benefits, those funds are also not counted.

Even it seems that your income doesn't fit your state's QMB guidelines, you should apply. This is because certain parts of your income and assets may not be counted toward the limits, and you may still qualify for one of the MSPs.

How do I apply for QMB?

If you think you may qualify for Medicare savings, it's important to fill out a QMB program application as soon as possible. Keep in mind that states may have different eligibility guidelines and application processes. Also, you will not be able to choose which MSP you want to enroll in. Instead, you’ll be enrolled in the program best suited to your personal financial situation.

To get started, call your State Health Insurance Assistance Program (SHIP) and speak to a Medicare expert to see if you qualify for QMB or another MSP in your state. Find your local SHIP office here or call 1-877-839-2675.

You’re also invited to visit BenefitsCheckUp¼, our free online tool designed to help you uncover all the money-saving benefits programs you qualify for, including MSPs. Find out if you can get financial assistance with food, utilities, medications, transportation, and more.