QMB pays your Medicare premiums, deductibles, and copays — not other medical bills

may have access to Medicare Beneficiary (QMB) is a Medicaid program that pays specific Medicare costs for people with low income. It covers your Part B premium (currently $164.90 per month), your Part A deductible, and your copayments and coinsurance when you use Medicare-covered services. QMB does not pay for services Medicare itself does not cover, and it does not pay for prescription drugs, dental, vision, or hearing aids.

QMB is one of four "Medicare Savings Programs" that Medicaid runs. The others — Specified Low-Income Medicare Beneficiary (SLMB), may have access to Individual (QI), and may have access to Disabled and Working Individual (QDWI) — cover different combinations of premiums and cost-sharing. QMB is the most generous of the four.

Key Takeaways

  • QMB pays your Part B premium, Part A deductible, and all copayments and coinsurance for Medicare-covered services.
  • You must be enrolled in Medicare Part A and Part B to use QMB, and your income must fall below the federal limit (roughly $1,500 per month for an individual in 2024, though this varies by state).
  • QMB does not cover prescription drugs, dental, vision, hearing aids, or any service Medicare does not cover.
  • You apply through your state Medicaid office, not through Medicare, and approval can take several weeks.
  • Once approved, QMB works automatically — providers bill Medicare first, then QMB pays the remaining cost-sharing you would owe.

What QMB actually pays

QMB covers three specific Medicare costs. First, it pays your Part B monthly premium in full. Second, it pays your Part A deductible (the amount you owe before Medicare starts paying for a hospital stay). Third, it pays all copayments and coinsurance for any service Medicare covers — including hospital stays, doctor visits, lab work, imaging, and outpatient surgery.

The key word is "Medicare covers." If Medicare does not cover a service, QMB will not pay for it either. This means QMB does not cover prescription drugs (that is Part D's role), dental work, vision care, hearing aids, or long-term care in a nursing home. It also does not cover services that Medicare considers experimental or not medically necessary.

QMB also does not pay Part A premiums. If you did not work long enough to may have access to for free Part A, you would still owe that premium yourself — though you may be able to get help through SLMB or another program.

Income and resource limits for QMB

To be approved for QMB, your income must be at or below 135 percent of the federal poverty line. For 2024, that means roughly $1,500 per month for a single person and $2,000 per month for a married couple, though these numbers change yearly and vary slightly by state. Your state Medicaid office can tell you the exact limit for your situation.

QMB also has a resource limit — the total value of money, investments, and property you own (not counting your home or car). The limit is $8,200 for an individual and $12,300 for a married couple as of 2024, though these amounts also change annually. If you are over the limit, you are not approved, even if your income qualifies.

Some states are more generous than the federal minimums. A few states use 150 percent of poverty instead of 135 percent, or have higher resource limits. Check with your state Medicaid office to learn what applies where you live.

How to apply for QMB

You apply through your state Medicaid office, not through Medicare or Social Security. You can apply online, by mail, or in person, depending on what your state offers. Start by contacting your state Medicaid program directly — you can find the phone number at medicaid.gov under "Contact Your State" or by calling 1-800-MEDICARE and asking for a referral.

You will need to provide proof of income (recent pay stubs, tax returns, or a letter from Social Security showing your benefit amount), proof of resources (bank statements), proof of citizenship or legal residency, and proof that you are enrolled in Medicare Part A and Part B. The application itself usually takes 15 to 30 minutes to complete.

Processing time varies by state but typically takes two to four weeks. Some states are faster; others slower. You can call your state Medicaid office to check on your application status after two weeks.

How QMB works once you are approved

Once you are approved, you do not have to do anything special when you see a doctor or go to the hospital. Your state will send you a QMB card or letter confirming your coverage. When you receive care, you show your Medicare card and your QMB card (or letter) to the provider. The provider bills Medicare first. Medicare pays its share and sends you a bill for your copay or coinsurance. Then QMB pays that remaining amount directly to the provider or to you, depending on how your state handles it.

Some providers may not know about QMB or may not accept it. If a provider refuses to accept QMB payment, contact your state Medicaid office — they can follow up on your behalf. You should never have to pay out of pocket for a Medicare-covered service if you have active QMB coverage.

QMB does not cover everything — know the gaps

Many people assume QMB covers all their medical costs because it covers copays and deductibles. It does not. QMB only covers what Medicare covers, and Medicare has significant gaps. Prescription drugs are the biggest one — QMB does not pay for them at all. You need a separate Part D plan (prescription drug coverage) for medications, and you may be able to get help paying Part D premiums through another Medicaid program.

Dental, vision, and hearing are also not covered by Medicare or QMB. If you need glasses, dentures, or a hearing aid, you pay out of pocket or look for community health centers that offer sliding-scale fees. Some states offer limited dental or vision coverage through their Medicaid programs, but this is separate from QMB and you would need to apply separately.

Long-term care in a nursing home is also not covered by Medicare or QMB. If you need extended nursing home care, you would need to look into Medicaid's long-term care program, which is different from QMB.

What happens if your income or resources change

You must report changes in income or resources to your state Medicaid office. If your income goes above the limit, your QMB coverage will end. If you receive a lump sum (an inheritance, a settlement, a tax refund), that counts toward your resource limit and could disqualify you if it pushes you over the cap.

Some states allow you to report changes online or by phone. Others require you to submit a written form. Contact your state Medicaid office to learn how to report changes in your situation. If you do not report a change and it is later discovered, you may have to repay benefits you received while ineligible — though states vary in how strictly they enforce this.

Frequently Asked Questions

Does QMB pay for my prescription drugs?

No. QMB does not cover prescription drugs at all. You need a separate Part D plan for medications. If you have low income, you may be able to get help paying your Part D premium through another Medicaid program, or you may may have access to for Part D's low-income subsidy.

Can I have QMB and Medicaid at the same time?

Yes. QMB is a Medicaid program, so you are technically on Medicaid when you have QMB. However, QMB is specifically for people on Medicare. If you also may have access to for full Medicaid coverage (which varies by state and income), you would have both, and full Medicaid would cover services QMB does not, like dental and long-term care.

What if I turn down Part B when I first become may be able to access for Medicare?

You can still apply for QMB, but you will need to enroll in Part B first. QMB cannot help you pay for Part B if you are not enrolled in it. If you turned down Part B and now want to enroll, you may face a late-enrollment penalty unless you have a may have access to reason. Talk to Medicare about your options before applying for QMB.

Does QMB cover my Part A premium?

No. QMB covers your Part A deductible and copays, but not the Part A premium itself. If you did not work long enough to may have access to for free Part A, you would still owe the premium. SLMB, another Medicare Savings Program, may help with Part A premiums if you do not may have access to for QMB.

What if my state denies my QMB application?

You have the right to appeal. Your state Medicaid office will send you a notice explaining why you were denied. The notice will include instructions for requesting a hearing. You typically have 30 to 60 days to file an appeal, depending on your state. Contact your state Medicaid office if you do not understand the denial or need help with the appeal process.