QMB is a Medicaid program that pays Medicare costs you would otherwise owe
QMB stands for may have access to Medicare Beneficiary. It is a Medicaid program that covers the premiums, deductibles, and copayments you owe for Medicare Part A and Part B. You must be enrolled in Medicare to use QMB, and your income and resources must fall below set limits. QMB does not cover prescription drugs, dental, or vision — those are separate programs.
The program exists because Medicare itself leaves gaps. You pay a monthly premium for Part B, and you owe a deductible before Medicare starts paying. QMB fills those gaps so you do not have to. Your state Medicaid office runs the program, so the exact rules and payment amounts vary by state.
Key Takeaways
- QMB pays your Medicare Part A and Part B premiums, deductibles, and copayments, but only if your income is below your state's limit.
- You must already be enrolled in Medicare Part A and Part B to be considered for QMB.
- Each state sets its own income and resource limits, so the threshold in one state may differ from another.
- You apply through your state Medicaid office, not through Medicare or Social Security.
- QMB does not cover prescription drugs, dental care, vision care, or hearing aids — you may be able to use other Medicaid programs for those.
Income and resource limits for QMB
Your income must be at or below 135 percent of the federal poverty line to be considered for QMB. For 2024, that means a single person can earn no more than roughly $1,550 per month, though this figure changes each year and varies slightly by state. A married couple living together can earn roughly $2,080 per month. These are federal guidelines, but your state may use slightly different numbers, so you need to check with your state Medicaid office.
Your resources — savings, investments, property you own — also have limits. Most states allow you to have up to $7,500 in countable resources if you are single, or $11,250 if you are married. Your home and one car do not count toward this limit. Again, your state may set different thresholds, so the exact number depends on where you live.
Income includes Social Security, pensions, wages, and some other sources. Your state Medicaid office will tell you which types of income count and which do not. Some income — like Supplemental Security Income (SSI) — may not count, or may count differently.
What QMB pays and what it does not
QMB covers your Medicare Part A premium (if you have to pay one), your Medicare Part B premium, your Part A deductible, and your Part B copayments. When you go to the doctor or hospital, you show your Medicaid card along with your Medicare card, and QMB pays what Medicare does not cover.
QMB does not cover prescription drugs. If you need help with drug costs, you may be able to use your state's Medicaid program or the federal Low-Income Subsidy (LIS) program for Medicare Part D. QMB also does not cover dental, vision, hearing aids, or long-term care. Some states offer separate Medicaid programs for those services, but QMB itself does not include them.
QMB also does not pay for services that Medicare does not cover. If Medicare says no to a treatment, QMB will not pay for it either.
How to apply for QMB through your state
You apply for QMB through your state Medicaid office, not through Medicare or Social Security. You can find your state office on the Medicaid website or by calling 1-800-MEDICARE. Some states let you apply online, by mail, or in person. Others require you to visit an office.
You will need to provide proof of your income (recent pay stubs, tax returns, or a Social Security statement), proof of your resources (bank statements), proof that you are a U.S. citizen or may have access to immigrant, and proof that you are enrolled in Medicare Part A and Part B. Bring your Social Security number and Medicare card.
Processing time varies by state. Some states decide within a few weeks; others take longer. Once you are approved, your state will send you a Medicaid card. You use both your Medicare card and your Medicaid card when you see a doctor or go to the hospital.
QMB compared to other Medicare cost programs
QMB is one of three programs that help pay Medicare costs. The other two are SLMB (Specified Low-Income Medicare Beneficiary) and QI (may have access to Individual). All three are run by state Medicaid offices.
SLMB pays only your Medicare Part B premium, not your deductibles or copayments. The income limit for SLMB is higher than QMB — usually around 150 percent of the federal poverty line. If you do not meet QMB's income limit but meet SLMB's, you can use SLMB instead.
QI pays only your Medicare Part B premium, and the income limit is even higher — usually around 175 percent of the federal poverty line. QI is often used as a backup if you do not meet the limits for QMB or SLMB. Each state decides how much QI money it has available, so QI may not always be open to new people.
| Program | Covers | Income Limit (approximate) |
|---|---|---|
| QMB | Part A and B premiums, deductibles, copayments | 135% of poverty line |
| SLMB | Part B premium only | 150% of poverty line |
| QI | Part B premium only | 175% of poverty line |
What happens after you are approved for QMB
Once your state approves you, you will receive a Medicaid card in the mail. You should receive it within a few weeks, though timing varies by state. Your approval usually starts on the first day of the month after your state processes your request, but some states backdate coverage to the month you applied.
When you see a doctor or go to the hospital, bring both your Medicare card and your Medicaid card. Tell the provider's office that you have QMB coverage. The provider will bill Medicare first, then bill your state Medicaid program for the remaining cost. You should not receive a bill for the amounts QMB covers.
Your QMB coverage continues as long as you remain enrolled in Medicare Part A and Part B and your income and resources stay below the limit. Some states ask you to recertify your income once a year; others recertify every few years. Your state will send you a notice if you need to recertify.
Frequently Asked Questions
Do I have to be on SSI or SSDI to get QMB?
No. You do not have to receive SSI or SSDI to be considered for QMB. You only need to be enrolled in Medicare Part A and Part B and have income and resources below your state's limits. Many people on fixed incomes — including those who receive only Social Security retirement benefits — meet the income limit.
What if my income goes up after I am approved?
If your income rises above your state's limit, you may lose QMB coverage. Your state will tell you when to report income changes. Some states have a grace period or allow small increases without ending coverage. Contact your state Medicaid office if your income changes.
Can I have both QMB and regular Medicaid?
Yes. QMB is a Medicaid program itself, so you will have Medicaid coverage. Your state may also cover additional services — like prescription drugs, dental, or vision — through its regular Medicaid program. Ask your state Medicaid office what other services you may be able to use.
What if I am denied for QMB?
Your state will send you a notice explaining why you were denied. You have the right to request a hearing to appeal the decision. The notice will tell you how to file an appeal and the deadline to do so. You can also contact your state Medicaid office to ask whether SLMB or QI might be an option instead.
Does QMB cover Medicare Advantage plans?
QMB can help pay premiums and cost-sharing for Medicare Advantage (Part C) plans, but the coverage works differently than it does for Original Medicare. If you have a Medicare Advantage plan, ask your plan and your state Medicaid office how QMB will work with your coverage.