What QMB Medicaid Covers and Who It's For

QMB is a Medicaid program that pays your Medicare costs instead of you paying them

QMB stands for may have access to Medicare Beneficiary. It is a Medicaid program run by your state that pays three things: your Medicare Part B premium (usually $164.90 per month in 2024, though this changes yearly), your Part B deductible, and your coinsurance on Medicare-covered services. You do not receive cash or Medicaid coverage for services Medicare does not cover — QMB only wraps around what Medicare already pays for.

The program exists because Medicare Part B costs money out of pocket, and some people cannot afford it. If you are already on Medicare and your income is low enough, your state's Medicaid program can cover those costs for you. You stay on Medicare; Medicaid just pays the bills Medicare sends you.

QMB is one of four Medicare Savings Programs (MSPs) that states run. The others are Specified Low-Income Medicare Beneficiary (SLMB), may have access to Individual (QI), and may have access to Disabled and Working Individual (QDWI). QMB covers the most — it pays premiums, deductibles, and coinsurance. The others cover fewer costs or have different income limits.

Key Takeaways

QMB pays your Medicare Part B premium, deductible, and coinsurance — not other medical bills or services Medicare does not cover.
You must be on Medicare Part A or Part B already, and your income must be below 135 percent of the federal poverty line (roughly $1,550 per month for a single person in 2024, though this varies by state and year).
You apply through your state Medicaid office, not Medicare, and the process usually takes two to four weeks.
Once approved, you show your QMB card to your doctor or hospital, and Medicaid pays Medicare's share directly — you typically pay nothing at the point of service.

Income and household size limits for QMB

QMB has an income limit of 135 percent of the federal poverty line. The federal poverty line changes every year. For 2024, 135 percent of poverty for a single person is approximately $1,550 per month, and for a couple it is approximately $2,080 per month. Your state may use a slightly different figure or update it at a different time of year, so call your state Medicaid office to confirm the exact number they use.

Income includes wages, Social Security, pensions, interest, and rental income. It does not include Supplemental Security Income (SSI) in most states — SSI is counted separately under different rules. If you receive SSI, tell the Medicaid office; they will know how to count your income correctly.

Your state counts only your income and your spouse's income if you are married. Adult children, roommates, or other household members do not count. If you are single, only your income matters.

Who can get QMB Medicaid

You must meet four conditions. First, you must be a U.S. citizen or may have access to immigrant. Second, you must already be enrolled in Medicare Part A, Part B, or both. Third, your income must be at or below 135 percent of the federal poverty line. Fourth, you must be a resident of the state where you are applying.

You do not have to be on Medicaid already. Many people on Medicare with low income are not on Medicaid for anything else — they just have Medicare. QMB is separate. You can be on QMB alone.

Age does not matter. Most QMB recipients are 65 or older because that is when most people go on Medicare, but younger people on Medicare (for example, due to disability or end-stage renal disease) can get QMB too.

How to apply for QMB through your state

Contact your state Medicaid office directly. You can find it by calling 211 or by searching "[your state] Medicaid office" online. Some states call it the Department of Health and Human Services, others call it the Department of Social Services. The name varies, but 211 will route you to the right place.

You will need to provide proof of income (recent pay stubs, tax return, or Social Security statement), proof of citizenship (birth certificate, passport, or naturalization papers), proof of residency (utility bill or lease), and proof that you are on Medicare (your Medicare card). Some states accept applications by mail, phone, or online; others require you to visit an office in person. Ask when you call.

Processing usually takes two to four weeks. Some states are faster; some are slower. Ask the Medicaid office for an estimate when you submit your application. If you are already on Medicaid for another reason (like SNAP or cash assistance), the process may be faster because they already have some of your information.

What QMB pays and what it does not

QMB pays three things: your Medicare Part B monthly premium, your Part B annual deductible, and your coinsurance on services Medicare covers. Coinsurance is the percentage you normally pay after you meet your deductible — for example, Medicare covers 80 percent of doctor visits, and you pay 20 percent. QMB pays that 20 percent.

QMB does not pay for services Medicare does not cover. It does not pay for dental, vision, hearing aids, or long-term care. It does not pay for prescription drugs (that is Part D). It does not pay your Part A deductible (the hospital deductible) — that is covered by a different program called SLMB-Plus or QI-Plus, depending on your state. If you need those, ask your Medicaid office which program covers them in your state.

QMB also does not pay copayments for Part D drugs or for services not covered by Medicare at all. If you see a provider who does not accept Medicare, QMB cannot help.

How QMB works when you see a doctor or go to the hospital

Once you are approved, you will receive a QMB card or a notice from your state Medicaid office. Show this to your doctor, hospital, or other provider when you receive care. The provider bills Medicare first. Medicare pays its share. Then the provider bills your state Medicaid program for the rest (your coinsurance or deductible). Medicaid pays it. You pay nothing.

In practice, you typically do not see a bill at all. The provider handles the billing between Medicare and Medicaid. If you do receive a bill, call the provider's billing department and give them your QMB information — they may not have submitted it correctly to Medicaid.

Some providers, especially in rural areas, may not be familiar with QMB. If a provider says they cannot accept it, ask to speak with their billing manager. QMB is a standard Medicaid program, and providers who accept Medicare and Medicaid should accept QMB.

QMB versus other Medicare Savings Programs

Your state runs four Medicare Savings Programs. QMB covers the most. SLMB (Specified Low-Income Medicare Beneficiary) covers your Part B premium and coinsurance but not your Part B deductible. It has a higher income limit — 135 to 150 percent of poverty, depending on your state. QI (may have access to Individual) covers only your Part B premium and has an even higher income limit. QDWI (may have access to Disabled and Working Individual) is for people under 65 who are working and have lost Medicare due to work income; it covers only the Part B premium.

If your income is too high for QMB, you may still may have access to for SLMB or QI. Ask your state Medicaid office which programs you might may have access to for. They will check all of them when you apply.

Frequently Asked Questions

Do I have to be on regular Medicaid to get QMB?

No. QMB is a separate program. You can be on QMB alone without any other Medicaid coverage. Many people on Medicare with low income use QMB to cover their Medicare costs and nothing else.

What happens to QMB if my income goes up?

If your income rises above 135 percent of the federal poverty line, you will no longer may have access to for QMB. Your state will notify you and end your coverage. You can reapply if your income drops again. Some states have a grace period of a few months; ask your Medicaid office about their rules.

Can I use QMB at any hospital or doctor?

Only at providers who accept both Medicare and Medicaid. Most do, but some do not. Call ahead or ask your doctor's office whether they accept QMB before you schedule an appointment. If a provider does not accept Medicaid, QMB cannot help you there.

Does QMB cover prescription drugs?

No. Prescription drugs are covered by Medicare Part D, which is separate. You need to enroll in a Part D plan through Medicare. Some Part D plans offer extra help for people with low income; ask Medicare or your state Medicaid office about that.

How long does QMB approval take?

Most states process QMB applications in two to four weeks. Some are faster. Call your state Medicaid office and ask for an estimate. If you are already on Medicaid, approval may be quicker because they already have your information on file.

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.