Medicaid can pay your Medicare Part B premium if you meet income and asset limits, but the program that does so depends on your state and your specific situation.

Medicare Part B covers doctor visits and outpatient care, and it costs money each month — the standard premium is deducted from your Social Security check. If your income is low enough, Medicaid may cover that premium for you through one of three programs. Which program covers you depends on your age, whether you also receive Supplemental Security Income (SSI), and where you live.

The three programs are the may have access to Medicare Beneficiary (QMB) program, the Specified Low-Income Medicare Beneficiary (SLMB) program, and the may have access to Individual (QI) program. Each has different income limits and covers different costs. Not every state runs all three, and income thresholds vary by state.

Key Takeaways

  • Medicaid covers Medicare Part B premiums through three separate programs: QMB, SLMB, and QI, each with different income limits that vary by state.
  • QMB is the most generous program and covers Part B premiums plus cost-sharing; SLMB covers only the premium; QI covers the premium but has the highest income limit of the three.
  • You must contact your state Medicaid office to find out which program you may be able to use, because income thresholds and program availability differ by location.
  • If you receive SSI, you are automatically enrolled in QMB in most states and do not need to take action.

The three Medicaid programs that cover Part B premiums

QMB (may have access to Medicare Beneficiary) is the most comprehensive. It covers your Medicare Part B premium, and it also covers your Part A deductible, coinsurance, and copayments. To be in QMB, your income must be at or below 100 percent of the federal poverty level. If you receive SSI, you are automatically enrolled in QMB in most states without having to do anything.

SLMB (Specified Low-Income Medicare Beneficiary) covers only your Medicare Part B premium — not deductibles or copayments. Income limits are higher than QMB: typically around 120 percent of federal poverty level, though this varies by state. You must contact your state Medicaid office to enroll in SLMB; it is not automatic.

QI (may have access to Individual) also covers your Part B premium but has the highest income limit of the three, usually around 135 to 175 percent of federal poverty level depending on your state. QI programs often have limited funding and may close to new enrollments when money runs out. Like SLMB, you must contact your state Medicaid office to enroll.

How income limits work and why they vary

Federal poverty guidelines set the baseline, but each state can set its own income thresholds within federal rules. This means a person with the same income might be covered in one state but not in another. For example, one state's SLMB program might use 120 percent of poverty as the cutoff, while another uses 110 percent.

Income limits also change each year when federal poverty guidelines are updated, usually in January. Your state Medicaid office publishes the current limits for your state. You can find your state office through the Centers for Medicare & Medicaid Services (CMS) website or by calling 1-800-MEDICARE.

When you contact your state office, have your income information ready — usually your most recent tax return or Social Security statement. They will tell you which program, if any, you may be able to use based on your income and assets.

What counts as income and assets

Income includes Social Security benefits, pensions, wages, and interest from savings. It does not include food stamps, housing assistance, or some other government benefits. Your state Medicaid office can tell you exactly what they count.

Asset limits also apply. QMB has an asset limit (usually around $7,500 for an individual, though this varies by state), while SLMB and QI may have higher or no asset limits. A home you live in and one vehicle do not count toward the asset limit. Again, your state office has the exact numbers for your location.

How to learn about you can use one of these programs

Call your state Medicaid office directly. You can find the phone number through the CMS website at cms.gov, or call 1-800-MEDICARE and ask for your state office. Have your Social Security number, income information, and asset information ready.

If you receive SSI, check with your state office to confirm you are enrolled in QMB. Some states enroll SSI recipients automatically; others require you to request it. If you are not receiving SSI, you will need to contact Medicaid to see whether SLMB or QI is available to you.

Processing times vary. Some states enroll you within a few weeks; others take longer. Once you are enrolled, Medicaid will coordinate with Medicare to pay your Part B premium directly to Medicare, so you do not have to handle the payment yourself.

What happens if your income changes

If your income increases above the limit for your program, you will lose coverage under that program. If your income drops, you may move into a more generous program — for example, from SLMB to QMB. You should report income changes to your state Medicaid office so they can update your enrollment.

Some states conduct annual reviews of your income and assets. Others review only when you report a change. Ask your state office what their process is so you know when to expect contact from them.

If your state does not offer the program you need

Not every state runs all three programs. Some states do not offer QI at all, or they close QI to new enrollments when funding runs out. If your state does not have the program that would cover you, you have no other Medicaid option for your Part B premium through these programs.

If you cannot get Medicaid to cover your Part B premium, you still have to pay it yourself. The standard premium is deducted from your Social Security check each month. If you cannot afford it, contact 1-800-MEDICARE to discuss your options; they can tell you about other programs or payment plans that might help.

Frequently Asked Questions

If I get SSI, do I have to do anything to get my Part B premium covered?

In most states, no — you are automatically enrolled in QMB when you receive SSI. However, some states require you to request it. Call your state Medicaid office to confirm you are enrolled. If you are not, ask them how to enroll.

What is the difference between QMB and SLMB?

QMB covers your Part B premium plus deductibles and copayments for Medicare Part A and Part B. SLMB covers only the Part B premium. QMB has a lower income limit. If your income qualifies you for QMB, you should be in QMB because it covers more.

Can I be in more than one of these programs at the same time?

No. You can only be enrolled in one program. If you may have access to for QMB, you will be in QMB. If you do not may have access to for QMB but may have access to for SLMB, you will be in SLMB. The programs are designed so that each person falls into one category based on income.

What if I do not know my state's income limit?

Call your state Medicaid office or 1-800-MEDICARE and ask for the current income limits for QMB, SLMB, and QI in your state. They will also tell you whether your income falls within those limits based on the information you provide.

If Medicaid pays my Part B premium, do I still have to pay copayments at the doctor?

It depends on which program covers you. QMB covers copayments and deductibles. SLMB and QI cover only the premium, so you still pay copayments and deductibles out of pocket when you see a doctor or go to the hospital.