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The Qualified Medicare Beneficiary (QMB) Program is a Medicare Savings Program that helps pay for Medicare Part A and Part B premiums, deductibles, and coinsurance.
See If You May Be Eligible
You may be eligible for the Qualified Medicare Beneficiary Program if you:
- Are entitled to Medicare Part A.
- Have countable assets at or below the program limit*. If there is one person in your family, the asset limit is $8,400. If there are two people in your family, the asset limit is $12,600.
- Have countable monthly income* at or below 100% of the federal poverty level (FPL) after certain credits are applied. If there is one person in your family, the monthly income limit is $1,132.50. If there are two people in your family, the monthly income limit is $1,525.83.
Medicaid should already be paying your Medicare Part A and B costs (meaning you do not need to apply for Qualified Medicare Beneficiary Program benefits) if you receive Medicare and Medicaid and either of the following apply to you:
- You are enrolled in the Supplemental Security Income (SSI) program.
- You were enrolled in SSI but lost it for one of the following reasons:
- You were getting Old Age Survivors Disability Insurance (OASDI).
- You are the disabled adult child of parents who died or became disabled, causing you to get an increased or initial Social Security payment that made you unable to get SSI.
- You are the disabled or elderly spouse of a person who died, causing you to get a Social Security benefit that made you unable to get SSI.
*The asset limits are effective January 1, 2022, and the income limits are effective February 1, 2022. The limits are based on federal guidelines, which may change each year.
How to Apply
How Payments Work
If you are eligible for the Qualified Medicare Beneficiary Program, Medicaid will start paying for your Medicare Part A and B premiums, deductibles, and coinsurance the first day of the month after your application is approved.
When Medicaid starts paying your Medicare costs, your Social Security payment will increase, and you will get a notice from the Social Security Administration. The Social Security Administration will give you a refund for any payment you made after the date you were enrolled in the Qualified Medicare Beneficiary Program.
Even though you are enrolled in the Qualified Medicare Beneficiary Program in the month after your application is approved, your Social Security payment may not be increased for one to three months. This is the time that is needed for payments to be adjusted by Medicaid, Medicare, and the Social Security Administration. Getting a refund for those one to three months means your payments may be higher than usual for a short amount of time.
For example, if your application is approved in April, you are enrolled in Qualified Medicare Beneficiary Program in May. Your Social Security payment may not be increased until July. You will get a refund for premiums you paid for May and June.