What Does Medicare QMB Mean? 

Original Medicare benefits first became available in 1965, and since then, tens of millions of American seniors have taken advantage of Medicare coverage to help pay for healthcare costs. Medicare benefits provide coverage for doctor visits, clinical diagnostic testing, surgery, hospital care and a range of other healthcare expenses.

Medicare coverage is designed to be affordable for seniors and those individuals who qualify under the age of 65 due to certain disabilities. Although most plans and coverage options require a monthly premium and annual deductible, many Medicare recipients find that the cost of Medicare is lower than that of private health insurance.

What is the Medicare QMB program?

Some Medicare recipients, however, find that the cost of maintaining Medicare benefits can be burdensome. Seniors who are classified as low-income may be able to find relief, however, through Medicare’s Qualified Medicare Beneficiary (QMB) Program. This program is designed to help offset some of the costs associated with carrying and utilizing Medicare benefits.

The QMB Program is designed for seniors who qualify for Medicare after reaching age 65 but whose monthly income is limited. Medicare also places a resource limit on those who can qualify for the QMB Program. The QMB Program is one of four Medicare Savings Programs designed to help seniors access the healthcare they need.

What are QMB qualification limits?

In order to qualify for the full QMB Program, Medicare recipients must fall below an income threshold that is set each year. The full QMB Program limits resources to $9090 for individuals and $13630 for married couples. The income limit in 2023 for partial QMB subsidies is $15160 for individuals and $30,240 for married couples. If beneficiaries notify the Social Security Administration that they expect to use some of their resources for burial expenses, the applicable 2023 resource limits are $10,590 ($16,630 if married) for the full program and $16,660 ($33,240 if married) for the partial subsidies. 

Resources include assets and accounts. Money in your bank account as well as any stock you own count toward your resource limit. Additionally, real and personal property like homes or investment properties as well as vehicles and household items count toward QMB Program qualifications.

Limitations are assessed from time to time and may change, so it’s important to stay up to date regarding current limitations. Additionally, you must report changes in your financial situation to your state’s Medicare benefits office. If you come into possession of additional assets or experience a change in your monthly income and fail to report this to Medicare, you may be responsible for penalties and fees if your account is audited in the future.

What does the QMB program provide?

If you qualify for the QMB Program, you may be able to receive money from your state’s Medicare benefits fund to help pay for your Medicare Part A and Medicare Part B premiums. Additionally, the QMB Program may help to offset the cost of deductibles and coinsurance or copay amounts.

Federal law prohibits the billing of cost sharing for seniors enrolled in the QMB Program. In previous years, some confusion arose from the practice of billing QMB Program participants as pharmacies and physicians’ offices were unaware that they were not supposed to bill for copays and coinsurance amounts. The Centers for Medicare & Medicaid Services (CMS) has since issued a clarification that states that no one enrolled in the QMB Program has a legal obligation to pay deductibles for Medicare Part A or Part B or coinsurance or copays for any item approved under Medicare coverage.