Eligibility for the qualified medicare benefits (qmb) program

If you need help with Medicare premiums, you may be eligible for the Qualified Medicare Beneficiary (QMB) program. To qualify, your assets and monthly income must fall below specific limits.

Four different Medicare savings programs (MSPs) can help people who have difficulty affording Medicare costs. These programs include: * Qualified Medicare Beneficiary (QMB) program *

Specified Low-Income Medicare Beneficiary (SLMB) program * Qualified Individuals (QI) program * Qualified Disabled and Working Individuals (QDWI) program The QMB program has certain

eligibility guidelines you must meet. And as with other MSPs, your income and resources must fall below the QMB’s set limits in order to participate in the program. Basics of the Medicare

QMB program The four MSPs cover specific Medicare premiums and other costs. As of 2023, more than 8 million people were enrolled in the QMB program. The QMB program covers: * Medicare Part A

premiums * Medicare Part B premiums * any coinsurances, copayments, or deductibles What are the qualifications for QMB? Since the QMB program aims to help individuals with low incomes, it

places limits on their monthly income and financial resources. If you exceed these limits, you may not be eligible for the program. Generally, participation is limited to individuals who

meet the federal poverty level. For 2025, the federal poverty level is $15,650 per year for individuals in Washington, DC, and 48 states. Limits are higher in Alaska ($19,550) and Hawaii

($17,990). WHAT IS THE INCOME LIMIT FOR QMB IN 2024? Specific financial requirements for the QMB for individuals are: * a monthly income limit of $1,325 * an asset limit of $9,660 For the

QMB for married couples, the financial requirements are: * a monthly income limit of $1,783 * an asset limit of $14,470 If you think your income and assets are too high to make you eligible

for this program, try applying anyway. Several exceptions and considerations are made when calculating income and assets. Income that isn’t counted toward QMB eligibility includes: * the

first $20 of your income for the month * the first $65 of any wages you earn for the month * half of any wages you earn after the initial $65 is deducted * food stamps * settlement payments

to eligible Native American landowners whose assets had been mismanaged by the United States * some federal judgment distribution payments and per capita payments of funds held in trust by

the Secretary of the Interior to members of Native American tribes (this includes purchases made with these payments) * up to $2,000 per year of income that Native Americans get from

interests in trust or restricted American Indian lands * student loans or grants from the Department of Education’s or Bureau of Indian Affairs’ educational programs * funds received by

Native Americans from the Claims Resolution Act of 2010 (Cobell v. Salazar) The program does allow you to have $20 in income each month above the federal poverty limit. Income limits may

also vary slightly by state. You must be a resident of the state in which you’re applying for the QMB program, and you must already be enrolled in Medicare Part A. Resources that aren’t

counted when you apply for the QMB program include: * your primary home * one vehicle * household items * engagement and wedding rings * burial plots * burial expenses of up to $1,500 * life

insurance that has a cash value below $1,500 * some native corporation stocks held by Alaska Native people How do you enroll in the Medicare QMB program? To enroll in the QMB program, you

first need to be enrolled in Medicare Part A. The next step is to review your income and resources to see if you fall below Medicare’s limits. But remember that there are exceptions to those

limits, and you’re encouraged to apply even if your income or resources exceed them. To apply for the QMB program, you’ll need to contact your state Medicaid office. You can check online to

find your state’s office locations or call Medicare at 800-633-4227 (TTY: 877-486-2048). The documentation you’ll need varies by state, but your application process will likely include

submissions of identification, proof of Medicare coverage, and financial information. How long does it take to get approved for QMB? Once you submit your application, you should receive a

confirmation or denial within 45 days. If you’re denied, you can request an appeal. Enrollment in any of the MSPs must be renewed each year. Even when your QMB is active, you may, at times,

be wrongfully billed for items or services that it covers. Contact Medicare for any billing problems. Be sure to carry documentation of your participation in the QMB program and show it to

your healthcare professionals. Frequently asked questions Medicaid covers services that aren’t typically included in Medicare. QMB is a form of partial Medicaid and will only assist with

paying for services that are already covered under Medicare. QMB covers the monthly premiums for both Medicare parts A and B, as well as any other associated out-of-pocket expenses. The SLMB

program covers only the monthly Medicare premium. Any healthcare professional who accepts Medicare has to accept someone enrolled in the QMB program. The takeaway Medicare is meant to

provide affordable healthcare coverage for older adults and other individuals with certain needs. Yet out-of-pocket costs can add up. A number of programs can help you pay for your share of

Medicare costs. The QMB program is just one way to get help paying your premiums, deductibles, and other costs. You must fall below income and asset limits to participate in the QMB program.

But even if you think you make or own too much, try applying anyway. Many assets and income sources aren’t included when calculating your eligibility.