Qualified Medicare Beneficiary

What is a Qualified Medicare Beneficiary?

A Qualified Medicare Beneficiary is a person for whom the government must cover certain health care costs, including premiums, deductibles and copays. The Qualified Medicare Beneficiary (QMB) program is a Medicare Savings Program that helps qualified individuals meet the costs of Medicare premiums and deductibles. To qualify, people must be eligible for Medicare and meet income and asset guidelines.

Deeper definition

The QMB program makes monthly premium payments towards recipients’ Medicare Part A (when applicable) and Medicare Part B plans, and pays deductibles and co-insurance payments. Recipients also receive assistance with prescription drug costs under the Medicare Part D plan.

To qualify for assistance, you must have Medicare Part A and meet income and asset guidelines. If you meet the guidelines but aren’t enrolled in Medicare Part A, the state where you reside will allow you to enroll in both the Medicare Part A and the QMB programs.

Each state is different regarding income and asset guidelines and enrollment time frames. While most states allow you to enroll at any time, some states require you to enroll at a specific time.

Providers are prohibited from charging patients who are part of the QMB program any outstanding deductibles, copay fees or coinsurance. The state is responsible for these payments irrespective of whether the service is a Medicaid-covered service or not.

Patients sometimes have trouble using their QMB benefits when their providers accept Medicare but not Medicaid. These providers are sometimes unaware that the patient is part of the Qualified Medical Benefit program. They may not realize they’re prohibited from billing the patient and must instead bill the state.

To apply for the QMB program, contact your local Medicaid office.

Qualified Medical Beneficiary example

Each state is different regarding its income and asset requirements for QMB. For example, in Washington State, your income must be no more than $990 for a person or $1,335 for a couple. You must have no more than $7,280 in assets for a person or $10,930 for a couple.

Assets include cash, bank accounts, certificates of deposit, savings bonds, stocks, recreational vehicles and real property (except the home you live in). If you meet these criteria, your premiums, copays and deductibles are paid. You also receive assistance with your prescription costs.

Learn more about the difference between Medicaid and Medicare at Bankrate.com.

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