What You Need to Know About Qualified Medicare Beneficiary (QMB) Program

What You Need to Know About Qualified Medicare Beneficiary (QMB) Program

The Qualified Medicare Beneficiaries (QMB) program assists Medicare beneficiaries in paying for medical services. To be eligible for the QMB program, you must be enrolled in Medicare Part A (Hospital Insurance Benefits), and your income must be below specific thresholds. In March, the federal cost of living adjustment is used to alter the income limitations each year. ​

What You Need to Qualify for the QMB Program?

The QMB program has three separate eligibility requirements. Medicare Part A eligibility, income constraints, and resource limits are among them. However, whether you have Original Medicare (parts A and B) or a Medicare Advantage plan, you can get QMB benefits.

Eligibility for Medicare Part A

You must also be qualified for Medicare Part A to participate in the QMB program. To be qualified for Part A, you must meet the following criteria:

  • 65 years or older and have a qualifying disability at any age and 
  • have the end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease).

Limits on Income

You must fulfill specific monthly income restrictions to be eligible for the QMB program. These restrictions differ depending on whether or not you are married. The following were the monthly income restrictions for the QMB program in 2021:

  • $1,094 per month for an individual
  • $1,472 per month for a married couple
  • Alaska and Hawaii have more significant monthly income restrictions. As a result, even though their monthly salaries are more meaningful, residents of these states may still be eligible for the QMB program.

Each year, the QMB program’s monthly income ceiling rises. So, even if your salary increases marginally, you should still apply for the program.

Resources are Limited

The QMB program has a resource restriction in addition to a monthly income limit. The following items are included in this limit:

  • Money in your checking and savings accounts, as well as stocks and bonds
  • Some resources are exempt from the resource limit. Things like your home, vehicle and furnishings fall into this category.

The resource limitations for the QMB program fluctuate based on whether or not you’re married, much like the income limits. The QMB program’s resource limits for 2021 are as follows:

  • $7,970 per person
  • $11,960 (married)
  • Every year, resource constraints are raised. However, if your resources have grown marginally, you should still apply for the QMB program, just as you should if your income has increased.

How to Enroll?

Contact your state’s Medicaid office to discover whether you qualify and for further information on the application process. If you have any more questions or concerns, your State Health Insurance Assistance Program (SHIP) may be able to assist you.

You must complete a brief application form as part of the enrolling procedure. 

As part of the application process, you may be required to provide further paperwork. It might be pay stubs, bank statements, or your income tax return details.

You must reapply for the QMB program each year if you are currently enrolled. It is because your income and resources may fluctuate from year to year. The Medicaid office in your state can provide you with information on when and how to reapply.

Some Other Medicare Savings Program (MSPs)

The four different benefits packages are based on a person’s salary. The income restrictions shown are for March 2021 to February 2022.

1. Benefits for Qualified Medicare Recipients – Basic (QMB-BAS)

The Department of Human Services pays for qualified beneficiaries’ Medicare premiums, deductibles, and coinsurance under this benefit package. The program has an income ceiling at 100% of the poverty line or $1,074 for an individual and $1,452 for a couple.

2. Disabled Workers – Qualified Medicare Beneficiaries (QMB-DW)

The government pays the Medicare Part A premiums for some disabled people who have lost their Social Security benefits because they are working and are not qualified for another Medicaid program. The program’s income ceiling is set at 200 percent of the federal poverty threshold, or $2,147 for a single individual and $2,904 for a couple.

3. Specified Low-Income Medicare Beneficiaries – Qualified Medicare Beneficiaries (QMB-SMB and SMF)

The Department solely pays qualified beneficiaries’ Medicare Part B premiums under this benefit package. Therefore, the federal government covers a portion of the expense of the SMB and SMF programs.

  • SMB: The SMB income ceiling is set at 120 percent of the poverty level, or $1,288 per person or $1,742 per couple. The federal government pays approximately 60% of this payment.
  • SMF: This is known as the Qualifying Individual (QI) program in most states. The federal government entirely funds the SMF program and serves persons with earnings between 120 and 135 percent of the poverty threshold, which is $1,449 for an individual and $1,960 for a couple.


One of four Medicare Savings Programs is the Qualified Medicare Beneficiary program. These programs are designed to assist those with low income and resources in paying their Medicare out-of-pocket expenses.

Premiums, deductibles, coinsurance, and copays for Medicare Parts A and B are all covered under expenses. In addition, you’ll be eligible for Extra Help if you qualify for the QMB program.

Contact your state’s Medicaid office for additional information about the QMB program in your state. They can assist you in determining your eligibility and provide you with all of the information required to apply. 

If you need any assistance in finding a suitable Medicare plan that suits your medical needs and budget, contact our licensed agents.

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