If you are entitled to Medicare Part A coverage, and have limited income and resources, you may be eligible for the QMB program. If you are eligible, your state’s Medicaid program may pay for your Medicare Part B premium, Part A and Part B deductibles, and coinsurance requirements.
Eligibility requirements for QMB
Although the rules may vary from state to state, in general, you must meet the following requirements in order to be eligible for the QMB program:
- You must be entitled to Medicare Part A.
- Your income must be at or below the national poverty level (income limits generally change annually).
- Excluding certain exempt property, you may not have resources that exceed a certain value (resource limits generally change annually). Some things, such as your home, one car, and certain other personal items, usually do not count as resources.
What does the QMB program cover?
The QMB program covers the cost of Medicare premiums, deductibles and coinsurance that Medicare beneficiaries usually pay. It means that your state covers these Medicare costs for you, and you have to pay only for anything that Medicare normally does not cover. QMB does not supplement your Medicare coverage but instead ensures that you will not be precluded from coverage because you cannot afford to pay the costs associated with Medicare.
Some states require you to pay a small co-payment when you see a doctor.
Related programs: The Specified Low-Income Medicare Beneficiary and the Qualifying Individual program
The Specified Low-Income Medicare Beneficiary Program
If your income is too high to qualify for QMB but is not more than 20 percent above the federal income poverty level, you may receive Specified Low-Income Medicare Beneficiary (SLMB) coverage, which pays for your Medicare Part B monthly premium only. You will, however, pay for Medicare deductibles, coinsurance, and any care not covered by Medicare. The eligibility requirements are the same as those under the QMB program except that your income cannot exceed the national poverty level by more than 20 percent.
The Qualifying Individual Program
If your income is too high for help under SLMB, you may qualify under the Qualifying Individual (QI) program. If your income is more than 20 percent but no more than 35 percent above the national poverty level, your state may pay your Medicare Part B premium. The QI program must be applied for each year because assistance is provided from a limited pool of funds on a first-come, first-served basis. Individuals who received the benefit in the last month of the previous year will be given priority.
Another program called the Qualified Disabled and Working Individual Program pays the Medicare Part A premiums only for disabled individuals in work incentive programs.
Applying for the Programs
If you have Medicare Part A and think you qualify for assistance, you must apply for Medicaid through a state, county, or local medical assistance office. If you aren’t receiving Medicare Part A but you believe you qualify, contact the Social Security Administration.
If you have questions or need assistance, contact the experts at Henssler Financial:
- Experts Request Form
- Email: experts@henssler.com
- Phone: 770-429-9166
Disclosures: The following information is reprinted with permission from Forefield, a division of Broadridge Financial Solutions, Inc. This article is meant to provide valuable background information on particular investments, NOT a recommendation to buy. The investments referenced within this article may currently be traded by Henssler Financial. All material presented is compiled from sources believed to be reliable and current, but accuracy cannot be guaranteed. The contents are intended for general information purposes only. Information provided should not be the sole basis in making any decisions and is not intended to replace the advice of a qualified professional, such as a tax consultant, insurance adviser or attorney. Although this material is designed to provide accurate and authoritative information with respect to the subject matter, it may not apply in all situations. Readers are urged to consult with their adviser concerning specific situations and questions. This is not to be construed as an offer to buy or sell any financial instruments. It is not our intention to state, indicate or imply in any manner that current or past results are indicative of future profitability or expectations. As with all investments, there are associated inherent risks. Please obtain and review all financial material carefully before investing. Henssler is not licensed to offer or sell insurance products, and this overview is not to be construed as an offer to purchase any insurance products.
