The Qualified Medicare Beneficiary (QMB) Program is one of four types of Medicare Savings Programs. The QMB Program is also the most comprehensive of the four, as it helps individuals with limited income and assets pay not only for Medicare Part A and B premiums, but also for deductibles and co-payments. This fall, a new rule will ensure that many more people gain access to this valuable program.
What Are Medicare Savings Programs?
Medicare, as a federal health insurance program, helps cover health care costs for tens of millions of people across the United States. However, Medicare is not free. Those who enroll in the program still pay premiums, deductibles, co-pays, and for other out-of-pocket health expenses. This is where Medicare Savings Programs (MSPs) can prove essential; they specifically seek to help Medicare recipients who have limited income and resources cover these costs.
State Medicaid agencies run the various MSPs, so the requirements to qualify can differ to some extent depending on where you live.
The Qualified Medicare Beneficiary Program
The QMB Program assists low-income Medicare recipients in paying for Part A and Part B premiums as well as deductibles, co-payments, and coinsurance for services covered by Parts A and B.
Note that Medicare Part A covers inpatient hospital care, skilled nursing facilities, hospice, and other select services. Most people do not have to pay monthly Medicare Part A premiums. However, the annual deductible for 2024 equals $1,632.
Part B, which covers outpatient medical care, comes with a monthly premium of $174.70 and $240 annual deductible as of 2024. As mentioned above, other costs include coinsurance and copays.
To be eligible for the QMB program, an individual typically must have Medicare Part A coverage. In addition, some states require that an individual’s income and resources fall below a specific dollar amount. For example, in some states, an individual must have no more than $1,255 in monthly income and $9,430 in resources. Other states have no such asset limits. In fact, as of 2024, more than a dozen states do not have any resource or income limit, including Louisiana, New York, Connecticut, Arizona, and Oregon.
The New Update for Supplemental Security Income (SSI) Recipients
Supplemental Security Income (SSI) is another type of safety net program, focused on supporting people with limited means who have a disability or are aged 65 and older. People who receive SSI benefits are in fact automatically eligible for the QMB program. However, many have never enrolled.
In large part, this is because the QMB enrollment process can be complex. According to the Centers for Medicare & Medicaid Services (CMS), more than half a million people who were eligible for the QMB program were not enrolled as of 2022.
According to a new rule going into effect October 1, 2024, state Medicaid agencies in 36 states and the District of Columbia will be required to enroll these individuals automatically in the QMB program.
Helpful Resources
Many people are struggling to cover their Medicare costs. Visit the Medicare website to see whether you might qualify for a Medicare Savings Program. Millions of people nationwide could benefit from one or more of these programs.
If you believe you might be eligible for the QMB program or another MSP, contact your state Medicaid agency or call 1-800-MEDICARE (TTY 1-877-486-2048) for more information.
You also can connect with your State Health Insurance Assistance Program (SHIP). SHIPs offer objective guidance on Medicare programs and your rights under the program.
In addition, you may wish to seek out an elder law attorney for insights into what Medicare Savings Program options may be available to you.
