What is a QMB?
QMB stands for a Qualified Medicare Beneficiary, where a beneficiary is an individual who receives Medicare benefits. This program is one of four Medicare Savings Programs that allow individuals to get assistance in paying their Medicare premiums. These MSPs also include Specified Low-income Medicare Beneficiary (SLMB), Qualifying Individual (QI) Program, and Qualified Disabled Working Individual (QDWI) – each program covers different parts of Medicare. There are specific restrictions on who is eligible for Federally regulated and statewide healthcare benefit initiatives. For the most part, individuals making over around $1,000 a month and couples making over about $1,300 are not considered QMB.
Income and Resource Limit
According to medicare.gov, these are the income and resource limitations to qualify for QMB in 2018:
Individual monthly income: $1,032
Married couple monthly income: $1,392
Individual resource limit*: $7,560
Married couple resource limit: $11,340
*The resource limit refers to the countable assets such as money in a checking or savings account, stocks, or bonds. It does not refer to assets such as a car or your home.
What does the QMB Provide?
If you are considered QMB, you typically will not receive bills for Medicare covered services by in-network providers. The QMB program will cover Part A and Part B plan premiums, copayments, coinsurance, and deductibles. There can also be coverage of Part D plans which deal with pharmacies and prescription drugs.
What Providers Can’t Do
Providers aren’t allowed to bill any portion of deductibles, copayments, or coinsurance for services covered by Medicare if you are considered a QMB. The only thing that providers may bill for is outpatient prescription drug charges. It is important to note that pharmacists may charge a small amount of Part D plan coverage.
When going to any appointment, make sure to bring all Medicare and QMB documentation cards, as well as any identification cards that may be required. If you are ever charged for a deductible, copayment, or coinsurance that was meant to be covered by Medicare, make sure to call your provider and remedy this issue. If the problem isn’t fixed, you can call 1-800-MEDICARE (1-800-633-4227).