How to Get on the Medicare QMB Program

Elderly woman talking with a doctor
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Many low-income elderly or disabled people struggle to pay their Medicare premiums. If this is your situation, you may be able to get help from your state. Once you are accepted into the Qualified Medicare Beneficiary, or QMB, program, you should not be charged for a visit to a Medicare-covered doctor, as the state pays all of your Medicare Part A and Part B premiums, coinsurance and deductibles.

Income Requirements

To be eligible for QMB, your income must be less than the poverty level set by the federal government each year. As of publication, the income limit is $993 per month for an individual and $1,331 per month for a married couple. However, QMB applies complex rules in deciding which income to include and which to discount. Typically, people who earn money from employment may still qualify for QMB even if their income is almost twice the federal poverty level.

Resources Requirements

Irrespective of income, you are not eligible for QMB if you hold assets worth $7,160 for an individual and $10,750 for a married couple, as of publication. Precise figures vary from year to year. Assets include money held in a savings or checking account, stocks and bonds. Some assets, such as your house, one car, furniture and various personal possessions, are not counted.

How to Apply

To receive QMB benefits, call or visit the department that administers Medicaid in your state -- usually your state's Department of Social Services or Social Welfare Department. Each state has its own application procedure, and it's worth filling out an application even if you think that your income is too high for QMB, because you may qualify for one of the two other state assistance programs: the Specified Low-Income Medicare Beneficiary Program and the Qualifying Individual Program. Disabled workers may also qualify for the Qualified Disabled and Working Individuals Program. These programs give fewer benefits, but the income limits are higher, depending on the program.

What Paperwork to Bring

Take identification, such as your birth certificate, passport or green card and proof of your address, when you visit your state's Medicaid office. You will need your Social Security and Medicare cards. Gather any paperwork that verifies your income and assets. This includes your pay stubs, income tax returns, Social Security Administration Award letter, bank statements, insurance policies, stock certificates and automobile registration papers if you own a car. You also will need a copy of your medical records and medical bill history, or the names and addresses of the medical professionals who are treating you.

What Happens After You Apply

You should receive notice of your QMB status within 45 days of filing an application, and if you are approved, your benefits will start the following month. If your application is denied, you have a right to appeal. Ask for details of your state's appeal process at the office where you applied. QMB is renewable annually, and you'll need to recertify or your benefits will stop. If you don't receive a recertification notice in the mail, contact your local Medicaid office for advice.

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