What Are the Income Guidelines for QMB?

Once people retire, or if they become disabled, their incomes are generally limited. This can lead to challenges meeting necessary expenses, including medical care. Medicare was introduced in 1965 to provide health insurance to those 65 and older and the disabled, but even Medicare has some significant out-of-pocket costs. There are premiums, co-pays and deductibles. Supplemental plans help but can be pricey as well. Medicare has several programs to help with out-of-pocket costs, including the Qualified Medicare Beneficiary (QMB) program.

Medicare Part A Costs

• Part A of Medicare covers hospitalization, some skilled nursing care and hospice. As of this article's publication date, there is no monthly premium for Part A as long as you've worked 40 quarters or more. There are significant out-of-pocket costs, though. If you're hospitalized, each benefit period (a benefit period is hospitalization for a specific condition; if you're hospitalized several times for the same condition, a new benefit period doesn't start until you've been out of the hospital 60 days or more) has a deductible of more than $1,000. Skilled nursing care is covered for the first 20 days; days 21-100 have a daily co-pay of more than $100, and there is no coverage after 100 days. Hospice care is covered.

Medicare Part B

• Medicare Part B covers visits to the doctor, durable medical equipment, lab tests and routine screenings. Part B has a monthly premium of more than $100. There's also a calendar year deductible of more than $100, and you're responsible for 20 percent of all Part B health expenses after that. If your doctor doesn't accept Medicare assignments, the doctor can charge you a percentage of the difference between his charges and what Medicare will pay (called excess charges).

Qualifying for QMB

• All these out-of-pocket costs led to Medicare offering help through programs such as Qualified Medicare Beneficiary. Qualification guidelines vary from year to year. In 2011, the QMB income limit for an individual is $928 per month. The limit for a couple is $1,246. The resource (savings, life insurance cash value) limit is $6,680 for an individual and $10,020 for a couple. Your state may have higher limits if you're working, so it's worth checking with your social services department even if you're over the limit. If you do qualify, QMB covers all your Medicare out-of-pocket costs.

Other Help

• Other Medicare programs help with Part A premiums (if you haven't worked enough to qualify) and Part B premiums. These include the Specified Low-Income Medicare Beneficiary program, the Qualifying Individual program and the Qualified Disabled & Working Individual program. The income and resource limits are higher; you can contact Medicare or your social services office for more information. Medicaid may also be an option if you're particularly impoverished; Medicaid becomes secondary to Medicare and covers nearly all of your out-of-pocket costs. Your Medicaid office can provide more information, as the qualifications vary by state.