What is a Qualified Medicare Beneficiary?

Medicare is a federal health insurance program for citizens over age 65 or under age 65 with a disability or end-stage renal disease. Most Medicare recipients pay a monthly premium for their coverage, via a monthly deduction from their Social Security benefits. For some low-income Medicare beneficiaries, paying the monthly premium creates a financial hardship. The government has developed a number of assistance programs to help low income Medicare beneficiaries pay for their medical care.

Definition of QMB

• Qualified Medicare Beneficiary -- often pronounced as "Quimby" by insurance professionals and social services providers -- is a Medicaid program that pays the monthly Medicare Part A and B premiums and Medicare deductible and co-pays for qualified individuals. You must be eligible for Medicare Part A, even if you are not yet enrolled, to qualify for QMB.

QMB Income Eligibility

• To qualify for QMB, you must meet income eligibility requirements. According to CMS, as of November 2010, you must have a monthly income of less than $923 per month as an individual, or $1,235 as a couple, to qualify for QMB. If you live in Alaska or Hawaii, the limits are slightly higher.

QMB Asset Eligibility

• In most states, you must also meet certain asset requirements to qualify for QMB. You cannot have more than $6,600 in resources if you are an individual, or $9,910 per couple. Assets are considered to be checking and savings accounts, stocks or bonds. Your home, vehicle, personal belongings and furnishings, burial plot and up to $1,500 saved for burial expenses are not considered assets.

Applying for QMB

• The only way to know for sure if you qualify for QMB is to apply. Because each state uses a different formula to determine monthly income, you may qualify for assistance even if your income appears to be over the limit. You can apply for QMB by contacting the medical assistance, or Medicaid, office in your state. Call 1-800-633-4227 to get the contact details for your state. You can also get help by calling your local elder services office or department of social or human services.

Other Assistance Programs

• If you do not qualify for the QMB program, there are additional assistance programs available for low-income Medicare beneficiaries with slightly higher incomes. The Specified Low-Income Medicare Beneficiary, or SLMB, and Qualifying Individual, or QI, programs pay the Medicare Part B premiums for qualified applicants. If you are over 65 or disabled, but still working, you may qualify for the Qualified Disabled & Working Individuals program that will pay your Medicare Part A premiums.

Prescription Drug Assistance

• Anyone who qualifies for QMB, SLMB, or QI benefits automatically qualifies for extra help in paying for Medicare prescription drug coverage. In some states, you may also qualify for additional financial help, such as food or heating assistance.