What Does Medicaid QMB Cover?

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Medicaid QMB is a type of Medicare savings program that helps pay Medicare premiums. The Medicaid QMB (Qualified Medicare Beneficiary Program) pays a portion of the Medicare Part A (hospital insurance) and/or Part B (medical insurance) premium.

The Qualified Medicaid Beneficiary Program pays coinsurance, deductible and co-payment amounts for Medicare Part A and Part B covered services. Providers are not allowed to bill a QMB for either the provider’s customary charges for Medicare Part A or Part B services or the balance of the Medicare rate.

Qualified Medicaid beneficiaries are protected from liability for Medicare Part A and Part B charges, even when the provider amounts are less than the Medicare rate. Providers who bill a qualified Medicaid beneficiary for amounts above the Medicaid and Medicare rates are subject to sanctions.

Eligibility requirements for the QMB program vary by state. However, as a general rule, the applicant must have Medicare Part A and satisfy income and assets guidelines. If the applicant does not have Part A but meets other eligibility guidelines, the applicant’s home state will institute a process to enroll in Part A and the QMB program. Individual states count income and assets differently to determine eligibility.

General income limits are $993 per month for individuals and $1,331 per month for married couples. Resource limits for the QMB Program are $7,160 for one person and $10,750 for married couples. Countable resources include stocks, bonds and money held in a checking or savings count. Countable resources do not include the applicant’s home, one car, furniture, household and personal items.