The Qualified Medicare Beneficiary (QMB) is a state program that helps people with low income pay their Medicare costs.
QMB pays for Medicare parts A and B premiums, along with copayments, coinsurance, and deductibles.
Aside from QMB, three other state programs may help a person with limited means pay the costs associated with Medicare. The eligibility requirements differ in each program, so if someone does not qualify for QMB, they may qualify for one of the others.
This article discusses the benefits and eligibility requirements of the QMB program. It also looks at the difference between Original Medicare and Medicare Advantage with regard to QMB, and looks at the other three programs that can help with Medicare costs.
Glossary of Medicare terms
- Out-of-pocket cost: This is the amount a person must pay for care when Medicare does not pay the total amount or offer coverage. Costs can include deductibles, coinsurance, copayments, and premiums.
- Premium: This is the amount of money someone pays each month for Medicare coverage.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before Medicare starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, coinsurance is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.

The QMB program is one of four state-run programs that help people who cannot afford their Medicare costs. Of the four programs, QMB is the one that offers the most assistance. A person who is enrolled in QMB is also enrolled in Medicaid.
The QMB program pays for the following:
- Part A monthly premiums
- Part B monthly premiums
- copayments
- coinsurance
- deductibles
In addition, QMB helps with prescription costs. The program does not allow drugstores to charge a person more than $4.60 for a prescription medication covered under Medicare Part D.
Learn about the difference between copayments and coinsurance.
The income eligibility for QMB is the same in most states, apart from Alaska and Hawaii, where they may be higher.
For an individual, the QMB income eligibility requirements in most states is $1,275, and $1724 for a married couple.
Other eligibility requirements involve countable resources, including bonds, stocks, and money in a savings or checking account. When Medicare adds up someone’s resources, they do not include:
- one car
- home
- furniture
- other household items
- burial plot
- up to $1,500 for burial expenses
An individual’s resource limit is $9,430.
A married couple’s resource limit is $14,130.
Whether a person is enrolled in Original Medicare or Medicare Advantage, they are eligible for QMB if they meet the income and resource requirements.
Original Medicare consists of Part A, which is hospitalization insurance, and Part B, which is outpatient medical insurance.
Medicare Advantage, also known as Medicare Part C, is an alternative to Original Medicare, so plans provide the same benefits as parts A and B. However, most plans also include the prescription drug coverage of Part D, along with extra benefits, such as dental care.
Billing
There are several differences between Original Medicare and Medicare Advantage versus the QMB program.
A Medicare-participating doctor, healthcare professional, or provider cannot bill a person with Original Medicare if they are part of the QMB program.
An in-network doctor, healthcare professional, or provider cannot bill someone with a Medicare Advantage plan. In other words, to avoid getting bills, an individual with Medicare Advantage must choose in-network doctors, healthcare professionals, or providers.
In addition to QMB, Medicare Savings Programs (MSPs) include the:
The income and resource requirements are standard in most states but vary in some states, including Alaska and Hawaii, where they may be higher. With this in mind, even if someone thinks they may not qualify for a program, they may wish to apply.
People who are interested in the programs can use this tool to find their local state and information on how to apply.
Below are the descriptions and eligibility requirements of each program.
Specified Low-Income Medicare Beneficiary program
The SLMB program helps people with Medicare Part A to pay their Part B monthly premiums. Eligibility requirements for income and resources in most states are the following:
- An individual’s monthly income limit is $1,526.
- A married couple’s monthly income limit is $2,064.
- An individual’s resource limit is $9,430.
- A married couple’s resource limit is $14,130.
Qualifying Individual program
Similar to the SLMB program, the QI program helps people with Medicare Part A to pay their Part B premiums. However, the income limits are higher.
A person must apply for the QI program every year. The program accepts applications on a first-come, first-served basis, but it gives priority to someone who is already enrolled.
Here are the eligibility requirements for income and resources in most states for QI:
- An individual’s monthly income limit is $1,715.
- A married couple’s monthly income limit is $2,320.
- An individual’s resource limit is $9,430.
- A married couple’s resource limit is $14,130.
Qualified Disabled and Working Individuals program
While the SLMB and QI programs help a person pay Part B premiums, the QDWI program helps someone pay Part A premiums. The following are the income and resource eligibility requirements in most states for QDWI:
- An individual’s monthly income limit is $5,105.
- A married couple’s monthly income limit is $6,899.
- An individual’s resource limit is $4,000.
- A married couple’s resource limit is $6,000.
Someone may quality for QDWI if one of the below conditions apply:
- They do not get medical assistance from their state.
- They are a working disabled person under age 65 years.
- They lost premium-free Part A when they went back to work.
- They meet the income and resource requirements of their state.
Medicare resources
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.
The Qualified Medicare Beneficiary (QMB) program and three other state programs provide help with Medicare costs for someone with limited means.
Of the four programs, QMB offers the most help because it pays Medicare Part A and Part B premiums, as well as copayments, coinsurance, and deductibles.
People enrolled in Original Medicare, as well as Medicare Advantage, are eligible for the QMB program if they meet the income and resource requirements. A person with an Advantage plan and enrolled in a QMP program must use in-network providers to avoid getting bills.