If you’re on Medicare and struggling with premiums, deductibles, and copays, there’s a little-known program that could eliminate virtually all your out-of-pocket costs—but most eligible beneficiaries don’t even know it exists.
Key Takeaways
- QMB (Qualified Medicare Beneficiary) covers all Medicare Part A and Part B premiums, deductibles, coinsurance, and copayments for eligible low-income beneficiaries
- Individuals can qualify with monthly income at or below $1,325 and assets under $9,660, while married couples need income at or below $1,783 and assets under $14,470
- QMB beneficiaries automatically receive Extra Help for prescription drugs and cannot be billed by providers for covered Medicare services
- The program saves beneficiaries $2,220 annually on Medicare Part B premiums alone
The Qualified Medicare Beneficiary (QMB) program serves as a financial lifeline for Medicare beneficiaries struggling with healthcare costs. This Medicaid-sponsored program eliminates the burden of Medicare cost-sharing expenses, transforming what could be overwhelming medical bills into manageable healthcare access.
QMB Covers Your Full Medicare Cost-Sharing—Deductibles, Premiums, and Copays
The QMB program functions as supplementary insurance by covering all of Medicare’s cost-sharing amounts. Unlike other Medicare Savings Programs that provide partial assistance, QMB eliminates virtually every out-of-pocket expense associated with Medicare-covered services.
When enrolled in QMB, beneficiaries receive complete protection from Medicare’s financial requirements. The program covers premiums, deductibles, coinsurance percentages, and fixed copayments for both Medicare Part A and Part B services. This coverage means beneficiaries can focus on their health rather than financial calculations when seeking medical care.
Healthcare providers are legally prohibited from billing QMB beneficiaries for any Medicare-covered services, though some states may impose minimal Medicaid copayments. Medicare.org provides detailed information about how this protection works in practice, helping beneficiaries understand their rights under the program.
Complete Medicare Part A and Part B Coverage Breakdown
1. Medicare Part A Hospital Coverage
QMB eliminates the substantial costs associated with hospital stays and skilled nursing facility care. The program covers the Medicare Part A hospital deductible of $1,676 per benefit period, which many beneficiaries face multiple times per year. Additionally, QMB pays the daily copayments that begin after day 60 of hospitalization—$419 daily for days 61-90 and $838 daily for days 91-150.
For skilled nursing facility stays, QMB covers the $209.50 daily copayment that applies to days 21-100. The program also covers Part A premiums for beneficiaries who don’t qualify for premium-free Part A, which can cost up to $518 monthly in 2025 (or $285 monthly for those with at least 30 quarters of coverage).
2. Medicare Part B Medical Coverage
The program covers Medicare Part B’s annual deductible of $257, eliminating this upfront cost barrier to outpatient medical services. QMB also pays the standard 20% coinsurance that applies to most Part B services, which can vary significantly depending on the medical procedures and treatments received.
This coinsurance coverage proves particularly valuable for beneficiaries requiring ongoing medical care, diagnostic tests, or specialist consultations. Without QMB, these 20% costs can accumulate rapidly, especially for beneficiaries with chronic conditions requiring regular monitoring and treatment.
3. Medicare Part B Premium Savings of $2,220 Annually
The most immediate and consistent benefit of QMB enrollment is the coverage of Medicare Part B premiums. For most beneficiaries, this premium costs $185 monthly in 2025, totaling $2,220 annually. Since these premiums are typically deducted from Social Security benefits, QMB coverage results in higher monthly Social Security payments.
This premium relief provides immediate cash flow improvement for beneficiaries living on fixed incomes. The additional $185 monthly can help cover essential expenses like food, utilities, or medications not covered by Medicare.
QMB Income and Asset Limits for 2025
Individual Income Limit $1,325, Asset Limit $9,660
Single individuals qualify for QMB when their monthly income remains at or below $1,325. This income limit reflects 100% of the Federal Poverty Guidelines plus a $20 general income disregard that applies to all Medicare Savings Programs. The $20 disregard means the first $20 of monthly income doesn’t count toward the qualification threshold.
Asset limits for individuals are set at $9,660, including countable resources like savings accounts, checking accounts, and certain investment accounts. Primary residences and one vehicle typically don’t count toward asset limits, allowing beneficiaries to maintain basic stability while qualifying for assistance.
Married Couple Income Limit $1,783, Asset Limit $14,470
Married couples face slightly higher thresholds, with monthly income limits of $1,783 and asset limits of $14,470. These limits apply to combined household income and resources, reflecting the economies of scale in shared living arrangements.
Couples should note that both spouses’ income and assets count toward these limits, even if only one spouse has Medicare coverage. However, the $20 income disregard applies per household, not per person, providing consistent relief across different family structures.
Higher Limits in Alaska and Hawaii
Alaska and Hawaii residents benefit from adjusted income limits reflecting these states’ higher costs of living. In Alaska, individual income limits reach $1,650 monthly, while married couples can earn up to $2,223 monthly. Hawaii’s limits are $1,520 for individuals and $2,047 for married couples.
These adjustments acknowledge regional economic differences while ensuring the program remains accessible to low-income beneficiaries regardless of geographic location. Asset limits remain consistent across all states, maintaining program uniformity where cost-of-living variations are less pronounced.
Automatic Extra Help for Prescription Drug Costs
Maximum $12.15 Generic and Brand-Name Drugs in 2025
QMB enrollment automatically qualifies beneficiaries for the Medicare Part D Low Income Subsidy, commonly known as Extra Help, subject to meeting income and resource requirements. This program dramatically reduces prescription drug costs, with beneficiaries paying no more than $12.15 per covered drug in 2025. For 2026, these costs are projected to be $5.10 for generic drugs and $12.65 for brand-name medications.
The Social Security Administration estimates the value of Extra Help benefits at approximately $6,200 annually per beneficiary. This substantial assistance can make the difference between affording necessary medications and going without critical treatments.
No Medicare Part D Premiums or Deductibles
Extra Help eliminates Medicare Part D premiums and deductibles entirely for QMB beneficiaries. Standard Part D plans often include monthly premiums ranging from $7 to over $100, plus annual deductibles up to $590 in 2025 (increasing to $615 in 2026).
This prescription drug coverage works seamlessly with QMB’s medical coverage, ensuring beneficiaries have complete protection across all Medicare services. The combination eliminates virtually all out-of-pocket healthcare expenses for covered services and medications.
QMB Plus: Dual Coverage with Full Medicaid Benefits
State-Dependent Additional Services Beyond Medicare
Beneficiaries qualifying for both QMB and full Medicaid benefits receive dual-eligible status, often called QMB Plus. These individuals access the complete range of their state’s Medicaid services in addition to QMB’s Medicare cost-sharing assistance.
QMB Plus benefits vary significantly by state, as each state designs its Medicaid program within federal guidelines. Some states offer additional services, while others provide more limited supplemental coverage. Beneficiaries should contact their state Medicaid office to understand specific available services.
Potential Vision, Dental, and Hearing Care Coverage
Many QMB Plus beneficiaries gain access to services Medicare doesn’t typically cover, including routine dental care, vision services, and hearing aids. These services can significantly improve quality of life and overall health outcomes for older adults.
Dental coverage might include routine cleanings, fillings, and extractions. Vision benefits could cover eye exams, glasses, and contact lenses. Hearing services may include hearing tests, hearing aids, and related equipment. The specific scope of these benefits depends on individual state Medicaid programs.
Provider Billing Protection—No Out-of-Pocket Costs for Covered Services
QMB provides robust legal protection against improper billing practices. Medicare providers cannot bill QMB beneficiaries for any Medicare-covered services, including deductibles, coinsurance, and copayments. This protection is absolute and backed by federal law, though it applies specifically to Medicare-covered services.
Beneficiaries should present both their Medicare card and Medicaid card (or QMB identification) when receiving services. If providers attempt to bill for covered services, beneficiaries can reference their QMB status and contact their state Medicaid office for assistance resolving billing disputes.
The only allowable charges are small Medicaid copayments that some states impose, typically ranging from $1 to $3 for certain services. These minimal copayments are far less burdensome than standard Medicare cost-sharing amounts.
Apply for QMB Through Your State Medicaid Office Today
QMB applications are processed through state Medicaid offices, not directly through Medicare or Social Security. Each state has its own application process, though many accept the standard Medicare Savings Program application form.
Beneficiaries should apply even if they believe their income or assets exceed the guidelines. Many states don’t count certain types of income or have higher limits than federal minimums. Additionally, states may offer retroactive coverage, potentially reimbursing Medicare costs from previous months.
The application process typically requires documentation of income, assets, and Medicare enrollment. State agencies can provide specific guidance on required documentation and application procedures. Processing times vary by state, but coverage generally begins the first day of the month after approval.