QMB stands for Qualified Medicare Beneficiary, a program that pays nearly all of your out-of-pocket Medicare costs. If you see “QMB” on your Medicare paperwork or Medicaid card, it means you’re enrolled in one of the most comprehensive cost-saving programs available to people on Medicare. The program covers your Part A and Part B premiums, deductibles, coinsurance, and copayments for every Medicare-covered service.
What QMB Covers
QMB is the broadest of the four Medicare Savings Programs, which are joint federal-state programs run through Medicaid. While the other three programs only help with monthly premiums, QMB goes further. It picks up:
- Part A premiums if you don’t qualify for premium-free Part A
- Part B premiums (currently $185 per month in 2025)
- All deductibles for both Part A and Part B
- All coinsurance and copayments for Medicare-covered services
In practical terms, this means you should pay nothing when you visit a doctor, go to the hospital, get lab work, or receive any other service that Medicare covers. QMB enrollment also automatically qualifies you for Extra Help, the program that lowers your prescription drug costs under Part D.
Billing Protections You Should Know About
Federal law prohibits every Medicare provider and supplier from billing you for cost-sharing amounts if you have QMB status. This isn’t optional for providers. Violating this rule breaks their Medicare provider agreement and can result in sanctions. The protection applies whether the provider accepts Medicaid or not, and it applies across state lines. If your QMB benefit comes from one state but you get care in another, the provider still cannot charge you.
One important detail: you cannot choose to pay these costs yourself. QMB beneficiaries are not allowed to elect to pay Medicare deductibles, coinsurance, or copays, even voluntarily. You may, however, owe a small Medicaid copayment in some states, which is typically just a few dollars.
If a provider sends you a bill for a Medicare-covered service, that bill is incorrect. You can report improper billing to 1-800-MEDICARE or to your state Medicaid office.
QMB With Medicare Advantage Plans
QMB protections apply regardless of whether you’re in Original Medicare or a Medicare Advantage plan. All Medicare Advantage providers must follow the same billing restrictions. They cannot charge you cost-sharing for covered Part A and Part B services. CMS recommends that Medicare Advantage plans proactively inform their network providers about a member’s QMB status, though the specific method varies by plan.
Who Qualifies for QMB
To qualify, you need to be enrolled in Medicare Part A and have income at or below 100% of the federal poverty level. For 2025, that’s roughly $1,325 per month for an individual or $1,793 for a married couple, though exact figures can vary slightly by state.
Most states also apply an asset or resource test, which limits the value of savings, investments, and other countable resources you can hold. However, several states have eliminated the asset test entirely, making it easier to qualify based on income alone. Alabama, Arizona, Connecticut, Delaware, Mississippi, New York, Oregon, Vermont, and Washington, D.C., have all dropped asset limits for QMB at various points. Your state may have different rules, so it’s worth checking with your local Medicaid office.
How QMB Compares to Other Medicare Savings Programs
There are four Medicare Savings Programs, and QMB offers the most help. The other three cover progressively less:
- QMB covers premiums, deductibles, coinsurance, and copays (income up to 100% of federal poverty level)
- SLMB (Specified Low-Income Medicare Beneficiary) covers only the Part B premium (income up to 120% of federal poverty level)
- QI (Qualifying Individual) covers only the Part B premium (income up to 135% of federal poverty level)
- QDWI (Qualified Disabled and Working Individuals) covers only the Part A premium for certain disabled workers
If your income is too high for QMB but still limited, you may qualify for one of these other programs. Washington, D.C., takes a unique approach: it has no separate SLMB or QI programs and instead treats all eligible beneficiaries up to 300% of the federal poverty level as QMB.
How to Apply
QMB is administered by your state Medicaid agency, not by Medicare directly. You apply through your state’s Medicaid office or department of social services. The application typically requires proof of income, assets (in states that still test for them), Medicare enrollment, and identity. Many states allow you to apply online, by mail, or in person. If you’re already receiving Medicaid, your state may evaluate you for QMB automatically.
Processing times vary by state, but once approved, your QMB status appears in Medicare’s systems, letting providers verify that you should not be billed for cost-sharing. If you’ve recently been approved and a provider doesn’t yet show your QMB status, bringing your Medicaid card or approval letter to appointments can help avoid billing errors.