Qualified Medicare Beneficiary (QMB)

What are the eligibility requirements for QMB?

You could be eligible as a Qualified Medicare beneficiary if you are:

• Entitled for Medicare Part A benefits;
• Have resources less than the program limits (see chart below). 
• Have income at or below 100% of the federal poverty level.

A QMB member who is eligible under more than one coverage group can choose under which coverage group eligibility is determined. Medicaid provides for some services not covered under Medicare, such as dental expenses and some prescription drugs.

What services are covered by QMB?

Under the QMB program, Medicaid only pays Medicare premiums, deductibles, and coinsurance for persons who are qualified Medicare beneficiaries. Medicare refers to the QMB group as a “Medicare Savings Program.” The QMB program provides the following benefits:

• Payment of Medicare Part A monthly premiums (when applicable).
• Payment of Medicare Part B monthly premiums and annual deductible.
• Payment of co-insurance and deductible amounts for services and items covered under both Medicare Parts A and B.
• Medigap premiums are not covered.

What if my income or resources are too high for QMB?

If your total countable income or resources are higher than the QMB limits, there are other program you may qualify for:

• Medically Needy: Ask the Iowa HHS office about Medically Needy if you have lots of medical bills and not enough money to pay the bills. If you are determined to be Medically Needy, you will need to pay your medical bills up to the spenddown deductible. 
• Specified Low Income Medicare Beneficiary (SLMB) or Expanded Specified Low Income Medicare Beneficiary (E-SLMB): SLMB and E-SLMB will only pay your Medicare Part B premium. The income limit is over 100% but less than 135% of the federal poverty level.

QMB Income and Resource Limits in 2024:

Do I need to pay anything for medical services?

You are responsible for services and items Medicare does not cover.

Where can I find further information on the QMB program?

For further information on the QMB program, you may access the Medicaid for the Qualified Medicare Beneficiary brochure.