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Qualified Medicare Beneficiary Programs

If you are entitled to Medicare benefits and have a low income, DMMA may pay your Medicare premiums and, in some cases, other "out-of-pocket" expenses such as deductibles and coinsurance. Individuals must be entitled to Medicare Part A to qualify for any of these programs. Recipients under these programs do not receive regular Medicaid services.

  1. Qualified Medicare Beneficiary Program (QMB) - Under this program, Medicaid pays for the following:
    • The Medicare Part A hospital premium. Most Medicare recipients receive this coverage free.
    • The Medicare Part B premium.
    • The Medicare Part A hospital deductible.
    • The annual Part B deductible.
    • The 20% coinsurance (for services such as physician visits and lab work).

    Your gross monthly income cannot exceed 100% of the Federal Poverty Level (see our Federal Poverty Level charts). Your assets are not considered.
  2. Specified Low Income Medicare Beneficiary (SLMB) Program - Under this program, Medicaid pays the Medicare Part B premium only. Your gross monthly income cannot exceed 120% of the Federal Poverty Level.
  3. Qualified Individual -1 (QI-1) Program - Under this program, Medicaid pays the Medicare Part B premium only. Your gross monthly income cannot exceed 135% of the Federal Poverty Level.

The QMB program was mandated by the Medicare Catastrophic Coverage Act (MCCA) of 1988. A summary of this legislation is available from the Centers for Medicare & Medicaid Services' Office of Legislation.

Last Updated: Wednesday April 25 2012
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