What Does Medicaid QMB Cover?

Health Compare
Dec 1, 2020

Medicaid QMB is short for Qualified Medicare Beneficiary. This program comes specially designed to help people who meet the dual-eligible criteria. This means that they qualify for Medicaid and Medicare benefits, and they have limited resources. The QMB program gives these people an alternative route to pay for any medical bills they have. They can use their Medicaid coverage to help pay for their Medicare premium costs and any other associated costs for any healthcare services they seek. 

Qualifying for the QMB Program

This program requires that any recipient fall under the dual-eligible category and meet the requirements for Medicaid and Medicare. Individuals with certain disabilities and individuals who are 65 years old and older can get Original Medicare. On the other hand, Medicaid is for people who have low incomes to help provide government-funded, affordable health insurance. 

The QMB program has strict income requirements that change from year to year. For 2020, the maximum monthly income you’re allowed to have if you’re not married is $1,084. For married couples, this amount goes up to $1,457 a month for income. Additionally, the QMB program has resource limits every year. For 2020, these limits cap at $7,860 for any individual with the plan and $11,800 for married applicants. You must be and stay at or below the federal poverty level for your state, and this fluctuates each year. The poverty line limit and the QMB requirement amount usually match to make it easier to keep track of. 

What the QMB Program Covers

This program helps you pay for your annual premiums for Part A and Part B of your Medicare benefits. This program will also help cover the cost of your copayments, coinsurance, and your deductibles. These costs can add up very fast, and this is especially true if you need several different medical services. 

The good news is that the QMB program can give you full payment for your Part A and Part B premiums. It’ll also cover the annual deductible costs in full, and it’ll pay for the coinsurance costs. In turn, you won’t get a bill for any approved care that you get while under Part A or Part B coverage as long as your services are from a Medicare-approved provider in an approved facility. There are no large exceptions to this rule except for the restrictions Original Medicare has in place. 

If you visit a provider that refuses to accept Medicare as insurance, the QMB plan requires this provider to comply with the set improper billing protections. They aren’t allowed to bill you directly for any services you get. Also, this provider has to accept the QMB and Medicare payment for any services you get, and they have to consider these payments as paying your bill in full. The improper billing protections set by this plan prevent people from using the QMB program from having to pay any cost-sharing expenses the provider might have. 

If you’re someone who currently has a Medigap plan, the QMB program won’t cover any premiums associated with it. States have the power to put specific laws in place regarding Medicare, Medicaid, and QMB programs. These state laws supersede any national laws that are in place, and they may force people to give a copay with specific services. This fee should be relatively small, and Medicaid or Medicare coverage should take care of most of the cost. 

If you meet the criteria to be eligible for the QMB program, it’s a good idea to apply for it to help you maximize all of your healthcare benefits. You’ll get financial support as an enrollee, and this can make a difference in the healthcare services you choose to get.