PM 06-12-00: Qualified Medicare Beneficiary (QMB) Program

WAG 06-12-00.

Qualified Medicare Beneficiaries (QMBs) are low-income persons who qualify for Medicare Part A (hospital insurance). QMBs must meet income and asset limits. These limits are higher than AABD Medical limits.

For a QMB person, HFS pays:

  • Medicare Part A premiums (if any);
  • Medicare Part B (Supplementary Medical Insurance) premiums; and
  • deductibles and coinsurance charges for all Medicare covered services, including Medicare services not covered by Medicaid.

A person may apply for only QMB, or for QMB plus cash and/or medical. Determine QMB eligibility:

  • for each AABD applicant, and
  • when a TANF, FamilyCare Assist, or Moms and Babies client claims to be a Medicare Part A beneficiary.

When a person on an active case starts receiving Medicare Part A, determine eligibility for QMB. See WAG 25-02-05 for Medicare Part A and Part B coverage groups.

HFS pays Part A (HIB) premiums for QMBs who are not eligible for free Part A (see PM 22-07-01-a). QMBs are included in the SMIB Buy-in Program (see PM 22-07-02).

Medical providers must enroll in Medicaid and accept Medicare assignment to be paid for services to QMBs.

Persons who receive QMB may take part in the Department of Revenue's Pharmaceutical Assistance Program.