The Qualified Medicare Beneficiary (QMB) program is a state program to help people with lower income pay for out-of-pocket Medicare expenses, such as deductibles, co-payments and premiums.
Individuals or couples must:
- qualify to receive Medicare Part A, even if not enrolled
- NOT be financially eligible for Medical Assistance
- have limited income and assets
QMB is not a program for families.
Individuals or couples must have income at or below 100% of the Federal Poverty Level (FPL), or a higher level set by their state. The 2015 monthly income limits posted on the Medicare website are:
Individual: $1,001
Couple: $1,348
The Qualified Medicare Beneficiary (QMB) Benefits are revised annually by the Centers for Medicare and Medicaid Services (CMS). These figures are usually updated in April of each year and can be found in the Federal Register, the official government source for administrative changes.
Updated figures from CMS can be found online at www.medicare.gov or by phone at 1-800-MEDICARE (1-800-633-4227).
Assets not over:
Individual: $6,000
Couple: $9,000
- These limits apply to personal assets including cash, bank accounts, stocks and bonds.
- These limits do not include home, car or $1,500 in burial fund.
You can request an application for QMB at your local health department, doctor's office, or hospital social work department. Applications may be downloaded from the Maryland Department of Human Resources website. Completed forms should be mailed to your local Department of Social Services. Mailing addresses are included on the back of the application form.
Any denial, termination, or reduction of benefits can be appealed. Call the telephone number provided in the denial letter you receive. Or call 1-800-332-6347 to request a hearing.
Appeals must be filed in writing at your local Department of Social Services office. It is best to file in person and to get a receipt showing that you filed the appeal.
Keep in mind:
- Appeals must be filed within 90 days of the action, or you cannot appeal
- If you file within 10 days of notice that benefits are being terminated or reduced, your benefits will continue until there is a decision. If you do not appeal within 10 days, the termination or reduction will happen.
The Office of Administrative Hearings will send you a notice telling you the time and place of your hearing. You must come to the hearing. If you can not come, tell the Office of Administrative Hearings and they will reschedule your hearing.
State and federal
Federal Law: 42 U.S.C., Chapter 7, Subtitle XIX
Federal Regulations: 42 C.F.R. § 400.200 Medicare, defines Qualified Medicare Beneficiary as it applies to Medicare.
Maryland State Law: COMAR 10.09.24.03-3