Qualified Medicare Beneficiary Program (QMB)

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

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What is the Qualified Medicare Beneficiary Program (QMB)?

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. 

Read the regulations: Code of Md. Regulations 10.09.24.03-3; Code of Federal Regulations, Title 42 ยง 400.200

Read the law:  U.S. Code, Title 42, Chapter 7, Subtitle XIX

 

Eligibility

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

There are additional non-financial requirements. Note that QMB is not a program for families.

Read the regulations: Code of Md. Regulations 10.09.24.03-3

Income and Assets - Individuals or married couples must have income at or below 100% of the Federal Poverty Level (FPL). Current monthly income and asset limits are posted on the Medicare website.

  • 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.
  • Income limits may be different if you are working.

 

Applying

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 Health website.

You can apply in person or by mailing the application to your local department of social services.

 

Appeals

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.

File appeals 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.

Read the regulations: Code of Md. Regulations 10.01.04*