TN 29 (08-99)

HI 00801.139 QMB Provisions

A. Policy

States are required to provide Medicaid to “qualified Medicare beneficiaries (QMBs)” for purposes of paying Medicare cost-
sharing expenses (i.e., Medicare premiums, deductibles, and coinsurance amounts).

States are responsible for making QMB determinations.

QMB eligibility begins with the month after the month the State makes the QMB determination.

B. Definition

A QMB is an individual who:

  • Is entitled to HI, including Premium-HI for the Aged, but excluding Premium-HI for the Working Disabled (see HI 00801.170 for a discussion of Premium-HI for the Working Disabled),

  • Has income that does not exceed 100% of the Federal poverty guidelines, and

  • Has resources that do not exceed the lower Extra Help resources (see HI 03030.025B.1.).

NOTE: Virtually all uninsured individuals who qualify for SSI are also likely to qualify for QMB status, provided they become entitled to Premium-HI.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0600801139
HI 00801.139 - QMB Provisions - 03/05/2013
Batch run: 03/05/2013
Rev:03/05/2013