The Qualified Medicare Beneficiary (QMB) group is a Medicaid eligibility group through which states cover Medicare Hospital Insurance (Part A) and Medical Insurance (Part B) premiums as well as cost-sharing (deductibles, co-payments, and coinsurance) for low-income Medicare beneficiaries.

The QMB group is one of the mandatory Medicaid eligibility groups known collectively as the Medicare Savings Programs (MSPs). For more information on the QMB eligibility group and other related MSPs, refer to HI 00801.140 and HI 00815.023. State Medicaid agencies are responsible for making QMB determinations.

QMB eligibility begins with the month after the month the state makes the QMB eligibility determination. Unlike other Medicaid eligibility groups, QMB eligibility has no provision for retroactive coverage. However, while the State may not establish a retroactive stat date, QMB enrollment may be processed retroactively.

To qualify for QMB coverage, an individual must meet their state’s eligibility requirements (e.g., income, resources, and state residency standards) and:

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  Be entitled to premium-free Part A or premium Part A; OR

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    Have Part B only and either:

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    Reside in a Part A buy-in state; or

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    Reside in a group payer state and have enrolled in conditional Part A at SSA during a Medicare enrollment period.

(Refer to HI 00801.140 for instructions on premium Part A enrollments for QMBs).

The federal QMB income and resource standards (hereafter “limits”) appear in HI 00815.23C and are set by federal law. States can, however, effectively raise QMB eligibility standards above the federal statutory limits by disregarding amounts or certain types of income and resources. Some states have used this authority to effectively eliminate resources tests when determining eligibility for the QMB eligibility group.

SSI recipients with premium-free Medicare Part A are automatically enrolled in QMB in all states without filing a separate Medicaid application. For SSI recipients who must pay a premium for Part A, automatic QMB enrollment is guaranteed only in Part A buy-in states.

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  HI 00801.140 Premium-Part A Enrollments for Qualified Medicare Beneficiaries (QMBs) – Part A Buy-In States and Group Payer States

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  HI 00815.023 Medicare Savings Programs Income Limits