Understanding the Qualified Medicare Beneficiary Program

Sal Selvaggio

What is the QMB program?
The Qualified Medicare Beneficiary (QMB) program, administered by D.C. Medicaid, provides secondary insurance coverage to Medicare beneficiaries who live in the District with income below $3,665 per month (single) or $4,950 per month (couple). It could cover all your Medicare cost-sharing charges, including premiums, deductibles, and coinsurance.

What will I save in Medicare premiums?
The QMB program pays your monthly Medicare premiums. Once you are approved for QMB, QMB will cover the full premium Medicare Part B amount of $164.90. Thus, increasing your monthly Social Security income. For most people, Medicare Part A does not have a premium. If you do have a Part A premium, the QMB program would cover it, as well.

How much will I save in Medicare cost-sharing charges?
The QMB program provides full supplementary insurance by covering all of Medicare’s cost-sharing amounts.

  • Original Medicare: QMB covers inpatient hospital deductibles of $1,600 and daily inpatient hospital and skilled nursing facility coinsurance charges. It covers the annual Part B deductible of $226 and all coinsurance charges (usually 20% of Medicare’s approved amount) for doctor visits, outpatient hospital services, and medical equipment.
  • Medicare Advantage: QMB covers your deductible and co-payments for inpatient hospital stays, outpatient hospital services, doctor visits, and medical equipment.

What happens to my Part D prescription drug plan?
People in QMB automatically qualify for Extra Help, a Medicare program that helps pay for your Part D prescription drug plan. Extra Help could cover your premium, deductible, and reduce your prescription copays to no more than $4.15 for generic and $10.35 for brand name prescription medications.

How is the QMB program different from Medicaid?
Medicaid, also known as Medical Assistance or QMB Plus, provides benefits for services not normally covered by Medicare. QMB, which is partial Medicaid, helps pay for services only if they are covered by Medicare. For example, QMB does not pay for dental or routine vision services because these services are not generally covered by Medicare.

Questions or to Enroll
If you have any questions or would like to enroll for QMB, contact the DC State Health Insurance Assistance Program (SHIP) Department of Aging and Community Living Helpline: 202-727-8370 I Fax: 202-741-5885 Email: ship.dacl@dc.gov

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