Qualified Medicare Beneficiary Programs

If an individual has a low income, DSS may pay his Medicare premiums and, in some cases, other "out-of-pocket expenses such as deductibles and coinsurance. Individuals must be entitled to Medicare Part A to qualify for any of these programs. Recipients under these programs do not receive regular Medicaid services.

1. Qualified Medicare Beneficiary Program (QMB)- This program was mandated by the Medicare Catastrophic Coverage Act of 1988. Under this program Medicaid pays for the following:
   • The Medicare Part A hospital premium. Most Medicare recipients receive this coverage for free.
   • The Medicare Part B premium.
   • The Medicare Part A hospital deductible.
   • The annual Part B deductible.
   • The 20% coinsurance (for services such as physician visits and labs).
   
   
   The gross monthly income cannot exceed 100% of the Federal Poverty Level (see our Federal Poverty Level charts). There is no asset test.
2. Specified Low Income Medicare Beneficiary (SLMB) Program - Under this program Medicaid pays the Medicare Part B premium only. The gross monthly income cannot exceed 120% of the Federal Poverty Level (see our Federal Poverty Level charts) .
3. Qualified Individual-1 (QI-1) Program - Under this program Medicaid pays the Medicare Part B premium only. The gross monthly income cannot exceed 135% of the Federal Poverty Level (see our Federal Poverty Level charts).
4. Qualified Individual-2 (QI-2) Program - Under this program Medicaid pays for only a small portion of the Medicare Part B premium. The gross monthly income cannot exceed 175% of the Federal Poverty Level (see our Federal Poverty Level charts).