A Qualified Medicare Beneficiary is someone enrolled in a state Medicaid program known as QMB, which pays Medicare Part A and Part B premiums, deductibles, coinsurance, and copayments for people with limited income and resources. If you qualify, your Part B premium alone — $202.90 a month in 2026 — is covered, along with the $1,736 Part A hospital deductible per benefit period, the $283 annual Part B deductible, and the coinsurance Medicare would normally leave on your tab. Every state is required to offer the program, and you apply through your state Medicaid office.
What QMB Pays For
Once your state approves you, Medicaid picks up the Medicare bills you would otherwise owe:
- Part A premiums, up to $565 a month in 2026 for people who didn’t work long enough to earn premium-free Part A. Most enrollees already have Part A at no cost.
- The Part B premium of $202.90 a month, which adds up to $2,434.80 over the year.
- The Part A hospital deductible of $1,736 per benefit period and the $283 annual Part B deductible.
- Coinsurance and copayments on Medicare-covered services.
The effect is close to a comprehensive Medicare supplement policy at no cost to you.
2026 Income and Resource Limits
To qualify, you must be enrolled in Medicare Part A (or eligible to enroll) and fall under both an income limit and a resource limit. For 2026:
- An individual can have monthly income up to $1,350 and resources up to $9,950.
- A married couple can have monthly income up to $1,824 and resources up to $14,910.
The income figures already include a $20 general income exclusion carried over from SSI rules, so the numbers you see are the actual ceilings. Alaska and Hawaii use slightly higher limits, and some states set their thresholds above the federal floor.1Medicare.gov. Medicare Savings Programs
What Counts as Income
Income includes Social Security benefits, pensions, wages, and interest. Some of it is partially excluded, so not every dollar of a Social Security check counts against the limit.
What Counts as Resources
Resources means liquid assets: bank accounts, stocks, and bonds. Your primary home, one vehicle, burial plots, and personal belongings don’t count. Several states have dropped the resource test altogether for Medicare Savings Programs, so savings that look disqualifying under the federal numbers may not be under your state’s rules. Check your state Medicaid rules before assuming you’re over the limit.1Medicare.gov. Medicare Savings Programs
Providers Can’t Bill You
Federal law prohibits Medicare providers and pharmacies from billing QMB enrollees for any Part A or Part B cost-sharing. No deductibles, no coinsurance, no copayments on Medicare-covered services. You owe nothing.2Centers for Medicare & Medicaid Services. Qualified Medicare Beneficiary Program Group
Improper billing is common anyway, often because a provider’s billing system never flags QMB status. If a bill shows up for a Medicare-covered service:
- Tell the billing office you’re in QMB and cannot legally be charged.
- Call Medicare at 1-800-633-4227. Medicare can confirm your status with the provider and ask them to stop billing and refund what you already paid.
- If the bill has gone to collections, file a complaint with the Consumer Financial Protection Bureau at (855) 411-2372.
If you already paid a bill you shouldn’t have, you’re entitled to a refund. A paid bill is not a closed matter.3Consumer Financial Protection Bureau. What to Do if You’re Wrongfully Billed for Medicare Costs
Automatic Help With Prescription Drug Costs
QMB doesn’t cover Part D directly, but qualifying for QMB makes you automatically eligible for Extra Help, also called the Low Income Subsidy. No separate application. Extra Help wipes out your Part D premium and deductible and waives the late enrollment penalty if you signed up for Part D after your initial enrollment window.4Medicare.gov. Help With Drug Costs
Under Extra Help in 2026, you pay at most $5.10 for a generic and $12.65 for a brand-name drug at a participating pharmacy. Once your total drug costs for the year hit $2,100, copayments drop to $0 for the rest of the year.4Medicare.gov. Help With Drug Costs
If Your Income Is Too High for QMB
Two related Medicare Savings Programs cover less but have higher income ceilings. Both pay only your Part B premium, and both use the same resource limits as QMB:
- Specified Low-Income Medicare Beneficiary (SLMB): monthly income up to $1,616 for an individual, $2,184 for a couple in 2026.
- Qualifying Individual (QI): monthly income up to $1,816 for an individual, $2,455 for a couple. QI funding is limited and awarded first-come, first-served each year.
You apply for all three through the same state Medicaid office, and the agency will evaluate you for whichever fits.1Medicare.gov. Medicare Savings Programs
How to Apply
Apply through your state Medicaid agency, which may go by another name like the Department of Social Services. Call 1-800-MEDICARE if you’re not sure which office to contact, or start from your state government website.
You’ll need to document your identity, age, Medicare enrollment, income, resources, and residency. Bring:
- Your Medicare card.
- Social Security benefit statements or pension records.
- Recent bank statements and investment account records.
- A driver’s license, state ID, or other proof of identity and residency.
Some states require a phone or in-person interview before deciding.
When Coverage Begins
QMB benefits are not retroactive. Coverage starts the first day of the month after your state approves you. Approved in March, you’re covered April 1. Any Medicare cost-sharing you paid before that date stays yours to pay, which is a good reason to apply as soon as you think you might qualify rather than waiting.5Medicaid.gov. Implementation Guide: Medicaid State Plan Eligibility – Qualified Medicare Beneficiaries
Keeping Your QMB Status
Approval isn’t permanent. Your state will review your eligibility periodically to confirm you still meet the income and resource limits. Federal rules cap those reviews at once every six months, but most states run them annually. When your renewal notice arrives, you’ll need to submit updated income and resource documentation. Missing the deadline can end your benefits, so handle the paperwork the way you’d handle a bill you can’t afford to skip.