Revision 21-2; Effective June 1, 2021
The Qualified Medicare Beneficiary (QMB) Program pays Medicare premiums, deductibles and coinsurance for a person who meets the requirements of this section.
To be eligible for QMB coverage, a person must:
- be entitled to benefits under Medicare Part A; and
- meet income and resources requirements.
The income limits for QMB are based on 100 percent of the federal poverty level (FPL), and are updated annually.
The resource limits are based on the consumer price index and are updated annually.
The person must provide proof of Medicare Part A entitlement to enroll for Medicare Part A. They may have a Medicare card or an enrollment letter from the Social Security Administration (SSA) showing entitlement to Part A.
If the person has no proof of entitlement, refer them to SSA for Part A enrollment if they:
- are 65;
- have a disability (as determined by SSA); or
- have chronic renal disease.
The person must enroll themselves. HHSC is not allowed to enroll the person for Part A as it can for Part B.
A person receiving Medicaid may also be eligible for QMB benefits if they meet the requirements of this section, including the following recipients:
- people of any age residing in a state supported living center;
- people 65 or older residing in a state hospital; and
- people of any age residing in an intermediate care facility for individuals with an intellectual disability or related condition (ICF/IID).
Medicare Savings Program Information, Appendix IX
Qualified Medicare Beneficiary (QMB), A-8100
Medicare Savings Programs Overview, Q-1000
MSP Resource Limits, Q-1300
QMB Income Limits, Q-2500
QMB Medical Effective Date, Q-2700
Qualified Disabled and Working Individuals (QDWI) – MC-QDWI, Q-6000