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Qualified Medicare Beneficiary (QMB)

Elderly couple

What is the Qualified Medicare Beneficiary (QMB) Program?

The Qualified Medicare Beneficiary (QMB) program helps District residents who are eligible for Medicare pay for their Medicare costs. This means that Medicaid will pay for the Medicare premiums, co-insurance and deductibles for Medicare covered services. It also means that you will receive extra help with your costs under the Medicare prescription drug benefit (Part D), which will limit the amount you pay for your prescriptions to only a few dollars each.

 

Who is eligible for the Qualified Medicare Beneficiary (QMB) Program? 

You can receive QMB coverage if you are:

  1. Medicare eligible; entitled to Medicare Part A or Part B (or both)
  2. A District Resident;
  3. A US citizen or have eligible immigration status; and
  4. Have income up to 300% of the FPL 

What does the Qualified Medicare Beneficiary (QMB) Program cover/include?

The DC Medicaid program pays for 

  • Medicare Part A and Part B premiums
  • Medicare deductibles for Medicare covered services
  • Medicare co-insurance for Medicare covered services
  • Extra help paying for prescription drug costs under Medicare Part D

Qualified Medicare Beneficiaries are usually people who have income too high for Medicaid, but need some extra help paying the bills. Even though DC Medicaid will pay for your Medicare costs, it does not mean that you are entitled to DC Medicaid benefits. The DC Medicaid program will assist you in paying for services covered under Medicare; but not for Medicaid services. 

When you get health services, remember to always show your QMB card whenever you show your Medicare card. This card is proof of your QMB status and means that your health care provider cannot bill you for Medicare co-pays or deductibles.

Even though DC Medicaid will help pay for your Medicare costs, it does not mean that you are entitled to DC Medicaid benefits. The DC Medicaid program will assist you in paying for services covered under Medicare; but not for Medicaid services.

If you lose your card, please call the District’s Office of the Health Care Ombudsman and Bill of Rights at 1-877-685-6391.

 

What is the Qualified Medicare Beneficiary Plus (QMB Plus) Program?

District residents who are eligible for Medicare coverage; and are eligible for Medicaid under the aged, blind or disabled category can receive full Medicaid benefits, plus help paying for their Medicare premiums, co-insurance and deductibles for Medicare covered services. To be eligible for the Qualified Medicare Beneficiary Plus (QMB Plus) Program, you must meet all of the requirements for Medicaid and all of the requirements for the QMB Program.

To learn more about Medicaid for the aged, blind, and disabled, select here

 

Additional Information for QMBs and QMB Plus Beneficiaries

If you change your address, please notify the Economic Security Administration (ESA) (formerly the Income Maintenance Administration (IMA)) as soon as possible at (202) 724-5506.

If you have any questions about this program or need help enrolling in the Medicare Drug Benefit, you may call the George Washington Law School Health Insurance Counseling Project at (202) 994-6272 or the Office of the Health Care Ombudsman and Bill of Rights at 1-877-685-6391.

 

Threshold in FPL

1 person household, monthly

2 person household, monthly

3 person household, monthly

 4 person household, monthly 5 person household, monthly 6 person household, monthly 7 person household, monthly 8 person household, monthly

QMB

300

 $2,942.50 

$3,982.50

$5,022.50 

$6,062.50 

$7,102.50 

$8,142.50 

$9,182.50 

$10,222.50

QMB Plus

100

$980.83

$1,327.50

$1,674.17

$2,020.83

$2,367.50

$2,714.17

$3,060.83

$3,407.50

 

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