Full Duals and Qualified Medicare Beneficiary (QMB) Only
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:
- Medicare eligible; entitled to Medicare Part A or Part B (or both)
- A District Resident;
- A US citizen or have eligible immigration status; and
- 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.
Who are Full Dual Beneficiaries?
Full Dual beneficiaries are individuals who are eligible for full Medicaid benefits and qualify for Medicaid to cover 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. Full Duals are also known as Qualified Medicare Beneficiary (QMB) Plus.
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) 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.
The District covers this population with household income up to 300% of the Federal Poverty Level:
| Category | QMB | QMB Plus (Full Duals) |
|---|---|---|
| Threshold in FPL | 300% + $20 disregard* | 100% + $20 disregard* |
| 1 person household, monthly | $3,785 | $1,275 |
| 2 person household, monthly | $5,130 | $1,723 |
Figures compiled using 2024 FPL numbers distributed by the U.S. Department of Health and Human Services
*$20 income disregard included