Qualified Medicare Beneficiary (QMB)


On April 1, 2016, most Iowa Medicaid programs were joined together into one managed care program called IA Health Link. Most existing Medicaid members were enrolled in IA Health Link on April 1, 2016, and most new members who become eligible after April 1, 2016, will also be enrolled in IA Health Link. QMB members are excluded from the IA Health Link program. 

What are the eligibility requirements for QMB? 
People who are entitled to hospital insurance under Medicare Part A may be eligible for benefits through the “Qualified Medicare Beneficiary” (QMB) coverage group. Under the QMB program, Medicaid only pays Medicare premiums, deductibles, and coinsurance for persons who are qualified Medicare beneficiaries. Medicare refers to the QMB group as a “Medicare Savings Program.”

You could be eligible as a qualified Medicaid beneficiary if you are:

  • 65 or older; 
  • Blind or disabled;
  • Eligible for Medicare Part A benefits;
  • Have resources less than $7,280 for a single person or $10,930 for a couple
  • Have income at or below 100% of the federal poverty level.

A QMB member who is eligible under more than one coverage group can choose under which coverage group eligibility is determined. Medicaid provides for some services not covered under Medicare, such as dental expenses and some prescription drugs.

What if my income or resources are too high for QMB?
If your total countable income or resources are higher than the QMB limits, there are other program you may qualify for:

  • Medically Needy: Ask the DHS office about Medically Needy if you have lots of medical bills and not enough money to pay the bills. If you are determined to be Medically Needy, you will need to pay your medical bills up to the spenddown deductible.
     
  • Specified Low Income Medicare Beneficiary (SLMB) or Expanded Specified Low Income Medicare Beneficiary (E-SLMB): SLMB and E-SLMB will only pay your Medicare Part B premium. The income limit is over 100% but less than 135% of the federal poverty level.

QMB Income and Resource Limits in 2016:

FOR FAMILY SIZE: MONTHLY INCOME LIMIT IS: RESOURCE LIMIT IS:
Individual $1,010 $7,280
Couple $1,355 $10, 930


What services are covered by QMB? 
The QMB program provides the following benefits:

  • Payment of Medicare Part A monthly premiums (when applicable).
  • Payment of Medicare Part B monthly premiums and annual deductible.
  • Payment of co-insurance and deductible amounts for services covered under both Medicare Parts A and B.
  • Medigap premiums are not covered.

Do I need to pay anything for medical services? 
Medicaid covers the cost of medically necessary services, such as physicians, dentists, hospitals, prescribed drugs that are not paid by Medicare drug plans, ambulance services, and eyeglasses.

Where can I find further information on the QMB program?
For further information on the QMB program, you may access the Medicaid for the Qualified Medicare Beneficiary brochure