The QMB program offers the strongest cost protection of any Medicare Savings Program. Here is what it covers and how to qualify.
What the QMB program pays for
QMB is the top tier of the four Medicare Savings Programs. It covers your Part B premium ($185/month in 2025), your Part A premium if you owe one, and your Medicare deductibles, coinsurance, and copayments. In effect, QMB can eliminate nearly all of your out-of-pocket Medicare cost-sharing. QMB enrollees are also automatically granted Extra Help, which sharply lowers Part D prescription drug costs. For many low-income seniors, QMB is more comprehensive than a Medigap policy, and it costs nothing. If your income is limited, this is one of the most valuable benefits you can claim. Call 1-800-MEDIGAP to check.
QMB balance-billing protection
A defining feature of QMB is federal balance-billing protection. Providers who accept Medicare are prohibited by law from charging QMB enrollees for Medicare-covered deductibles, coinsurance, or copays, even if the provider does not take Medicaid. If you receive a bill for these amounts, it is improper. Contact the provider, show your QMB status, and notify your state Medicaid office or 1-800-MEDICARE if it continues. This protection shields the most vulnerable beneficiaries from surprise medical bills and is a major reason QMB is so valuable. 1-800-MEDIGAP can explain how to assert this right.
2025 QMB eligibility and how to apply
For 2025, the QMB income limit is roughly $1,325/month for an individual and $1,783 for a couple, with resource limits near $9,660 (individual) and $14,470 (couple), excluding your home and one car. Some states raise these limits or drop the asset test. Apply through your state Medicaid office with proof of income and resources; approval usually takes about 45 days. Because allowable deductions can bring borderline applicants under the limit, do not assume you earn too much. Call 1-800-MEDIGAP for a free, accurate eligibility review before you rule yourself out.