Medicaid: Qualified Medicare Beneficiary (QMB) Program

Who is eligible?

You may be eligible for the QMB Program if you:

• Are entitled to Medicare Part A or Part B-ID benefits.
• Have countable assets at or below the program limit.
  • If it’s just you, you cannot have more than $9,430 in assets.
  • You and your spouse cannot have more than $14,130 in assets.
• Have countable monthly income at or below 100% of the federal poverty level after certain credits are applied.
  • If it’s just you, you cannot make more than $1,255 each month.
  • You and your spouse cannot make more than $1,703.33 each month.

Asset and income limits are based on federal guidelines, which may change yearly.

The following groups are automatically enrolled in the QMB Program:

• People who are enrolled in the Supplemental Security Income (SSI) program.
• People who currently receive Medicaid, and who used to be enrolled in the SSI program but lost their SSI benefits when they began to receive Social Security benefits (such as retirement, disability, disabled adult child, or widow/widower benefits).

How do I apply?

You can apply:

• Online.
• By phone.
• In person.
• By mail.

Learn how to apply.

How do payments work?

If you are eligible for the QMB Program, Medicaid will start paying your Medicare Part A and B or Part B-ID premiums, deductibles, and coinsurance on the first day of the month after your application is approved.

When that happens, your Social Security payment will go up because the premiums for Medicare Part A and B or Part B-ID will no longer be deducted. You’ll get a notice from the Social Security Administration. They’ll give you a refund for any payments you made after the date you were enrolled in the QMB Program.

Your Social Security payment may not change for one to three months, though. That’s because it takes time for Medicaid, Medicare, and the Social Security Administration to adjust payments. This means your payments may be higher than usual for a short time.

Example: If your application was approved in April, you’re enrolled in the QMB Program in May. Your Social Security payment may not change until July. You’ll get a refund for premiums you paid for May and June.

Who do I contact for help?

You can call the Wisconsin Medigap Helpline at 800-242-1060. You can also contact your local benefit specialist.