The QMB Program Eliminates All Medicare Out-of-Pocket Costs

Medicare premiums, deductibles, copayments, and coinsurance for covered services are eliminated for those who qualify for the Qualified Medicare Beneficiary (QMB) program. Federal law prohibits any Medicare provider from billing a QMB enrollee for Medicare cost-sharing, regardless of whether the provider accepts Medicaid. Enrollees have a right to a refund if billed for a covered service.

QMB is the most comprehensive of the four Medicare Savings Programs. Enrollment automatically triggers Extra Help, the Part D prescription drug subsidy. In 2026, Extra Help caps annual drug costs at $2,100 and limits brand-name drug prescriptions to $12.65.

In most states, 2026 monthly income limits for QMB are $1,350 for an individual and $1,824 for a couple. States apply a $20 general income disregard and exclude roughly half of earned income from work. Most states apply a resource limit of $9,660 for individuals and $14,470 for couples, though twelve states have eliminated the asset test. Home, one vehicle, and personal belongings are excluded from these calculations.

Applications are submitted through state Medicaid offices.