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What Is QMB, Medicare QMB, & Medicare Beneficiary Explained

Health Insurance conceptual focusing on Medicare. Contact Wise Insurance for more information.

Many seniors receiving Medicare may still struggle to pay their out-of-pocket healthcare costs. However, they may not know that programs are available, if they qualify, to ease these financial obligations. Wise Insurance advises struggling seniors about these programs and can determine if they have the qualifications to start receiving benefits.

We are the leading experts in Houston and surrounding areas when it comes to improving quality, affordability, and accessibility to Medicare information. 

At Wise Insurance, we believe struggling seniors should know that resources are available to help ease their budget. This guide will explain the Qualified Medicare Beneficiary Program (QMB), who can qualify for it, and how to apply.

What is the Qualified Medicare Beneficiary Program (QMB)?

The Texas Health and Human Services Commission (HHSC) offers four Medicare Savings options under the state’s Medicaid program. These Medicare Savings Programs help Medicare recipients struggling to pay for Medicare Part A and Part B premiums, deductibles, coinsurance, and copayments. One of those programs is the QMB plan. 

In 2017, one out of eight people receiving Medicare were enrolled in the QMB program across the United States. 

The QMB plan is designed to help pay for Medicare Part A and Medicare Part B premiums, deductibles, and coinsurance if you meet the specific financial resources requested.

If enrolled under this program, you will not be obligated to pay for Medicare Part A or Part B out-of-pocket expenses you would usually be billed for under these plans.  

Who Can Qualify for Medicare QMB?

Seniors receiving Medicare benefits but with severe income and resource limitations are eligible to receive QMB benefits. Limitations can change from year to year, but checking the government Medicare website will help you determine whether your income and resource limitations fall within the eligibility parameters. 

Your monthly income limitations are only part of qualifying for the QMB plan. The amount of resources you possess is also factored in. 

Money in checking, savings, or retirement accounts will be counted toward your eligibility specifications. Stocks and bonds are also counted as resources. However, certain assets are not included in determining your eligibility, such as:

  • Your home
  • One car
  • Burial plot
  • Allocated burial expenses of up to $1500
  • Furniture
  • Other household and personal items

Monthly income and resource limits will also depend on whether you are married or not married. 

As of 2023, all added resources should not be more than $9,090 on an individual level and no more than $13,630 as a married couple in order to qualify for the Medicare QMB Plan.

How do I apply for Medicare QMB?

Because the state Medicaid program manages the QMB plan, you must contact the Texas HHSC to enroll. Contacting our team at Wise Insurance can help you alleviate the process. Qualifying for Medicare QMB can be a difficult process for many people, which is why we’re here to help. 

You’ll have to supply financial information, including the following:

  • Social security numbers and birth dates
  • Costs you pay for bills, such as rent, mortgage, water, gas, electric, sewage, and phone
  • The value of the items you pay for or own, such as vehicles, money in bank accounts, stocks, etc.
  • Health insurance information
  • The money you receive from jobs and other sources

Once you apply, they will review it and let you know if they need more information or if you can receive benefits. 

Get With the Qualified Medicare Beneficiary Program

Residents 65 years or older living in Houston and the surrounding areas who need access to affordable healthcare rely on Wise Insurance to guide them through the complexities of Medicare and additional assistance programs they may be qualified for. We understand that Houston residents may not even be aware of the programs that help struggling seniors, and we’re here to clear a path to ease the financial burden of healthcare.

If you’re eligible to receive Medicare or have been receiving Medicare for some time and are struggling financially, contact us or book an appointment with Wise Insurance to learn about supplemental insurance or savings plans that will help ease your healthcare concerns.


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