Qualified Medicare Beneficiary (QMB) Program
The Qualified Medicare Beneficiary (QMB) program, administered by DC Medicaid, provides secondary insurance coverage to Medicare beneficiaries who live in the District and have limited income. For 2026, individuals with monthly income up to $4,010 and couples with income up to $5,430 may qualify. QMB can cover all Medicare cost‑sharing charges, including premiums, deductibles, and coinsurance.
What will I save in Medicare premiums?
The QMB program pays your monthly Medicare premiums. Most people do not pay a premium for Medicare Part A, but if you do, QMB will cover it. QMB also covers the 2026 Medicare Part B premium of $202.90 per month.
If the Social Security Administration deducts your Part B premium from your Social Security check, your monthly benefit should increase by that amount after you are approved for QMB. If you do not see an increase within two months of receiving your QMB approval letter, please contact us.
How much will I save in Medicare cost‑sharing charges?
The QMB program provides full supplementary insurance by covering all Medicare cost‑sharing amounts.
Original Medicare: QMB covers the 2026 Part A hospital deductible of $1,736, daily hospital and skilled nursing facility coinsurance, the Part B annual deductible of $283, and all Part B coinsurance (usually 20% of Medicare‑approved amounts) for doctor visits, outpatient services, and medical equipment.
Medicare Advantage: QMB covers your deductibles, copayments, and coinsurance for inpatient hospital stays, outpatient hospital services, doctor visits, and medical equipment. Providers may not bill you for these costs.
What happens to my Part D prescription drug plan?
People enrolled in QMB automatically qualify for Extra Help, a Medicare program that lowers prescription drug costs. Extra Help may cover your Part D premium, eliminate your deductible, and reduce your prescription copays to no more than $5.10 for generics and $12.65 for brand‑name medications (amounts may vary slightly in 2026).
How does the law protect me?
Federal Medicare law states that QMB beneficiaries cannot be billed for Medicare cost‑sharing. When Medicare pays, you pay nothing. Providers and Medicare Advantage plans are prohibited from charging QMB enrollee’s deductibles, coinsurance, or copayments. If a provider bills you in error, they may owe you a refund.
How is the QMB program different from Medicaid?
Medicaid, also known as Medical Assistance or QMB Plus, covers services not normally covered by Medicare. QMB, which is partial Medicaid, only helps pay for Medicare‑covered services. For example, QMB does not pay for dental or routine vision services because Medicare generally does not cover them. If you are unsure which program you are enrolled in, please contact our office at 202‑727-8370.
Inform your providers
Always show both your Medicare card and your QMB card at medical appointments. If you have been approved for QMB and need a replacement card, contact the Health Care Ombudsman’s Office at 877‑685‑6391.
Problems or questions? Call us!
When health care providers are not familiar with the QMB program, billing problems may occur. If any provider bills you for Medicare deductibles or copayments, contact our office right away at 202‑727‑8370 or email [email protected]. We will work with you and the provider to resolve the issue.
