The Qualified Medicare Beneficiaries (QMB) program helps people who have Medicare pay for their medical care. To receive benefits from the QMB program you must be receiving Part A (Hospital insurance benefits) coverage of Medicare and your income must fall within certain limits. Income limits are changed annually in March based on the federal cost of living adjustment.
QMB has four benefit packages based on an individual’s income. The income limits listed are for March 2018 through February 2019.
- Qualified Medicare Beneficiaries – Basic (QMB-BAS). In this benefit package the Department of Human Services pays for eligible clients’ Medicare premiums, deductibles and co-insurance. The income limit for this program is set at 100 percent of the poverty level or $1,012 for an individual and $1,372 for a couple.
- Qualified Medicare Beneficiaries – Disabled Worker (QMB-DW). In this package the Department pays for the Medicare Part A premiums for some disabled workers who lost eligibility for Social Security because they are working and who are not eligible for another Medicaid program. The income limit for this program is set at 200 percent of the poverty level or $2,024 for single person and $2,744 for a couple. Most individuals are not eligible for QMB-DW in Oregon due to the existence of the Employed People with Disabilities Program (EPD), which provides full Medicaid benefits.
- Qualified Medicare Beneficiaries – Specified Low-Income Medicare Beneficiary (QMB-SMB and SMF). In this benefit package, the Department only pays for the Medicare Part B premiums of eligible clients. The federal government pays for a portion of the cost of the SMB and SMF programs.
- SMB - The income limit for SMB is set at 120 percent of the poverty level or $1,214 for individuals or $1,646 for a couple. The federal government pays 60 percent of this benefit.
- SMF - The federal government also mandates that we serve people with incomes between 120 percent and 135 percent of the poverty level which equals $1,366 for an individual and $1,858 for a couple. In most states, this is called the Qualifying Individual (QI) program; however, in Oregon this is called the SMF benefit. Unfortunately, we are only allowed to serve a specific number of people each year in this category. If we reach our maximum number we must shut down enrollment. The federal government pays 100 percent of the SMF program.
- Please note: Individuals who are eligible for any other Medicaid benefit offerred by the state are not eligible for the SMF program.
Beginning January 1, 2016, there is no longer a resource limit for the QMB programs in Oregon.
How to apply
To apply for QMB, contact your Oregon Department of Human Services (DHS) or Area Agency on Aging (AAA) local office. The agency will make a decision on your application within 45 days of the date you submit your application.