QMB | Qualified Medicare Beneficiary Medicaid Program in Florida

Qualified Medicare Beneficiary (“QMB”) is one class of Medicaid, referred to as Medicare Savings Programs.  These programs exist around the country. About 7.8 Million Americans are enrolled in a QMB program according to CMS. But qualification standards can differ between states and so this article is limited to Florida’s QMB Medicaid program.

Qualified Medicare Beneficiary enrollees have no obligation to pay Medicare deductibles, coinsurance or co-pays (rather state Medicaid programs pay these costs). QMB is also designed to help reduce the cost of prescription medications.

Because these costs are generally covered in a skilled nursing home setting; QMB applicants are almost always those on Medicare who live at home, in an independent living community or assisted living facility (ALF).

QMB - Helps Pay for Prescriptions and Co-Pays

Those enrolled in the Qualified Medicare Beneficiary (QMB) program will get their Medicare Part D premium reduced or covered completely through the LIS/Extra Help Medicaid Program. This will result in most medication costs (all prescriptions that are Medicare approved) requiring a copay of zero or $10.00.  

In addition, Qualified Medicare Beneficiary enrollees will not have to pay co-pays or co-insurance when they seek treatment from a Medicare medical provider.

While Medicaid Waiver programs also include the benefits associated with QMB. QMB also has the additional benefit of no wait-list.

QMB Also Gives You Extra Money

What attracts most people to the QMB Medicaid program in Florida is the drastically reduced (or sometimes eliminated) prescription drug coverage along with the benefit of no longer having to pay a co-pay or co-insurance with doctor visits. But in addition, there is an actual cash benefit as well -- QMB also pays for Medicare Part B premiums.

As a result, most Floridians will see an extra $164.90 (the typical Medicare Part B premium as of 2023) deposited into their bank account each month. Those funds are extra help to pay for the costs of living in Florida.

In addition, those who qualify for QMB (or Medicaid Waiver for that matter) may also be able to enroll in a Medicare Advantage D-SNP Plan. D-SNP stands for dual-enrolled special needs plan. These Medicare Advantage / Part C plans include more comprehensive health insurance, with typically more generous health, vision, and dental benefits. D-SNP plans also usually provide a monthly allowance of funds (usually around $200.00) that can be put towards utility payments, over-the-counter needs, as well as healthy foods.

Between saving money (by not having to pay co-pays) and literally receiving extra cash in their pocket (by not having Medicare premiums automatically deducted from their social-security income + being provided with extra funds each month to put toward the electric or water bill), QMB makes a significant difference in my clients’ lives.

QMB Qualification Standards

Florida’s QMB Eligibility includes income and asset criteria that can be found at this article that discusses lesser-known Florida Medicaid Programs. For those who do not immediately qualify for the Qualified Medicare Beneficiary program (because of their income or assets), our experienced Medicaid-planning lawyers can provide legal and ethical ways to protect your income and assets to qualify for QMB in Florida.

In other words, if your assets or income are currently too high to qualify for QMB Medicaid in Florida, we can still help you with proper Medicaid planning. You wont have to wait five years, sell your house or go broke before being able to obtain QMB Medicaid in Florida.

In order to qualify for QMB, the applicant must either be aged (65 or older) or deemed disabled. This can be an incredibly valuable program for those who pay significant amounts of money trying to control diabetes or for cancer treatments and medications.

For those under the age of 65, unsure if they are considered disabled, should know that certain cancer diagnoses and neurological diseases (e.g. acute leukemia, non-Hodgkin lymphoma, gallbladder cancer, liver cancer, thyroid cancer, small-cell cancer, ALS, Huntington Disease, Lewy Body Dementia (and other dementia's), Giant Axonal Neuropathy, and many others) will automatically deem someone disabled.

Difference Between QMB and Medicaid Waiver Program in Florida

Medicaid Waiver is for those Floridians who need help paying for home-health care or ALF bills. For those already enrolled in a Medicaid Waiver program in Florida, they will receive all the same benefits as those who only have QMB. In other words, QMB is really for those Medicare recipients who don't yet need help with their activities of daily living but who are in need of assistance paying for health care and prescription medications.

In addition, QMB does not have a waitlist, while the Medicaid Waiver / Home and Community Based Medicaid has a waitlist that last for months and months. We often assist our Medicaid clients, who need assistance with their activities of daily living, with strategies to qualify and apply to both programs. The primary benefit to applying for both QMB and Medicaid Waiver benefits in Florida is to start receiving QMB benefits now while waiting to come off the Medicaid Waiver waitlist.

Tips for Those Already Enrolled in QMB

Medicare medical providers are not allowed to bill QMB participants for certain Medicare-related costs. It is literally illegal.

If you get a bill for Medicare deductibles, coinsurance or co-payments, make sure your doctor/medical provider knows you are in the QMB program. If your provider won’t stop billing you, you can call 1-800-MEDICARE. If your medical provider has placed you into collections for these charges and a debt collector is calling you, file a complaint with the Consumer Financial Protection Bureau (855-411-2372).

Finally, if you are already receiving Florida QMB Medicaid benefits and are starting to have difficulty with your activities of daily living, it may be time to apply for the Florida Medicaid Waiver program (home and community-based services to help pay for home-health care or ALF care). There is a waitlist and an Elder law attorney who focuses on Medicaid planning that can assist if you need help.

QMB Program Information from CMS

Three Tips for People in the Qualified Medicare Beneficiary Program

Other Florida Medicaid Programs that We Help Our Clients Obtain

Florida Long Term Care Medicaid Program

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