I’m confused about the term QMB Plus. I thought people who don’t qualify for full Medicaid—like if their assets exceed $3,000 for a couple in Texas—might qualify for a Medicare Savings Program like QMB because the asset limit there is $14,130. But when I read about Medicare Advantage plans, they mention QMB Plus with full Medicaid benefits. I thought anything with ‘QMB’ in the name was a lower tier than Medicaid, so I’m not sure why they call it ‘QMB Plus’ if it includes full Medicaid benefits. Is QMB Plus somewhere between full Medicaid and QMB? Thanks!
QMB+ means you qualify for both QMB and full Medicaid. Similarly, SLMB+ means you qualify for both SLMB and full Medicaid.
When a Dual-Eligible Special Needs Plan (D-SNP) says it requires full Medicaid, it often lists all categories, like QMB+, SLMB+, and FBDE. Some plans also include QMB, even though it’s technically a partial dual.
QMB+ and SLMB+ differ from FBDE because FBDE (meaning you have both Medicare and full Medicaid) doesn’t always cover the Part B premium.
@Drew
Sounds like you’re an agent with that detailed explanation, haha!
I have the same question about SLMB+. I thought SLMB existed because of its higher income and resource limits. What’s the point of SLMB with full Medicaid benefits? Does the limit go back down to match Medicaid?
Here’s a definition I found on United Healthcare, but even after reading it multiple times, I’m still confused:
'Qualified Medicare Beneficiary Plus (QMB+): You get Medicaid coverage of Medicare cost-share and are also eligible for full Medicaid benefits. Medicaid pays your Part A and Part B premiums, deductibles, coinsurance, and copayment amounts for Medicare-covered services. You pay nothing, except for Part D prescription drug copays (if applicable).
‘Specified Low-Income Medicare Beneficiary (SLMB+): Medicaid pays your Part B premium and provides full Medicaid benefits. You are eligible for full Medicaid benefits. At times, you may also be eligible for limited assistance from your state Medicaid agency in paying your Medicare cost-share amounts. Generally, your cost-share is 0% when the service is covered by both Medicare and Medicaid. There may be cases where you have to pay cost-sharing when a service or benefit is not covered by Medicaid.’
It all comes down to three basic levels. Some plans only pay your Part B (SLMB or QI, which are partial Medicaid). Others cover Part B and out-of-pocket costs (QMB). The highest level pays Part B, out-of-pocket costs, and includes a separate health plan from the state (FBDE, QMB+, SLMB+). There are a few other variations, but that’s the basic idea.