What QMB pays in Florida
DCF's ESS Policy Manual (2040.0817) says QMB pays "Medicare premiums, coinsurances and deductibles." In 2026 that means:
- The Part B premium, $202.90 a month, and the Part A premium if you don't get Part A premium-free;
- The Part B deductible ($283) and the 20% Part B coinsurance;
- The Part A hospital deductible ($1,736 per benefit period) and hospital coinsurance;
- Skilled nursing facility coinsurance ($217 a day for days 21 to 100). Florida's manual says this includes the full Medicare coinsurance for nursing home care, with no patient responsibility during the Medicare benefit period.
The billing protection
Medicare.gov says that if you qualify for QMB, Medicare providers aren't allowed to bill you for services and items Medicare covers, including deductibles, coinsurance and copayments. You may get a bill for a small Medicaid copayment, if one applies. Show your Medicare card and your Medicaid or QMB card each time you get care.
Who qualifies in Florida
- You're enrolled in Medicare Part A, or conditionally enrolled through Social Security with a letter from DCF (ESS 1440.1504);
- Your countable income is at or below 100% of the federal poverty level. DCF's Appendix A-9.1 lists the monthly amounts by household size;
- Your countable assets are within $9,950 for one person or $14,910 for a couple. Your home and one car don't count;
- You're a U.S. citizen or qualified noncitizen.
If your income is a bit higher, SLMB (up to 120%) or QI1 (up to 135%) pays the Part B premium instead. QMB starts the first day of the month after DCF decides, under 42 U.S.C. 1396a(e)(8); it isn't backdated.
QMB and Florida's special needs plans
Under Florida's contract with AHCA, coordination-only D-SNPs may enroll only people with partial Medicaid help, such as QMB, SLMB, QI or QDWI. See dual-eligible special needs plans in Florida. The full guide is Medicare Savings Programs in Florida.
Related questions
What are the Medicare Savings Program income limits in Florida?
QMB, SLMB and QI1 bands.
How do I apply for a Medicare Savings Program in Florida?
ACCESS Florida, step by step.
Will Florida Medicaid take my house after I die if I get a Medicare Savings Program?
Estate recovery and QMB.
Sources
- Florida DCF — ESS Program Policy Manual, Chapter 2000, 2040.0817 Qualified Medicare Beneficiaries (PDF)
- Florida DCF — ESS Program Policy Manual, Chapter 1400, 1440.1504 Medicare Part A (PDF)
- Florida DCF — Appendix A-9.1, effective April 2026 (PDF)
- Medicare.gov — Medicare Savings Programs (QMB billing protection)
- eCFR — 42 CFR 422.504, Contract provisions
- U.S. Code — 42 U.S.C. 1396a(e)(8), QMB effective date
- AHCA — D-SNP contract, Attachment I-B (PDF)
More questions in this guide
- What documents do I need to apply for a Medicare Savings Program in Florida?
- Will Florida Medicaid take my house after I die if I get a Medicare Savings Program?
- How do I apply for Extra Help with Medicare drug costs in Florida?
- How do I apply for a Medicare Savings Program in Florida?
- What are the Medicare Savings Program income limits in Florida?
- Does Florida count my house or car for Medicare Savings Programs?
Part of the guide: Medicare Savings Programs in Florida · All questions
Frequently asked questions
Is QMB the same as full Medicaid in Florida?
No. DCF's manual (ESS 2040.0817) says QMB-only Medicaid is limited to Medicare premiums, coinsurance and deductibles. DCF checks both on the same application.
Does QMB work with a Medicare Advantage plan?
Yes. QMB pays the Part B premium either way, and federal rules (42 CFR 422.504(g)(1)(iii)) require Medicare Advantage plans' provider contracts to protect dual-eligible members from Medicare cost sharing the state is responsible for.
What should I do if a doctor bills me while I have QMB?
Tell the office you're in the QMB program and show your Medicare and Medicaid cards. If the bill isn't fixed, call 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048).
Does QMB give me Extra Help?
Yes. Anyone approved for QMB gets Extra Help with Part D drug costs automatically, under 42 CFR 423.773(c).
Medicare in your Florida county
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