Louisiana QMB Eligibility

What QMB Covers in Louisiana

The Qualified Medicare Beneficiary program is the most generous tier of Louisiana's Medicare Savings Programs. QMB pays your Medicare Part B premium ($202.90/month in 2026), covers the Part A premium if you don't get it free, and picks up all Medicare deductibles and coinsurance — including the $1,736 Part A hospital deductible and the $283 Part B annual deductible.

QMB also comes with a legal protection that the other tiers don't offer: balance billing prohibition. Under Social Security Act § 1902(n)(3)(B) (42 U.S.C. § 1396a(n)(3)(B)), Medicare providers cannot bill QMB enrollees for any cost-sharing, regardless of whether the provider participates in Louisiana Medicaid. If a provider sends you a bill for a Medicare copay or coinsurance, that bill is illegal.

Income and Asset Requirements

To qualify for QMB in Louisiana in 2026, your countable monthly income must be at or below:

• $1,350 for an individual
• $1,824 for a married couple

These are 100% of the Federal Poverty Level after Louisiana applies the standard $20/month general income disregard. If your gross Social Security is $1,365/month, the $20 disregard brings your countable income to $1,345 — under the limit.

Louisiana does not count assets for QMB. The state eliminated the resource test in 2019 under a Section 1902(r)(2) waiver. Your savings account balance, home equity, car value, retirement accounts, and any other assets are completely irrelevant to QMB eligibility. If you've read that the limit is $9,950, that's the federal default — it does not apply in Louisiana.

Who Can Apply

You must meet three non-financial requirements:

1. Medicare Part A entitlement — either premium-free (40+ quarters of work) or enrolled through Part A buy-in (Louisiana is a buy-in state, so you can enroll in Part A conditionally through SSA even without 40 quarters)
2. Louisiana residency — physical presence plus intent to remain
3. U.S. citizenship or qualified alien status — Legal Permanent Residents generally need five years from their qualifying date, with exceptions for refugees and asylees

Under-65 individuals on Medicare through SSDI or End-Stage Renal Disease can also qualify. SSI recipients in Louisiana get automatic full Medicaid but still need a separate QMB determination to activate cost-sharing protection and the buy-in.

Income Counting Rules That Matter

LDH uses SSI-based income counting, not the MAGI rules used for Medicaid expansion. Key differences that affect eligibility:

Social Security is counted at gross, not net. LDH looks at the amount on your award letter or 1099, not what hits your bank account after the Part B premium deduction.

The $20 disregard applies first to unearned income. If you have both unearned and earned income, any unused portion of the $20 carries over to earned income, followed by a $65 earned income disregard and then a 50% reduction of remaining earnings.

Spousal income is deemed if you're married and living together. Both incomes are combined and measured against the couple limit. If you're separated or one spouse enters a care facility, deeming stops the following month.

An adult child's income is never counted. If your parent lives with you, your income does not affect their QMB eligibility.

How to Apply

File through any of LDH's channels: MyMedicaid.la.gov, the paper BHSF Form 1-MB by mail (P.O. Box 91278, Baton Rouge, LA 70821-9278) or fax (1-877-523-2987), by phone at 1-888-342-6207, or in person at a regional Medicaid office.

If approved, QMB coverage starts the first day of the month after the approval decision — it is not retroactive. LDH transmits a buy-in file to CMS, and SSA stops deducting the Part B premium within 30 to 90 days, then refunds any premiums withheld after your eligibility date.

The Louisiana Medicare Savings Programs & Extra Help Guide includes a step-by-step income worksheet and document checklist to prepare before you apply.

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