TennCare QMB: Eligibility, Benefits and How to Apply in Tennessee

The Qualified Medicare Beneficiary program — QMB — is the most comprehensive tier of Tennessee's Medicare Savings Programs. It doesn't just cover the $202.90 monthly Part B premium. TennCare also picks up the Part B deductible, all Medicare copays and coinsurance, and the Part A hospital deductible. For someone facing a $1,736 hospital deductible on a fixed income, that changes everything.

2026 Income and Asset Limits

TennCare starts with your parent's gross monthly income and subtracts a $20 unearned income disregard. After that deduction, countable income must fall at or below 100% of the Federal Poverty Level:

• Single: up to $1,350 per month gross
• Married couple: up to $1,824 per month gross

Assets must stay under $9,950 (individual) or $14,910 (couple). TennCare counts bank accounts, CDs, stocks, and retirement accounts that allow lump-sum withdrawal. It excludes the primary home regardless of value, one vehicle, personal belongings, and up to $1,500 per person in burial funds.

If earned income is involved — say your parent works part-time — TennCare applies an additional earned income disregard: the first $65 plus half of remaining gross wages are excluded.

What QMB Actually Covers

Here is what TennCare pays when someone has QMB status in 2026:

• Part B premium: $202.90/month
• Part B annual deductible: $283
• Part B coinsurance (typically 20% of approved charges)
• Part A hospital deductible: $1,736 per benefit period
• Part A daily coinsurance for extended stays ($434/day for days 61–90)
• Skilled nursing facility coinsurance ($217/day for days 21–100)
• Part A premium if your parent lacks 40 work quarters ($311 or $565/month)

That last point matters more than most people realize. Tennessee is a Part A Buy-In State, which means someone without enough work credits to get premium-free Part A can apply at Social Security at any time of year — not just during the General Enrollment Period — and TennCare will pay the premium through QMB.

Balance-Billing Protection

Federal law (42 U.S.C. § 1396a(n)(3)(B)) prohibits any Medicare-enrolled provider from billing a QMB enrollee for Medicare deductibles, copays, or coinsurance. This applies whether the provider is in-network or out-of-network, and whether your parent has Original Medicare or a Medicare Advantage plan.

In practice, automated billing systems still send these bills. If your parent receives one, the provider must write it off. Calling 1-800-MEDICARE (1-800-633-4227) and filing a formal complaint is the fastest way to stop it.

SLMB and QI enrollees do not have balance-billing protection — this is unique to QMB.

How to Apply

Applications go through TennCare Connect, not through Social Security or Medicare directly:

1. Apply online at tenncareconnect.tn.gov, by phone at 1-855-259-0701, or at any county DHS office
2. TennCare checks income and assets through electronic data matching with the IRS, SSA, and Equifax. If that clears, no paper documents are needed
3. Processing takes 20 to 40 days
4. QMB starts on the first of the month after approval — there is no retroactive coverage

If you're applying for a parent, fill out the Authorized Representative section (Step 1 on the application). TennCare does not accept representative designations filed with Social Security.

Automatic Extra Help

Every QMB enrollee is automatically deemed eligible for Part D Extra Help. That eliminates the Part D deductible ($615 in 2026), caps prescription copays at $12.65 for brand-name drugs, and removes Part D late enrollment penalties.

The Tennessee Medicare Savings Programs & Extra Help Guide includes worked income calculations, a document checklist, and step-by-step instructions for the TennCare Connect portal.

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