Full Duals and Qualified Medicare Beneficiary (QMB) Only

Qualified Medicare Beneficiaries have income too high for Medicaid but need some extra help paying certain medical cost. Even though DC Medicaid will pay for your Medicare costs, it does not mean that you are entitled to DC Medicaid benefits. The DC Medicaid program will assist you in paying for services covered under Medicare; but not for Medicaid services.

When you get health services, remember to always show your QMB card whenever you show your Medicare card. This card is proof of your QMB status and means that your health care provider cannot bill you for Medicare co-pays or deductibles.

Even though DC Medicaid will help pay for your Medicare costs, it does not mean that you are entitled to DC Medicaid benefits. The DC Medicaid program will assist you in paying for services covered under Medicare; but not for Medicaid services.

Who are Qualified Medicare Beneficiary (QMB+) Full Dual Beneficiaries?

Full Dual beneficiaries are individuals who are eligible for full Medicaid benefits and qualify for Medicaid to cover Medicare premiums, co-insurance and deductibles for Medicare covered services. It also means that you will receive extra help with your costs under the Medicare prescription drug benefit (Part D), which will limit the amount you pay for your prescriptions to only a few dollars each. Full Duals are also known as Qualified Medicare Beneficiary (QMB) Plus.

To learn more about Medicaid for the aged, blind, and disabled, select here .

Who is eligible for the Qualified Medicare Beneficiary (QMB) Program?

You can receive QMB coverage if you are:

Medicare eligible; entitled to Medicare Part A or Part B (or both)

District Resident;

US citizen or have eligible immigration status; and

Have income up to 300% of the FPL.

What does the Qualified Medicare Beneficiary (QMB) Program cover/include?

The DC Medicaid program pays for:

Medicare Part A and Part B premiums;

Medicare deductibles for Medicare covered services;

Medicare co-insurance for Medicare covered services.

Extra help paying for prescription drug costs under Medicare Part D

If you lose your card, please call the District’s Office of the Health Care Ombudsman and Bill of Rights at 1-877-685-6391.

Additional Information for QMBs and QMB Plus Beneficiaries

If you change your address, please notify the Economic Security Administration (ESA) as soon as possible at (202) 724-5506.

Please reach out to Office of the Health Care Ombudsman and Bill of Rights at 1-877-685-6391 if you have questions about the QMB program, or if you are already enrolled and notice that your monthly Medicare premiums are not being covered or have not received your QMB card.

Need free Medicare health insurance information, counseling, education, and assistance through our DC State Health Insurance Assistance Program (SHIP). Please contact them at 202-727-8370 or email [email protected] .

The District covers this group with household income up to 300% of the Federal Poverty Level

Category QMB Threshold in FPL Monthly Income Limit (300% FPL +$20 disregard= Limit)* 1 person household, monthly $3,990+20 = $4,010 2 person household, monthly $5,410+20 = $5,430

Figures compiled using 2026 FPL numbers as of January 16, 2026 distributed by the U.S. Department of Health and Human Services. * $20 income disregard is included