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ALJ/MAC Decision Database


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 MEDICARE SAVINGS PROGRAMS
 

For more information, follow one of the links below or scroll down the page.


QMB (QUALIFIED MEDICARE BENEFICIARY PROGRAM)
QMB PROVIDER CERTIFICATION FOR T19
SLMB (SPECIFIED LOW-INCOME MEDICARE BENEFICIARY PROGRAM)
QI (QUALIFIED INDIVIDUAL PROGRAM)
OBTAINING QMB, SLMB & QI BENEFITS
ARTICLES AND UPDATES


QMB, SLMB, AND QI PROGRAMS:

Assistance with Meeting the Costs of Medicare Premiums and Deductibles

 

The Qualified Medicare Beneficiary program (QMB), Specified Low-Income Medicare Beneficiary program (SLMB), and Qualified Individual program (QI), help Medicare beneficiaries of modest means pay all or some of Medicare’s cost sharing amounts (ie. premiums, deductibles and copayments). To qualify an individual must be eligible for Medicare and must meet certain income guidelines which change annually. The income guidelines change April 1 each year.

 

Please note that the eligibility criteria listed below are federal standards; states may have more, but not less, generous standards (for example Connecticut currently has no asset limit for QI).

 

QMB (Qualified Medicare Beneficiary Program)

 

The QMB program provides the following benefits:

  • Payment of Medicare Part A monthly premiums (when applicable).

  • Payment of Medicare Part B monthly premiums and annual deductible.

  • Payment of co-insurance and deductible amounts for services covered under both Medicare Parts A and B.

Note: Medigap premiums are not covered by QMB, SLMB, or QI.

 

Eligibility criteria for this program require that:

  • The individual must be eligible for Medicare Part A insurance, (even if not currently enrolled).

  • The monthly income must be at or below 100% of the annual federal poverty level [FPL x 1]. The federal poverty level is announced early each year. The income eligibility level for the Qualified Medicare Beneficiary program changes to reflect that figure each April.See our recent article for specific amounts for early 2010.

  • Uses the Low Income Subsidy asset test of $6,000/individual and $9,000/couple, indexed each year according to the Consumer Price Index.  (The indexed amount for 2009 is $6,600/individual and $9,910/couple; the amounts for 2010 have not yet been announced.)

  • Individual states may still eliminate or further increase the amounts above.  For example, as of 2010 there is no asset limit for QMB in Connecticut.

Note: Individuals who are eligible for Medicare Part A but not enrolled, may conditionally enroll in Medicare Part A at any time during the year and then apply for QMB to cover the cost of the Medicare Part A premium which must otherwise be paid by voluntary enrollees (those not automatically eligible for Medicare Part A through Social Security or Railroad Retirement entitlement).

 

If an individual is eligible for this program, purchasing additional Medigap coverage for Medicare premiums, deductibles, and/or co-payments may be unnecessary. To determine whether or not to retain a Medigap policy, a review of the benefits covered by the Medigap policy must be made to see if the Medigap plan covers services other than the Medicare cost-sharing that may be useful to the person.

 

CMS (formerly HCFA) summary, supplementary information, and final regulations concerning (1) Medicare Part A coverage, through payment of monthly premiums, for disabled individuals under age 65 who have lost Social Security and Medicare because of substantial gainful activity, and (2) state buy-in agreements and payment of Medicare Part A premiums for "Qualified Medicare Beneficiaries".

 

QMB Provider Certification for Title 19

 

The QMB program will pay the 20% Medicare Part B co-insurance only if the provider of services is certified as a Medicaid provider.

 

Note, however, a provider may choose to treat only QMB patients and not all Medicaid recipients and only the QMB patients he chooses to see. Providers have no obligation to treat Medicaid patients or anyone in particular.

 

Physicians and other Part B providers may become Medicaid certified by calling the State Medicaid contractor, EDS, at (860) 832-9259. EDS will send a provider enrollment package. The provider only has to fill out a form in order to become Medicaid certified. DSS also has a Medicaid provider relations department.

 

SLMB (Specified Low-Income Medicare Beneficiary Program)

 

The SLMB program provides the following benefits:

  • Payment of the Medicare Part B monthly premium only.

Eligibility criteria for this program require that:

  • The individual must be eligible for Medicare Part A insurance, (even if not currently enrolled).

  • The monthly income must be between 100% and 120% of the annual federal poverty level [between FPL and (FPL x 1.2)]. The federal poverty level is announced early each year. The income eligibility level for the Specified Medicare Beneficiary program changes to reflect that figure each April.*  See our recent article for specific amounts for early 2010.

  • Uses the Low Income Subsidy asset test of $6,000/individual and $9,000/couple, indexed each year according to the Consumer Price Index.  (The indexed amount for 2009 is $6,600/individual and $9,910/couple; the amounts for 2010 have not yet been announced.)

  • Individual states may still eliminate or further increase the amounts above.  For example, as of 2010 there is no asset limit for SLMB in Connecticut.

QI (Qualified Individual Program) (also know as ALMB) - Limited Expansion of SLMB

 

The Balanced Budget Act of 1997 expanded the SLMB program for certain "qualified individuals" by increasing the income guidelines, but Congress only appropriated a limited amount of funds to each state to pay for this expansion. Once a state’s appropriated money is gone, even eligible individuals will not be able to get into the program.  The program has been extended through December 2010.

  • Individuals with incomes between 120% and 135% of the federal poverty level [between (FPL x 1.2) and (FPL x 1.35)] may be eligible for payment through the SLMB program of their Medicare Part B premium for the calendar year.  See our recent article for specific amounts for early 2010.

  • Uses the Low Income Subsidy asset test of $6,000/individual and $9,000/couple, indexed each year according to the Consumer Price Index.  (The indexed amount for 2009 is $6,600/individual and $9,910/couple; the amounts for 2010 have not yet been announced.)

  • Individual states may still eliminate or further increase the amounts above.  For example, as of 2010 there is no asset limit for QI in Connecticut.

  • Individuals must apply every year for these benefits;

  • It is important to apply early to have a better chance of obtaining these benefits. Applications from those meeting the eligibility requirements will be granted on a first come first served basis;

  • Priority for the following year will be given to those who received the benefits during the previous calendar year;

  • These benefits are not available to those who qualify for any other kind of Medicaid (T19).

Obtaining QMB, SLMB, and QI Benefits

 

Requests for applications for QMB, SLMB, or QI benefits are made to the state Department of Social Services (DSS) office serving the town of residence and may be conducted over the telephone. Eligibility for QMB is effective on the first day of the month following the month in which DSS has all the information and verification necessary to determine eligibility. This should not take more than 45 days. SLMB entitlement may be retroactive up to three months prior to the date of application if the person is otherwise eligible.

 

Remember income levels change April 1st each year.

 

For more information, please telephone your district DSS office.

 

* To this amount, add $20/month ($240 annually) to represent the federally-allowed income disregard but check with your state to determine if your state allows a higher amount to be disregarded.  Residents of Connecticut can add $227/month ($2,724 annually).  Check each April for changes to this amount.


SAVINGS PROGRAM ARTICLES AND UPDATES

 
 


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