Qualified Medicare Beneficiary Programs
If an individual has a low income, DSS may pay his Medicare premiums and, in some cases, other "out-of-pocket expenses such as deductibles and coinsurance. Individuals must be entitled to Medicare Part A to qualify for any of these programs. Recipients under these programs do not receive regular Medicaid services.
- Qualified Medicare Beneficiary Program (QMB)- This program was mandated by the Medicare
Catastrophic Coverage Act of 1988. Under this program Medicaid pays for the following:
- The Medicare Part A hospital premium. Most Medicare recipients receive this coverage for free.
- The Medicare Part B premium.
- The Medicare Part A hospital deductible.
- The annual Part B deductible.
- The 20% coinsurance (for services such as physician visits and labs).
The gross monthly income cannot exceed 100% of the Federal Poverty Level (see our Federal Poverty Level charts). There is no asset test. - Specified Low Income Medicare Beneficiary (SLMB) Program - Under this program Medicaid pays the Medicare Part B premium only. The gross monthly income cannot exceed 120% of the Federal Poverty Level (see our Federal Poverty Level charts) .
- Qualified Individual-1 (QI-1) Program - Under this program Medicaid pays the Medicare Part B premium only. The gross monthly income cannot exceed 135% of the Federal Poverty Level (see our Federal Poverty Level charts).
- Qualified Individual-2 (QI-2) Program - Under this program Medicaid pays for only a small portion of the Medicare Part B premium. The gross monthly income cannot exceed 175% of the Federal Poverty Level (see our Federal Poverty Level charts).
