QUALIFIED MEDICARE BENEFICIARIES

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QUALIFIED MEDICARE BENEFICIARIES (QMB)

Medicare Savings for You

If you are elderly, or disabled and have a low income and are eligible for

Medicare, your State may pay some or all of your Medicare expenses.

Federal law requires that State Medicaid programs pay Medicare costs for certain

elderly and disabled persons with low incomes and very limited assets. What this

means is that, depending on your income and the value of things you own, you

will not have to pay as much money out of your own pocket for hospital,

physician, and other services covered by Medicare. You could save hundreds if

not thousands of dollars each year.

Two Programs Offer Help

There are two programs to help people pay their Medicare expenses. One is called

the " Qualified Medicare Beneficiary " or " QMB " program. The other is called the

Specified Low-Income Medicare Beneficiary " or " SLMB " program.

The QMB program is for persons with limited resources whose incomes are at or

below the national poverty level. It covers the cost of the Medicare premiums,

coinsurance and deductibles that Medicare beneficiaries normally pay out of

their own pockets. If you qualify for assistance under the QMB program, you will

not have to pay:

- Medicare's hospital deductible which is $760 per benefit period in 1997.

- The daily coinsurance charges for extended hospital and skilled nursing

facility stays.

- The Medicare Medical Insurance (Part premium, which is $43.80 per month in

1997.

- The $100 annual Part B deductible.

- The 20-percent coinsurance for services covered by Medicare Part B, depending

on which doctor you go to.

The State covers these Medicare cost sharing amounts for you. You are only

responsible for paying for the various medical supplies and services not covered

by Medicare, such as routine physicals, dental care, hearing aids, and

eyeglasses. And, if required by your State, you would also be liable for nominal

cost sharing amounts each time you go to the doctor or use other benefits that

require copayments.

While the QMB program helps those whose income is at or below the national

poverty level, the SLMB program is for persons whose incomes are slightly higher

than the poverty level, but not more than 20 percent higher. If you qualify for

assistance under the SLMB program, you will not have to pay:

- The $43.80 monthly Part B premium.

The State will pay the premium for you. You will, however, continue to be

responsible for Medicare's deductibles, coinsurance, and for charges for health

care services and medical supplies not covered by Medicare.

How Do I Qualify?

The rules may vary from State to State but, in general terms, to qualify for

assistance under the QMB program, you must meet the following requirements:

1. You must be entitled to Medicare Part A. If you do not have Part A or do not

know whether you are entitled to Part A, check with any Social Security

Administration office or call 1-.

Most people are entitled to Part A based on their own employment or the

employment of a spouse. Even if you or your spouse did not work or did not work

long enough to entitle you to Part A, your State may buy it for you.

If you are under 65, you can get Part A if you are on kidney dialysis or have

undergone a kidney transplant. You can also get Part A if you have received

disability benefits from either the Social Security Administration or the

Railroad Retirement Board for more than 24 months.

2. Your financial resources such as bank accounts, stocks, and bonds cannot

exceed $4,000 for one person or $6,000 for a couple. Some things - like the home

you live in, one automobile, burial plots, home furnishings, personal jewelry,

and life insurance - usually do not count as resources.

3. Your income must be at or below the national poverty level. The QMB monthly

income limits in 1997 are listed below and include a $20 income disregard:

All States except Alaska and Hawaii

$678 (individual)$ 905 (couple)Alaska$843 (individual)$1,126 (couple)Hawaii$776

(individual)$1,037 (couple)

Income includes, but is not limited to, Social Security benefits, pensions and

wages. Interest payment and dividends can also count as income.

What If My Income Is Slightly Higher Than the Poverty Level?

If you do not qualify for QMB assistance because your income is too high, you

may be able to get help under the SLMB program. To qualify for SLMB assistance,

you must meet requirements one and two listed under the previous section.

Also, your income cannot exceed the national poverty level by more than 20

percent. This means that in 1997 the SLMB monthly income limits are:

All States except Alaska and Hawaii

$809 (individual)$1,081 (couple)Alaska$1,007 (individual)$1,347

(couple)Hawaii$927 (individual)$1,240 (couple)

Where Do I Apply?

If you already have Medicare Part A and think you qualify for either QMB or SLMB

assistance, you must file an application for Medicaid at a State, county, or

local medical assistance office - not a Federal office. You can get the

telephone number for your medical assistance office by looking under the

" Toll-Free 800' Numbers " section of the Medicaid Office of Beneficiary Services

homepage. This section contains State-by-State Medicaid toll-free phone numbers.

What If I'm Not Covered By Medicare Part A?

If you are age 65 or older and think you qualify for this assistance but do not

have Medicare Part A, you should first contact a Social Security Administration

office. You may need to file an application for Medicare Part A. The telephone

number and address for the nearest Social Security Administration office can be

found in the telephone book. If you need help in getting this information, call

1-.

What Do I Ask For?

When you contact your medical assistance office, ask about the QMB or SLMB

program or the " Medicare Buy-In " program. Explain that you think you qualify for

help in paying your Medicare costs and you want to know when and where you can

file an application for Medicaid.

What Should I Bring With Me?

When you file an application for Medicaid, be prepared to answer questions about

your income, property you own, and other assets. You will be expected to have

copies of documents like bank statements, property deeds, and insurance policies

to show the amount of cash you have and the value of things you own.

Verification of your enrollment in Medicare Part A and of your income and assets

will be important in determining your eligibility for assistance. As your

application is processed, you may be required to go through a face-to-face

interview with a Medicaid caseworker.

If Your Application Is Denied

If your application for assistance under either the QMB or SLMB program is

denied, you have a right to appeal within 30 days of the denial. You file an

appeal at the place you filed your Medicaid application.You are guaranteed a

hearing.

If you need assistance or advice, you may want to contact your State agency on

aging. Assistance also may be available from the Legal Aid or Legal Services

office in your State. These offices provide free legal services to people whose

incomes are within certain guidelines.

The telephone numbers for all State offices can be found in the telephone

directory under " State Government. "