Disabilities Guidebook: Medicaid Coverage of Medicare Premiums and Deductibles: The Qualified Medicare Beneficiary (QMB) Program

Disabilities Guidebook: Medicaid Coverage of Medicare Premiums and Deductibles: The Qualified Medicare Beneficiary (QMB) Program

Last updated: April 2013

(Chapter 8 Section 6 from Guidebook of Laws and Programs for People with Disabilities

What It Is: Under the Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLIMB) and Qualified Individual-1 programs, Medicaid can help with Medicare premiums, co-payments and deductibles.

Where to Apply: The local office of the Illinois Department of Human Services.

Who May Be Eligible: People living in Illinois who are low-income and enrolled in Medicare.

I. Your Legal Rights

Help in Paying Medicare Premiums, Co-payments and Deductibles
Participants in the Medicare program must pay monthly premiums, co-insurance and deductibles. These out-of-pocket costs can be considerable. Under the QMB program, Medicaid will cover all Medicare premiums, deductibles and co-insurance amounts. Under the SLIMB and Qualified Individuals-1 programs, Medicaid will cover only your Medicare Part B premium.

If you are eligible for the QMB program, you will receive a "Mediplan card" from the Illinois Department of Healthcare and Family Services (HFS). You can present this card to your doctor or other medical provider so that they may bill HFS. In order to obtain QMB coverage of a bill, you must receive treatment or services from a medical provider who accepts Medicare assignment and also participates in the Medicaid program.

Who is Eligible?

Qualified Medicare Beneficiary (QMB) Program
Under the QMB program, all Medicare premiums, deductibles and co-insurance amounts are covered.

To be eligible for this program, you must:

  • Be enrolled in Medicare Part A;
  • Have monthly income of below 100% of the federal poverty level; and
  • Have assets of $4000 or less for one person, or $6000 or less for a couple.

Specified Low Income Medicare Beneficiary (SLIMB) and Qualified Individuals-1 (QI-1) Programs
Under the SLIMB and QI-1 programs, only your Medicare Part B premium is covered.

To be eligible for SLIMB, you must:

  • Be enrolled in Medicare Part A;
  • Have monthly income of between 100% and 120% of the federal poverty level;
  • Have assets of $4000 or less for one person, or $6000 or less for a couple.

The requirements for the QI-1 program are the same except that your monthly income must be at or below 135% of the federal poverty level, and you cannot be eligible for Medicaid (a person who is eligible for Medicaid only after meeting a spend down is not considered eligible for Medicaid).

Other Eligibility Rules
Citizenship. You must be an Illinois resident, and you must be a U.S. citizen or be within one of the permitted classes of non-citizens, as set forth in the section on Medicaid for Adults.

Income and Assets. The QMB and SLIMB programs each have their own income limits (see above). The program does not count the first $25 of income (other than SSI income) for each person who is a household member.

Each program also has certain asset limits. Certain assets are exempt (not counted), similar to the assets which are exempt under the regular Medicaid rules, such as your home, furniture, and one car.

How to Apply
You file an application with your local Illinois Department of Human Services (IDHS) Family and Communication office or by line and mail-in application available at: https://wb.dhs.illinois.gov/wbpublic/register/wb/wbHomePre.do

Under the QMB program, your QMB benefits will begin the first day of the month following the approval of your application. Under the SLIMB program, if you specifically request, your benefits can be effective up to three months before the month of application.

Under both programs, the State department will redetermine your continuing eligibility once every 12 months.

II. What to Do If You Are Denied

Participation in QMB, SLIMB, or QI-1

Appeal Rights
If your application is denied, you are entitled to file an appeal with IDHS. You must make the appeal in writing and must file it within 60 days of the date of the notice of ineligibility.

IDHS will give you a hearing at which you will be entitled to present evidence in your behalf. See the section in this chapter titled "Medicaid For Adults" for a complete description of the appeal process.

III. Where to Go for More Information

Phone Numbers
For information about the location of your nearest IDHS office or for other general information, call the IDHS-Bureau of Customer Inquiry and Assistance at (800) 843-6154 (v); (800) 863-6339(TTY).

Statutes and Regulations
State regulations concerning QMB, SLIMB and QI-1 are at 89 Ill.Admin.Code Part 120.70 through 120.76,
Subpart D

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