Low-income Medicare beneficiaries can receive help paying their premiums and co-payments.
Most Americans are eligible for Medicare, the federal health insurance program, when they turn 65. If you have worked for at least 10 years in Medicare-eligible employment, you are automatically enrolled in Medicare Part A, hospital insurance, and Part B, medical insurance. Most people do not pay a premium for Medicare Part A, but Part B costs anywhere from $96.40 per month to $110.50 per month. There are programs to help low-income Americans cover the cost of those premiums.
QMB Eligibility
The Qualified Medicare Beneficiary program, also known as "Quimby," pays the Medicare Part A and Part B premiums, as well as all deductibles, coinsurance and co-payments, for low-income beneficiaries. As of 2010, a Medicare recipient earning less than $923 per month as an individual, or a married couple earning less than $1,235 per month, qualifies for QMB. In addition to income, beneficiaries must pass the asset test to be eligible for QMB. As of 2010, you cannot have more than $6,600 in assets for an individual, or $9,910 for married couples. Assets include cash in bank accounts, stocks and bonds. Your house, car or money saved for burial expenses does not count toward assets. Qualifying for QMB also automatically makes the beneficiary eligible for his state Medicaid program.
Applying for QMB Assistance
To apply for Medicaid and QMB Benefits, a Medicare recipient should call or visit her state department of human or social services or the local area agency on aging. If you already receive state Medicaid benefits, you can call the Social Security Administration to enroll in QMB.
Medicare Special Needs Plans
In some areas, people designated as QMB are eligible for Medicare Special Needs Plans, also known as "snip" plans. Medicare Special Needs Plans are a type of Medicare Advantage plan, usually a Health Maintenance Organization or Preferred Provider Organization. These plans are offered by independent insurance companies, and generally only serve a specific segment of the population. When you join a SNP, all of your medical services and prescriptions are covered by the plan. To enroll in a SNP, call your local agency on aging or department of social services office to find out which plans are available in your area and how you can sign up.
Other Assistance Programs
If you do not qualify as a QMB, there are other assistance programs for low-income Medicare recipients. These programs only cover the cost of Medicare Part B premiums. If your income is less than $1,103 per month for an individual, or $1,477 per month for a couple, and you receive Medicaid, you may qualify as a Specified Low-Income Medicare Beneficiary. If your income is too high for Medicaid, you may be able to get help as a Qualified Individual. A Qualified Individual is someone who makes less than $1,239 per month, or $1,660 as a couple. QI benefits are assigned on a first-come, first-served basis annually and beneficiaries must reapply every year, unlike the other programs. Asset limits apply for SLMB and QI programs. Contact your state Medicaid office to see if you are eligible.
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