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What are the Medicare Cost-Sharing Programs?
The Medicare Cost-Sharing Programs help Medicare beneficiaries with their Medicare costs. These programs may pay the Medicare premiums, co-payments and deductibles. See section 612 for the rules on retroactive coverage. There are four programs:
Qualified Medicare Beneficiaries (QMB) - This program pays the Part B Medicare premium, Medicare co-payments and deductibles. It may pay the Part A premium for some clients.
Specified Low-Income Medicare Beneficiaries (SLMB) – This program pays the Part B Medicare Premium.
Qualifying Individuals (QI) – This program pays the Part B Medicare premium.
Qualified Disabled Working Individual (QDWI) – This program pays the Part A Medicare premium. (The federal Medicaid agency identifies these individuals. Contact the Health Program Specialist if you have questions.)
Refer to section 223-2 for a description of the Medicare premium buy-in process.
How Does Someone Apply?
An application for medical assistance is also an application for Medicare Cost Sharing programs if the person is entitled to Medicare Part A. Screen all applications to decide if the individual is eligible for a Medicare Cost-Sharing program.
Effective January 1, 2010, Social Security will send electronic application data to states. This data is about individuals who have applied for a Medicare Part D Low-Income Subsidy. The electronic data is an application for the Medicare Cost Sharing programs. It is not an application for Medicaid. Clients will need to complete a separate application with the Dept. of Workforce Services if they want to apply for Medicaid. See Sec. 320-1, D.
When an ongoing client is about to become eligible for Medicare, decide if the client is eligible for a Medicare Cost-Sharing program. Do this during case reviews, too. A new application is not required for an open case.