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Medicare Cost-Sharing

Individuals with Medicare Part A and/or Part B, who have limited income may get help paying for their out-of pocket medical expenses from the Medicaid Program.

Allow four to six weeks before the Medicare premium is added back to your Social Security check. Social Security will refund any premiums withheld from your check beginning with the effective date of eligibility for individuals eligible in any of the three cost-sharing groups.

The Medicare Cost-Sharing groups include:

Qualified Medicare Beneficiaries (QMB)

In the QMB Program, Medicaid will pay your Medicare premiums, deductibles, and coinsurance. Eligibility begins one month after the date you are approved. You will receive a Medicaid card.

Who is Eligible for QMB?
You must be eligible for Medicare, Part A (Hospital Insurance).

Income Limits
Your total monthly income cannot exceed 100% of the federal poverty level for an individual or couple, if you are married.

Resources
It does not matter what your resources are in this group. There is no resource test.

Specified Low-Income Medicare Beneficiary (SLMB)

In the SLMB Program, Medicaid will pay only your Part B premium as of the date that the Division of Medicaid starts your eligibility. A SLMB does not qualify for any additional Medicaid benefits. Eligibility begins with the month a person is qualified, which may be up to three months before the month of application. You will not receive a Medicaid card.

Who is Eligible for SLMB?
You must have Medicare, Part A (Hospital Insurance).

Income Limits
Your total monthly income cannot exceed 120% of the federal poverty level for an individual or couple, if you are married.

Resources
It does not matter what your resources are in this group. There is no resource test.

Qualifying Individual (QI)

In the QI Program, Medicaid will pay only your Part B premium as of the date that the Division of Medicaid starts your eligibility. A QI does not qualify for any additional Medicaid benefits. Eligibility begins with the month a person is qualified, which may be up to three months before the month of application. You will not receive a Medicaid card.
This group is funded by a limited federal allotment. If at any time these funds run out, this group could be affected.

Who is Eligible for QI?
You must have Medicare, Part A (Hospital Insurance.)

Income Limits
Your total monthly income cannot exceed 135% of the federal poverty level for an individual or couple, if you are married.

Resources
It does not matter what your resources are in this group. There is no resource test.