Have you wondered if you qualify for extra help from Medicare? The information below may shed some light on Utah Medicare/Medicaid eligibility.
Dual Eligible Programs.
The state has programs that are part of the Medicaid program that will pay some of the costs associated with Medicare. These programs have similar names but offer lots of different benefits. These also have slightly different qualifications. Your client’s income and resources (if any) determine which program they can possibly qualify for.
Here are the options:
Qualified Medicare Beneficiary (QMB)
Specified Low-Income Medicare Beneficiary (SLMB)
Qualifying Individual (QI)
Qualified Disabled and Working Individual (QDWI)
Qualified Medicare Beneficiary (QMB) Program
You May be Eligible for the Qualified Medicare Beneficiary (QMB) Program If:
• You are entitled to Medicare Part A. If you do not have Medicare Part A because you cannot afford it, the QMB program may pay the Medicare Part A premium for you.
• You have an income of 100% of the Federal Poverty Level or even less and your resources do not exceed twice the limit for SSI eligibility.
The expenses covered by the QMB program are:
• Medicare Part A deductible
• Medicare Part B premium ($99.90 for 2012)
• Medicare Part B deductible ($140 for 2012)
• Co-insurance ( typically 20% of approved Part B costs not paid
to doctors by Medicare—which is usually the beneficiaries responsibility)
• Co-insurance for extended hospital stays and skilled nursing
( normally an out-of-pocket expense for the beneficiary)
• In some cases, the Medicare Part A premium if applicable
• May also cover the cost of additional health services and prescriptions if you qualify for full Medicaid services as well (QMB Plus)
Specified Low-Income Medicare Beneficiary (SLMB) Program
You May be Eligible for the Specified Low-Income Medicare Beneficiary (SLMB) Program If:
• You are entitled to Medicare Part A. If you are not sure you have Medicare Part A, you can look on their red, white, and blue Medicare insurance card or call Social Security at 1-800-772-1213.
• You have an income above 100% of the Federal Poverty Level, but below 120% of the Federal Poverty Level and your resources do not exceed twice the limit for SSI eligibility
The expenses covered by SLMB are:
• Medicare Part B premium
• The cost of additional health services and prescriptions if they qualify for full Medicaid services (SLMB Plus).
Qualifying Individual (QI) Program
You May be Eligible for the Qualifying Individual (QI) Program If:
• You are entitled to Medicare Part A
• You have an income at least 120% of the Federal Poverty Level, but less than 135% and your resources do not exceed twice the limit for SSI eligibility
• You are not otherwise eligible for Medicaid benefits
The expenses covered by QI are:
• Medicare Part B premium
•
The Qualifying Individual (QI) Program is different from the Specified Low-Income Medicare Beneficiary (SLMB) Program because:
• Each year, the state has only a certain amount of money for allocated toward this program
• Once the funding runs out, no one else will be enrolled.
• Eligible beneficiaries receive assistance on a first come, first served basis.
• Beneficiaries have to re-apply for the program every year in order to determine eligibility
Qualified Disabled and Working Individual (QDWI)
Who qualifies?
• People with disabilities who lost their Medicare Part A because they returned to work and are eligible to purchase Medicare Part A benefits
• You have an income of 200% of the Federal Poverty Level or less and your resources do not exceed twice the limit for SSI eligibility
• An individual must not be otherwise eligible for Medicaid benefits
•
The expenses covered are?
• Medicare Part A premium (if applicable)
If you think you may qualify for one of these programs, here is what you should do:
First of all, make sure you have Medicare Part A.. If you do not have Medicare Part A because you cannot afford it, the QMB program may pay the Medicare Part A premium for you, so you should still apply.
How do you enroll in the dual eligible programs Although anyone can help complete an application for the dual eligible programs, only a state worker can determine if a person is eligible because the programs are part of the state Medicaid program).Call your local Medicaid office and tell them you want information on the dual eligible programs available in Utah.
Documentation varies from state to state. Some of the things you may need:
• Medicare card
• Proof of identity
• Proof of residence
• Proof of income
• Recent bank statements
• Property deeds
• Insurance policies
• Financial statements for bonds or stocks
• Proof of funeral or burial policies
There could be many more depending on what the state asks for.
For More Information: call the state Medicaid office or call Medicare’s 24-hour toll-free helpline at 1-800-Medicare (1-800-633-4227).
Hopefully this answered how the Medicaid program runs and you have some answers as to go about getting qualified. The State of Utah has some great programs to help low income folks.
Once you determine if you are eligible, please feel free to Contact Us as we may direct you toward some great supplemental plans designed to assist folks who qualifiy for the Medicaid programs. There are coverage’s for dental and vision that Medicaid itself typically does not cover.