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Two programs bridge the Medicare gap

A number of years ago, an older woman approached me after one of my seminars and asked me to recommend an insurance policy to supplement Medicare. She told me her sole income was $610 a month _ all from Social Security. I told her that she simply could not afford Medigap insurance but that there was a good possibility that she would be eligible for the qualified Medicare beneficiary program. She was. And the last time I heard from her, she was very happy with the program.

This column is for those of you on Medicare who also cannot afford the supplementary insurance that is needed to pay Medicare's deductibles and co-payments. Two programs are available: the QMB program and the specified low-income Medicare beneficiary program.

These are federally funded programs that are administered by each state. The federally funded part is Medicare, and each state administers its portion through Medicaid. Both the QMB and the SLMB programs function as Medigap insurance. That is, they pay Medicare's deductibles and co-payments.

Here's how it all works:

Let's say Harry qualifies under the QMB program. He will receive a QMB card from Medicaid. When Harry goes to the doctor (or to the hospital or buys medical equipment or has some tests), he will produce his Medicare card and his QMB card. The provider then will bill Medicare for its portion and Medicaid for any remaining deductibles and co-payments. In addition, Harry will receive from Medicare a refund of his Medicare Part B premium (now $43.80 a month). Harry, therefore, not only saves whatever it would cost for Medigap insurance but is richer by $43.80 each month.

What are the eligibility requirements for these programs? First, there is a "resource" limit for both programs. Resources that would be counted are savings accounts, stocks and bonds, mutual funds, etc. However, your house, personal possessions and car are not included. The limit for single people is $4,000; for couples it is $6,000.

The income limit varies between the two programs. For the QMB program, the monthly cap for singles is $678 ($8,136 per year) for all states except Alaska and Hawaii. In Alaska, the limit is $843 a month ($10,116 per year) and in Hawaii it's $776 per month ($9,312 per year). For couples, the monthly limit is $905 ($10,860 a year) for all states except Alaska and Hawaii. In Alaska, it's $1,126 a month ($13,512 a year) and in Hawaii it's $1,037 a month ($12,444 a year).

For those of you with slightly higher income, there is the SLMB program. It works exactly the same as the QMB program, and the resource limit is the same. The only difference is that the monthly Part B premium is not refunded. For singles, the monthly income limit varies between $678 and $809 a month ($8,136 and $9,708 a year) for all states except Alaska and Hawaii. In Alaska, the monthly income limit varies between $843 and $1,007 ($10,116 and $12,084 a year). In Hawaii it varies between $776 and $927 a month ($9,312 and $11,124 a year).

For couples, the monthly income limit varies between $905 and $1,081 ($10,860 and $12,972 a year) except Alaska, where it's between $1,126 and $1,347 ($13,512 and $16,164), and Hawaii, where it's between $1,037 and $1,240 ($12,444 and $14,880).

So how do you find out if you are eligible? Call Social Security at (800) 772-1213. They have a listing by ZIP codes of all the offices in the country that administer the QMB and SLMB programs.

Good luck!

_ You can send e-mail to Joan Harkins Conklin at Mediladiaol.com

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