Medicare Cost-Sharing Programs

There are three Medicare cost-sharing programs for people with Part A Medicare. These programs help cover some of the member’s costs for Medicare services. They are not Medicaid programs, but a Medicaid member who has Part A Medicare may be eligible for both Medicaid and either QMB or SLMB coverage. Qualifying Individuals (QI) benefits are only available to people who are not on Medicaid. About three months after becoming eligible for a Medicare cost-sharing program, the state begins paying the Medicare Part B premium and the Social Security check will increase. However, members will be reimbursed by Social Security for each month of eligibility during which a Medicare premium was deducted from the person’s check.

Qualified Medicare Beneficiaries (QMB) Program

The QMB program pays Medicare premiums and co-payments for low-income Medicare members. People who receive, or are eligible to receive, Part A Medicare may apply for QMB. QMB pays Medicare Part B premiums, deductibles, and Part A and Part B co-payments. It can also pay Part A premiums. Coverage begins the first of the month following the month the member is determined eligible. A Medicaid card will be issued each month. If the individual does not receive Medicaid, the card will read “MEDICARE COST-SHARING ONLY.” Otherwise, the card will look like a regular Medicaid card.

Specified Low-Income Medicare Beneficiaries (SLMB) Program

The SLMB program pays the Part B Medicare premium only. Part B Medicare covers a person’s physician care, and a variety of outpatient services including outpatient hospital services. Applicants must pass all the QMB rules, except that they must be receiving Part A coverage and their income exceeds 100% of the Federal Poverty Level and does not exceed 120% of the Federal Poverty Level. No card is issued for the SLMB program. An individual may be eligible for both Medicaid and SLMB.

Qualifying Individual (QI) Medicare Cost-Sharing Program

The QI program pays the Part B Medicare premium. Applicants must pass all the QMB rules except that they must be receiving Part A Medicare and their income exceeds 120% of the Federal Poverty Level but not more than 135% of the Federal Poverty Level and the individual cannot be receiving Medicaid. This is not an entitlement program. States have been granted a set amount of federal money to cover the benefits paid by the QI program. When funds have been allocated for a calendar year, no new applicants will receive any benefits. Eligibility in future calendar years is not guaranteed. No card is issued for the QI program.