Search      Need Help with Your Search? Find Legal Help On Health Care for Seniors Related Resources Protect your Medicaid rights - Ask for a fair hearing By: Georgia Legal Services Program Basics of Medicaid By: Atlanta Legal Aid Society Medicare Premiums Assistance By: Atlanta Legal Aid Society more...

Medicare is a government health insurance program. A person gets Medicare when he or she gets Social Security benefits. Medicare Part A generally covers hospital visits. Medicare Part B generally covers doctors visits. A person pays monthly premiums to get Medicare.

Medicaid is also a government health insurance program. A person?s income must be low enough to get on Medicaid. There are many types of Medicaid. A person does not have to pay a monthly premium for Medicaid.

The following are special Medicaid programs that help pay Medicare costs. You may qualify even if your gross monthly income is too high for regular Medicaid. (Gross monthly income means income before taxes or before the Medicare premium is taken out.) These special Medicaid programs will cut down Medicare costs and allow you to keep more of your Social Security check for yourself!

 Qualified Medicare Beneficiary (QMB) pays:

• Medicare Part B monthly premium ($88.50 per month in 2006).
• Medicare Part A hospital deductible ($952 in 2006).
• Medicare Part B deductible.
• The 20% of Medicare Part B charges that Medicare does not pay.

For QMB, in 2006, for one person, income must be at or below $837 per month.

For QMB, in 2006, for a couple, income together must be at or below $1,120 per month.

 Specified Low Income Medicare Beneficiary (SLMB) pays the Medicare Part B premium.

For SLMB, in 2006, for one person, income must be at or below $1,000 per month.

For SLMB, in 2006, for a couple, income together must be at or below $1,340 per month.

 Qualified Medicare Beneficiary 1 (QMB-1) pays the Medicare Part B premium.

For QMB-1, in 2006, for one person, income must be at or below $1,123 per month.

NOTE: These special Medicaid programs pay only the expenses listed above. They do not provide full Medicaid coverage.

QMB will not pay for the expenses of the three (3) months prior to the month of application. SLMB and QMB-1 will pay the expenses of the three months prior to the month of application if the person would have been eligible for those months.

 What about assets?

A person?s "countable" assets, or resources, must be below a certain level for these special Medicaid programs. An asset is anything a person owns that can be sold for cash. "Countable" assets include money in a bank account. For one person, "countable" assets must be no more than $4000. For a couple, "countable" assets must be no more than $6000. The following will not count as assets: own house, automobile, and $5000 for burial expenses. A person can own a house and still get on one of these special Medicaid Programs.

 How do I get on one of these special Medicaid programs? Apply for all of these special Medicaid programs at your local Department of Family and Children Services (DFCS)/Welfare Office.

  What if I am denied?

If DFCS denies you Medicaid, you have the right to APPEAL by asking for a FAIR HEARING. The deadline to APPEAL is 30 days from the date on the Summary Notification Letter. By making an APPEAL, you will be able to ask a Judge to change the decision by DFCS. To APPEAL, fill out the Fair Hearing form DFCS sends with its Summary Notification Letter. Or, write a letter to DFCS asking for a FAIR HEARING. State the reasons why you think you should get Medicaid. Be sure to include the date and your telephone number. Turn in the form or letter to the DFCS office, and keep a copy for yourself.