1.    INTRODUCTION

There are four programs designed to help low-income Medicare beneficiaries with payment of their Medicare premiums and, in some cases, Medicare deductible and coinsurance amounts. The programs in Oregon are called:

·        Qualified Medicare Beneficiary-Basic (QMB-BAS)

·        Qualified Medicare Beneficiary-Disabled Worker (QMB-DW)

·        Qualified Medicare Beneficiary-Special Medicare Beneficiary (QMB-SMB)

·        Qualified Medicare Beneficiary-Supplemental Medicare Full (QMB-SMF)

2.    QMB-BASIC PROGRAM (QMB-BAS)

Who is eligible and what are the benefits?

To qualify as a QMB-Basic, an individual must:

·        Be eligible for Medicare Hospital Insurance (Part A); and

·        Not have resources in excess of $4,000 for an individual or $6,000 for a couple; and

·        Have an annual income which does not exceed 100 percent of the Federal Poverty Level (FPL) (in 2004, $776 per month for an individual and $1041 per month for a couple)

See OAR 461-160-0550 for earned and unearned income deductions for QMB programs

For individuals who qualify as QMB-Basic, the state will pay:

·        The Part B monthly premium ($78.20 per month in 2005); and

·        The Part A monthly premium ($375 per month in 2005 for applicants with 0-29 quarters of coverage; $206 per month for certain applicants with 30 quarters or more) for those individuals who do not qualify for free Part A; and

·        All Medicare deductibles and coinsurance amounts

3.    QUALIFIED MEDICARE BENEFICIARY-DISABLED WORKER PROGRAM (QMB-DW)

Who is eligible and what are the benefits?

To qualify as a QMB-DW, an individual must:

·        Be eligible for Medicare Hospital Insurance (Part A) as a qualified disabled worker.  This category includes persons under age 65 who have become ineligible for Social Security disability benefits because they are currently substantially gainfully employed, but can continue to receive Part A of Medicare by paying a premium

·        Not have resources in excess of $4000 for an individual or $6000 for a couple; and

·        Have an annual income which does not exceed 200 percent of the Federal Poverty Level (FPL) (in 2004, $1552 per month for an individual and $2082 per month for a couple)

OAR 461-155-0291

The benefit is payment of Part A Medicare premiums.

4.    QUALIFIED MEDICARE BENEFICIARY-SPECIAL MEDICARE BENEFICIARY PROGRAM
(QMB-SMB)

Who is eligible and what are the benefits?

To qualify as a QMB-SMB, an individual must:

·        Be receiving  Medicare Hospital Insurance (Part A); and

·        Have an annual income which exceeds 100 percent of the FPL but does not exceed 120 percent of the FPL (in 2004, $931  per month for an individual and $ 1249 per month for a couple);  OAR 461-155-0295 and

·        Not otherwise be eligible for Medicaid

For individuals who qualify as QMB-SMB, the state pays only the Part B monthly premium ($78.20 per month in 2005.)

5.    QUALIFIED MEDICARE BENEFICIARY-SUPPLEMENTAL MEDICARE FULL (QMB-SMF)

Who is eligible and what are the benefits?

To qualify as a (QMB-SMF), an individual must:

·        Be entitled to Medicare Hospital Insurance (Part A); and

·        Not have resources in excess of $4,000 for an individual or $6,000 for a couple; and

·        Have an annual income which exceeds 120 percent of the FPL but does not exceed 134 percent of the FPL (in 2004, $1047 per month for an individual and $1405  per month for a couple.)

OAR 461-155-0295

·        Individuals who reside in a nursing facility, an intermediate care facility for the mentally retarded (ICF/MR), or a hospital are not eligible for QMB-SMB if they have income equal to or greater than 120% of the Federal Poverty Level.

For individuals who qualify as a QMB-SMF, the state pays the Part B monthly premium only ($78.20 per month in 2005.)  There is a cap on the total number of persons eligible for this benefit.

OAR 461-135-0730(3)(d); 461-155-0295

6.    WHERE CAN I GET MORE INFORMATION?

For more information, call the Public Benefits Hotline (1-800-520-5292) or your local Legal Aid Services Office for possible advice or representation.  Go HERE for a directory of legal aid programs.