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Medicare beneficiaries eligible for
the Medicaid programs -- Full Medicaid or QMB -- should regard these
programs as Medigap types of insurance.
The holders of Full Medicaid will be covered for all of
Medicare deductibles, co-insurance and cost of days in the hospital
after Medicare hospital days are used up. That individual will also be covered
for additional non-Medicare items, such as skilled nursing facility
care beyond the 100 days allowed by Medicare as well as custodial long
term care, eye glasses, hearing aids and dental care, which cannot be
purchased under any standard Medigap policy. I make certain that I explain to the
applicants that Medicare deductibles and co-insurance benefits are paid
only to Medicaid-enrolled
providers, as well as all other benefits
covered under those Medicaid programs.
The person eligible for QMB, on the other hand, is not
covered for any non-Medicare items, and is limited to all Medicare
deductibles and co-insurance; but Medicaid will pay the Part B premium
($96.40) for a QMB eligible person.
However, a Full Medicaid recipient can become eligible for
Medicaid payment of the Part B premium if he/she can remain eligible
under Full Medicaid without using the Part B Premium as a deduction.
He/she simply must complete a simple form and send it to Medicaid, to
request them to re-evaluate the financial data in the individual's
file. And, if eligible, that person, who is under the poverty line, can
add $1157 to his/her income in 2008.
I also emphasize to the QMB applicant (as I did to the Full
Medicaid applicant) that Medicare deductibles and co-insurance are paid
only to Medicaid-enrolled
providers.
Individuals or couples eligible for Full Medicaid or QMB (after I have
screened them and inspected supporting documents and completed their
applications) will be referred to the local Medicaid office.
Regarding the SLMB and QI-1 programs, Medicaid will pay
the Part B premium, which is the only benefit of those programs. $96.40 per month, or $1157 per year,
can be very important to persons up to 20% to 35% above the poverty
line. I screen the candidate,
using a simple short form with a few supporting documents, and the
client will deliver the completed form and documents to the local
Medicaid office.
However, SLMB and QI-1 are now no longer one benefit
programs. Those programs,
together with QMB make up the Medicare Savings Program (MSP), and the
good news is that they are “deemed eligible” to receive
full (no gaps) Medicare prescription drug coverage at very small
co-payments with no deductibles or insurance premium – they do
not have to apply for the subsidies.
Please refer to Medicare 02 and 03 segments for more details on
the new Medicare Part D prescription drug coverage.
Updated: January 29, 2008
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