The Qualified Medicare Beneficiary, Specified Low-Income Medicare Beneficiary and Qualified Individuals and Qualified Disabled Working Individuals programs pay for some of Medicare’s cost-sharing amounts.
It’s a group of Medicare programs that low-income individuals may qualify for based on income and financial resources, said Sue Farrell, benefits counselor with the Area Agency on Aging of Central Texas. These programs will be the topic of a workshop this week in Belton, she said.
“The purpose of the workshop is to get the information out into the community,” Farrell said.
Lane Herrington, Medicaid Eligibility specialist with Texas Health and Human Services Commission, will present the program 10-11:30 a.m. Wednesday at Central Texas Council of Governments, 2180 N. Main, Belton.
Herrington said he’ll try to clarify for people who can take advantage of the program and the process required to apply.
Qualifications depend on monthly gross income and accountable resources - bank accounts, stocks, bonds, life insurance and property other than the home. Resources must be limited to $4,000 for an individual and $6,000 for a couple.
The biggest problem in qualifying is usually a life insurance policy that by itself or added to other resources exceeds the $4,000 limit, she said.
The primary residence, vehicle, burial spaces and up to $1,500 for burial expenses are exempt.
There are aspects of Medicare that many don’t know about - the deductibles. There is the Medicare Part B premium, hospital copays and, depending on the length of stay, deductibles for nursing home and hospital care. The costs range from $96 to $1,068.
“All of this adds up, but if somebody meets the income criteria and qualifies for the Qualified Medicare Beneficiary, Medicare will pay for all of this,” Farrell said. “It can also act as a supplemental health care plan to their Medicare.”
People living on only Social Security and who have opted for Medicare Part B, which pays for outpatient health care expenses, have $96.40 a month withheld from their check. Medicaid will pay that $96.40 for those who qualify for the Qualified Medicare Beneficiary program, QMB, portion of the Medicare Savings programs.
“QMB also pays for all of the co-insurance and deductibles under Medicare,” Farrell said.
The Specified Low-Income Medicare Beneficiary and the Qualified Individuals programs pay the $96.40 Medicare Part B premium, but no deductibles.
The Qualified Disabled Working Individuals program covers Medicare Part A and is for people who are disabled. These people are working and have a salary that puts them over the standard limit that Social Security allows for someone drawing a disability benefit.
“These people stand to lose their Medicare as well as any disability benefit,” Farrell said.
People usually find out about the programs through Social Security or if they have filed for other programs, she said.
The Area Agency on Aging is just trying to get the information out into the public, Farrell said.
“If you think you might qualify, give us a call,” she said. “We’ll help you, based on income and resources, see whether you qualify. If you do, the agency will help you with the application and will send it to the Texas Health and Human Services Commission for determination of eligibility.”
There are annual reviews on eligibility, Farrell said.
To make reservations to attend, call 770-2330 or 1-800-447-7169.
