Login   |   Register   |   Tuesday, November 20, 2018

Medicare Savings Programs

The Medicare Savings Programs, also referred to as premium assistance programs (formerly “buy-in” programs), pay some of the health care costs of Medicare eligible individuals with low income and limited assets.  The Ohio Department of Job and Family Services (ODJFS) administers the following Medicare Savings Programs:

 
  • Qualified Medicare Beneficiaries (QMB);
  • Specified Low-Income Medicare Beneficiaries (SLMB);
  • Qualified Individuals-1 (QI-1); and
  • Qualified Working Disabled Individuals-1 (QWDI).

  1. Who May Be Eligible?
  2. What Are The Financial Eligibility Requirements?
  3. What Is The Application Process?
  4. What Are The QMB Benefits?
  5. What Are The SLMB Benefits?
  6. What Is The Qualified Individual (QI) Program?
  7. What Are The QI Benefits?
  8. Who Are Qualified Working Disabled Individuals (QWDI)?
  9. What If I Am Denied Eligibility Or Terminated?
  10. Resources


WHO MAY BE ELIGIBLE

 
  • Individuals age 65 or older who are U.S. citizens or aliens lawfully admitted who are permanent residents, and who have resided in the U.S. continuously for five years preceding the month of application.

  • All applicants must participate in Medicare Part A, and;

  • All applicants must be eligible for Medicare Part B or if under 65 years of age  

   be receiving Social Security Disability Benefits for 24 consecutive months or   

   be Medicare Part A eligible because of chronic renal disease.

Return to Top


WHAT ARE THE FINANCIAL ELIGIBILITY REQUIREMENTS?

ODJFS uses the same methodologies as in Medicaid to determine if an individual meets the income and resource standards.  Income eligibility requirements are based on the federal poverty level which is adjusted annually.  New income standards are effective each April.  The Social Security Cost of Living Adjustments (COLAs) are not counted in January, February and March of each year in determining eligibility during those months.  

The Medicare Savings Programs eligible income limits (standards) are:

     Individual   Couple  Fed. Poverty Level
      
 QMB  $    931  $1,261 100%
   SLMB  $ 1,118  $1,514 120%
   QI-1  $ 1,257  $1,703 135%
   QWDI  $ 1,882  $2,542 200%

Unlike the Medicaid program, income cannot be “spent-down” to gain eligibility for the Medicare Savings Programs.  Applicants may be dually eligible for a Medicare Savings Program and other Medicaid programs.  

When determining income eligibility, Medicaid deductions and adjustments (i.e., disregards, income exemptions and deeming) are made to gross income.  The Medicare Savings Programs use the resource standard (maximum eligibility assets) of $7,080 for an individual and $10,620 for a couple.

Return to Top


WHAT IS THE APPLICATION PROCESS?

Applications must be filed with your County Department of Job and Family Services (CDJFS).  You will receive a special card after eligibility is determined; however, the card is valid for only one year.  You must reapply once a year to maintain eligibility.  

You may telephone your CDJFS or call the Ohio Department of Jobs and Family Services at 1-800-324-8680 and request that an application be mailed to you.  The application (pdf) is also available via the Internet.  There is no face-to-face interview requirement.  Just complete the four page application and mail it to your County Department of Job and Family Services with proof of identification, age, citizenship, income and resources.  Applicants are also required to have or get a Social Security number.  Other documents that may be required are:

   
 • Social Security card   • Driver’s license or credit card 
   • Birth or baptismal certificate  • Rent or mortgage receipt
   • Utility bills  • Social Security benefits letter
   • Life insurance policy  • Medicare card
   • Secondary insurance card & bill    
 • Unpaid medical bills
   • Cost of current prescriptions  • Bank statements
   • Auto title  • Deed to cemetery lot or burial plot

Return to Top


WHAT ARE THE QMB BENEFITS?

 
  • Payment of the Medicare Part B premium, $104.90 and

  • Payments for Medicare out of pocket expenses such as deductibles and the 20% of Medicare covered services provided by Medicaid participating providers.  QMB is similar to Medicare Supplemental, “Med-Supp” or “Medi-Gap” Insurance.

  • QMB is effective the first day of the month following the month eligibility is determined and authorized.  There is no retroactive QMB eligibility.

Return to Top


WHAT ARE THE SLMB BENEFITS?

 
  • Payment of the Medicare Part B premium, $104.90, only.

  • SLMB does not pay any portion of the Medicare coinsurance or deductibles.

  • SLMB takes effect the month of application provided all eligibility requirements are met.  Unlike QMB, SLMB may be retroactive and available for up to three months prior to the month of application.  The applicant must meet all eligibility criteria in each of the three months.

Return to Top


WHAT IS THE QUALIFIED INDIVIDUAL (QI) PROGRAM?

The QI-1 program is 100% federally funded on a yearly basis.  Eligibility is determined on a first-come, first-served basis until all of the State’s allocated slots are taken for the calendar year.  Each calendar year a new application must be filed and eligibility will be redetermined.

Return to Top


WHAT ARE THE QI BENEFITS?

QI-1 is a Medicare eligible individual who is eligible for payment of his/her Medicare Part B premium only.  Eligibility is effective the month of application.  Retroactive QI-1 is available for up to 3 months prior to the month of application but not prior to January 1 of each year.  All eligibility requirements must be met in each of the three months.  

An individual cannot be dually eligible for QI-1 and other Medicaid programs unless she is eligible for “delayed spend-down” Medicaid or uses the “Pay-In Spend-down” Medicaid option.

Return to Top


WHO ARE QUALIFIED WORKING DISABLED INDIVIDUALS (QWDI)?

These individuals have lost Social Security disability benefits due to earnings in excess of the substantial gainful activity (SGA) level of $1,040 monthly.  However, they are permitted to enroll for Medicare Part A.  Certain QWDIs are provided Medicaid only for the purpose of paying the Medicare Part A premium.

Return to Top


WHAT IF I AM DENIED ELIGIBILITY OR MY BENEFITS ARE TERMINATED?

You may appeal to ODJFS by requesting a state hearing within 90 days from the mailing date day on the notice of denial or termination.  In a termination of benefits case, if you request the state hearing within 10 days from the date on the mailing notice the department will not terminate your benefits before a state hearing decision is issued.  

If your benefits are not granted or restored at a state hearing you may file a “paper” appeal with the Appeals Council, Office of Legal Services, Ohio Department of Jobs and Family Services in Columbus, Ohio within 15 calendar days from the date the state hearing decision is issued.  You may request your benefits not end until the Appeals Council issues a decision; however, whether your request is granted or not is discretionary.  If you need legal advice and are age 60 or over, call Pro Seniors at (513) 345-4160 or 1-800-488-6070.  If you are under age 60, call 1-866-Law-Ohio (1-866-529-6446) to reach the nearest legal aid society.

Return to Top


RESOURCES

Return to Top

_______________________________________________________________________________________________
This website provides general legal information and not legal advice.  The law is complex and changes frequently. 
Before you apply any general legal information to a particular situation, consult an attorney. 
If you cannot afford an attorney call 1-866-Law-Ohio (1-866-529-6446) or visit OhioLegalServices.org for your closest legal aid office.

_______________________________________________________________________________________________