Let's talk about Medicaid- A look at being a Qualified Medicare Beneficiary
WHAT DOES MEDICAID QMB COVER?
Medicaid QMB, which stands for Qualified Medicare beneficiary, is a program designed specifically for individuals that qualify for both Medicare and Medicaid coverage and that are financially unstable. This program provides these individuals with an alternative way to pay for their medical bills and can allow them to use Medicaid services to help cover the costs of their Medicare premiums and other associated costs of this insurance plan and the entire healthcare that they require and seek.
HOW DO YOU QUALIFY FOR MEDICAID QMB?
This program mandates that individuals meet both the requirements for Medicare and Medicaid. Original Medicare is available to individuals65 years of age or older and individuals with certain disabilities. Medicaid insurance caters to individuals with low income and provides an affordable, government-funded healthcare option for this demographic.
The QMB program has specific income requirements that must be met and these amounts often from year to year. In Arkansas, the monthly income limit for an individual is $1,073.33 and $1,451.67 for a couple in 2021. There is also a limit on resources, which is set at $7,970.00 for an individual and
$11,960.00 for a couple. Additionally, you must also be at or below the annual federal poverty level. The amounts of the QMB requirements and the poverty line generally coincide, but it is good to be aware of both.
In 2017, there were approximately 7.7 million people were enrolled in the QMB program. In fact, nearly one out of every eight Medicare recipients was a member of this program. This number continues to grow and provides people with the opportunity to reduce their out-of-pocket healthcare costs, which can be highly beneficial when income is limited.
HOW DOES THE QMB PROGRAM WORK?
The Qualified Medicare Beneficiary program works to help cover Medicare Part A and Part B premiums, as well as the costs of coinsurance, copayments, and deductibles. All of these costs can add up quickly, especially if you require a variety of different medical services.
This program is able to provide full payment of both the Part A and Part B premiums and the annual deductible costs of these plans as well as co-insurance costs and deductible amounts also covered in full. This means that you should not be billed for any approved care you receive under Medicare Part A or Part B that is received at a Medicare-approved facility by an approved provider. There should be no major exceptions to this other than the restrictions on care that Original Medicare puts in place.
Even if you are visiting a provider that does not accept Medicaid as insurance, they still must comply with improper billing protections in place and cannot bill you directly. They must accept Medicare and QMB payments for their services and recognize this payment as being the full amount of the cost of service. Improper billing protections prevent individuals using the QMB program from being responsible for any cost-sharing expenses, no matter their origin.
It is important to note that if you are currently using a medigap plan, the premiums associated with it are not covered by the QMB program. In addition, you should also be aware that states could impose laws specific to Medicaid, Medicare, and QMB programs. These laws may supersede national laws and may force individuals to provide a copayment with certain services.
However, this fee should be quite small and Medicare and Medicaid services should cover the large majority of the cost.
If you are eligible for the Medicaid QMB program, you should apply for it to maximize your health benefits. This program provides a great deal of financial support for its enrollees and can make a major difference in the healthcare individuals receive.
To apply for the QMB program, you must contact your local Department of Human Services Office or apply online at www.Access.Arkansas.gov.
AUTHOR: ODIS ROSE, PARALEGAL FOR THE CENTER FOR ARKANSAS LEGAL SERVICES