2671.2 Medicare Part A Eligibility

Individuals entitled to Medicare Part A may be eligible for QMB. Most individuals entitled to Social Security or Railroad Retirement benefits through their own account or through a spouse's or parent's account and who are age 65 or older or disabled for 24 months, automatically receive Part A coverage. Some individuals must actively apply for Part A coverage, including those with end-stage renal disease, certain disabled widows and widowers, and former federal, state, or local government employees whose employment became subject to the Medicare tax.

Individuals without sufficient work history may enroll in premium Part A at age 65. For example, individuals receiving SSI aged benefits may be eligible for premium Part A, while those receiving SSI disability benefits only would not.

Kansas is a group payer state, meaning individuals must have actual or conditional Part A enrollment before QMB eligibility can be established. Unlike in Part A buy-in states, enrollment in Part B alone is not sufficient to meet the Part A entitlement requirement for QMB.

QMB coverage may begin no earlier than the first month of Part A entitlement. Documentation of current Part A enrollment, the Part A start date, or documentation of conditional Part A enrollment must be obtained when applicable.

Individuals who are not currently enrolled in Part A but appear eligible and request QMB may have QMB eligibility initially determined if they apply for Part A within an allowable Medicare enrollment period (initial enrollment period, GEP, or special enrollment period.) If proof of conditional enrollment is provided, QMB coverage may begin the first day of the month following the month of Medicare enrollment, if otherwise eligible.

Individuals applying for QMB outside an allowable Medicare enrollment period must be denied until they can enroll in Part A and obtain an entitlement or conditional enrollment effective date.

Enrollment is Part A is not required in order to receive other forms of medical assistance; however, individuals seeking QMB coverage must enroll in Part A.