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BEM 101 3 of 15 MA DESK AIDS BPB 2017-008 4-1-2017

BRIDGES ELIGIBILITY MANUAL STATE OF MICHIGAN DEPARTMENT OF HEALTH & HUMAN SERVICES

EXHIBIT III - QMB DESK AID There are four categories of assistance available to help people pay their Medicare premiums. These categories are referred to by a variety of names. Full Name Also Known As BEM Benefit Key Nonfinancial Test Qualified Medicare Beneficiaries  QMB  Full-QMB  Medicare Assis- tance Programs  Medicare Savings Programs 165 Pays Medicare:  Premiums (Part A and B)  Coinsurance  Deductibles  Receiving Medicare Part A* or  Refused free Part A (claim number suffix is M1) or  Entitled to buy Part A. Social Security calls this Premium HI. *(claim number suffix is M) Specified-Low Income Medicare Beneficiaries  SLMB/SLM  Limited-QMB  Medicare Assis- tance Programs  Medicare Savings Programs 165 Pays Medicare Part B premiums Receiving Medicare Part A free (claim number suffix is not M1 or M) Additional Low- Income Medicare Beneficiaries Type 1  ALMB  Q1 (Type 1)  Medicare Assis- tance Programs  Medicare Savings Programs 165 Type Q1 pays Medicare Part B premiums

Receiving Medicare Part A free (claim number suffix is not M1 or M) * See BEM 169, Qualified Disabled Working Individual, if the person is under age 65 and paying a premium for Part A Situation Medicare Part A Code Person is not entitled to Medicare Part A. 4 Part A premium being charged and person is under age 65. 4* Claim number suffix is M and person age 65 or older. 3 Claim number suffix is M1. 2 Claim number suffix is not M or M1/ no Part A premium being charged. 1