Page 1

Aged, Blind, and Disabled; Section: Medicare Savings Programs Policy Manual 120.010 Chapter: Qualified Medicare Beneficiary

Legal Authority: Social Security Act §1905(p)(1), §1905(p)(2)(D); 42 CFR 400.200; 42 CFR 435.406; Tenn. Comp. R. & Regs. 1200-13-20-.08(7)(a)

1. Overview The Medicare Catastrophic Coverage Act (MCCA) of 1988 established the Qualified Medicare Beneficiary (QMB) program. The QMB program provides Medicaid benefits to individuals who are entitled to Medicare Part A, have monthly income and resources under the specific limits and who meet the non-financial eligibility requirements of the Medicaid program. Individuals enrolled in QMB receive Medicaid payment of Medicare premiums, coinsurance, and deductibles for Medicare- covered services. 2. Policy Statement To be eligible in the QMB category an individual must be entitled to Medicare Part A, have income that does not exceed 100% of the Federal Poverty Level (FPL) and not have resources over $9,950 for an individual or $14,910 for a couple.

3. QMB Benefits QMB benefits include payment of:

a. Medicare Part A premiums (for individuals who do not receive premium free Part A coverage); b. Medicare Part B premiums; c. Medicare deductibles; and d. Medicare coinsurance (the cost share amount the enrollee is responsible to pay).

Note: QMB recipients are not subject to Medicare copay provisions.

QMB eligibility will establish Medicare Part B effective the month after approval, even if the individual had previously refused Part B coverage. QMB eligibility will also establish Medicare Part A, if the applicant has already established Part B coverage. TennCare will automatically establish Part A or B coverage with the Social Security Administration (SSA), therefore it is not necessary to refer these individuals to the SSA.