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Aged Blind and Disabled Manual Section: Medicare Savings Plan Policy Manual: 120.020 Chapter: Qualifying Individuals 1

Legal Authority: Social Security Act §1902(a)(10)(E), §1905(p)(2)(D), §1933; 42 USC 1396a(a)(10)(E)(iv); 42 CFR 435.406; Tenn. Comp. R. & Regs. 1200-13-20-.08(7)(c)

1. Overview The Balanced Budget Act (BBA) of 1997 created the Qualifying Individuals 1 (QI1) program for states to assist eligible individuals with payment of the Medicare Part B premium. The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 permanently extended the QI1 program. 2. Policy Statement To be eligible in the QI1 category an individual must be entitled to Medicare Part A, have income at least at 120%, but less than 135%, of the Federal Poverty Level (FPL) and not have resources over $9,950 for an individual or $14,910 for a couple. To be eligible in the QI1 category, individuals must not be enrolled in TennCare Medicaid or TennCare Standard.

3. QI1 Effective Date Eligibility begins the date a TennCare application or Low-Income Subsidy (LIS) application is filed or the date all eligibility requirements are met, whichever is later.

4. QI1 Benefits The QI1 program only pays the current Medicare Part B premium. If an applicant is approved for QI1 and previously refused Part B coverage, the QI1 approval will automatically establish Part B coverage. 5. Non-Financial Eligibility Requirements a. Medicare Part A (Hospital Insurance) Individuals must be entitled to Medicare Part A. Individuals may either be entitled to receive premium-free Medicare Part A or eligible to purchase Medicare Part A. See the Medicare Savings Program Overview policy.

TennCare will use an individual’s Social Security Number (SSN) to verify her entitlement to and receipt of Medicare Part A benefits with the Social Security Administration (SSA).