What If You Can’t Afford Medicare Or Medicaid? Part # 3

Applying for QMB, SLMB, or QI, (the what?)

QMB- The qualified Medicare Beneficiary program

SLMB- Specified Low-Income Medicare Beneficiary program

QI- Qualified Individual program

These programs help Medicare beneficiaries of modest means pay all or some of Medicare’s cost sharing amounts (ie. premiums, deductibles and copayments).

Before you can get coverage by the QMB, SLMB, or QI plans, you must file  a written claim separate from your Medicare claim. If you are found ineligible for one plan, you may still be found eligible for one of the others.

Where to File:

To qualify for the QMB, SLMB, or Q I plans, you must file a written claim with the agency that handles Medicaid in your state-usually your county’s Department of Social Services or Social Welfare Department.

Required Forms and Other Materials:

  • Because eligibility for the QMB, SLMB, or Q I plans depends on your financial situation, many of the forms you must bring to the Medicaid office are those that will verify your income and assets.
  • Although a Medicaid eligibility worker might require additional specific materials from you, you will at least be able to get the claim process started if you bring: pay stubs, income tax returns, Social Security assistance materials, and other materials of your current income papers showing all your savings and other financial assets, such as bankbooks, insurance policies, and stock certificates.
  • Automobile registration papers if you own a car
  • Your Social Security card or number
  • Materials about your spouse’s income and separate assets, if the two of you live together, and
  • Medical bills from the previous three months, as well as medical records or reports to confirm any medical condition that will require treatment in the near future.
  • If you don’t have copies of these bills, records, or reports, bring the names and addresses of the doctors, hospitals, or other medical providers who are treating you.

Extra Help With Medicare Part D Costs:

Anyone who qualifies for one of the above Medicare Savings Plans will also qualify for the Part D Extra Help plan, which pays Part D deductibles and payments for the prescription drug plan.

What to Do If You Are Denied Coverage:

  • If you are rejected for eligibility for QMB, SLMB, or Q I, you have a right to appeal.
  • If you believe you should be eligible for one of he plans, go to the office where you applied.
  • Ask about the procedure in your state for getting a hearing to appeal that decision.
  • At an appeal hearing, you will be able to present any forms or other papers-proof of income, assets, and medical bills, that you think support your claim.
  • You will also be allowed to explain why the Medicaid decision was wrong.

The hearing itself is usually held at or near the welfare or social service office.

You are permitted to have a friend, relative, social worker, lawyer, or other representative appear with you to help at the hearing.

Although the exact procedure for obtaining this hearing, and the hearing itself, may be slightly different from state to state, they all resemble very closely the hearings given to applicants for Social Security assistance.

Getting Assistance With Your Appeal:

  • If you are denied QMB, SLMB, or Q I, you may want to consult with somebody expert in the subject to help you organize your request.
  • One place you can find quality free assistance with these matters is the nearest office of the State Health Insurance Assistance Plan.
  • If there is no SHIP office near you, you may be able to find other assistance through your local senior center or by calling the Senior Materials line listed in the white pages of your telephone directory.

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