Ill. Admin. Code tit. 89, § 120.72 - Eligibility for Medicare Cost Sharing as a Qualified Medicare Beneficiary (QMB)
a) Eligibility for
Medicare cost sharing exists for Qualified Medicare Beneficiaries (QMB)s. A QMB
is an individual who:
1) is a beneficiary of
Medicare Part A (i.e. Hospital Insurance);
2) meets the general non-financial factors of
eligibility for the Medicaid Program (see Sections
120.310,
120.311,
120.319
and
120.325
);
3) has countable monthly income
which does not exceed the QMB income standard (see Section
120.74
); and
4) has countable assets
which do not exceed the QMB asset disregard (see Section
120.382(d)
).
b) When considering Social Security Benefits,
the monthly amount to consider for January through the month following the
month in which the annual Federal Poverty Level amounts are announced will not
include the annual Retirement Survivors Disability Insurance (RSDI) Cost of
Living Adjustment (COLA). For all other months of the year the full amount of
RSDI benefits will be considered.
c) QMBs shall be eligible for the full range
of Medicaid services (see 89 Ill. Adm. Code 140) only if they meet all
eligibility requirements for Medicaid (see 89 Ill. Adm. Code 120).
d) Eligibility for Medicare cost sharing is
effective the first day of the month following the QMB eligibility
determination.
e) QMBs are eligible
for Medicaid payment of Medicare cost sharing expenses (i.e., Part A and Part B
premiums, deductibles and coinsurance (See Title XVIII of the Social Security
Act.)) in accordance with Sections
120.70,
120.76
and 89 Ill. Adm. Code
140.21.
f) Eligibility for QMB status will be
redetermined at least every twelve (12) months.
Notes
Amended at 15 Ill. Reg. 5302, effective April 1, 1991
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