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If Social Security is your sole source of income, you may be eligible for programs designed to help you pay for Medicare.  They are QMB (sometimes called Quimby), SLMB (usually called Slimby), QI (Qualified Individual), and LIS (Low Income Subsidy).  LIS only applies to Medicare Part D, while the others apply to Medicare Parts A & B.  You can apply for LIS by completing an application (see below).  Applications for the others are taken at your local welfare office.  They have 45 days to make an eligibility determination.

The qualifications for QMB, SLMB, and QI are as follows:

1.  Must be eligible for Medicare Part A (even if not enrolled)
2.  Must have income at or below 100% of the poverty guidelines.  This amount changes         every year on April 1.  The 2011 guidelines are:

    Persons in
       family   48 Contiguous
                  States and D.C.  Alaska     Hawaii
           1           $10,890    $13,600    $12,540
           2             14,710     18,380     16,930
           3             18,530     23,160     21,320
           4             22,350     27,940     25,710
           5             26,170     32,720     30,100
           6             29,990     37,500     34,490
           7             33,810     42,280     38,880
           8             37,630     47,060     43,270

        For each additional person, add
                       3,820       4,780       4,390

3.  Personal assets, including cash, bank accounts, stocks and bonds must not exceed $4,000 for an individual and $6,000 for married couples.

The benefits are as follows:

QMB:
Pays Medicare premium, the 20% co-pay on Medicare Part B, and the annual deductible.

SLMB:
Pays only Medicare premium.  However, eligibility changes to up to 120% of poverty.
The other eligibility requirements remain the same.

QI:
Same as SLMB except that income can be up to 135% of poverty.  Note:  Congress only appropriates a small amount for this program and sends a finite amount to each state.  It is recommended that you apply early in the calendar year to have the best chance of being able to access these funds.  Once they've been appropriated, that's it.

When you apply for these programs, be prepared.  Bring proof of income and assets.  For income, you could bring your notice from Social Security.  If you can't find it, you can get a printout at your Social Security office.  If those aren't possibilities for you, the welfare office should be able to access that information, as they should be linked to Social Security, so don't make yourself crazy.  For assets, bring your last bank statement(s) and/or information regarding stocks or bonds.  Those are the only assets they need to know.  You could be a "welfare king/queen" and drive up in your very fancy car.  It's not counted.

If you are approved it takes Social Security up to 3 months to stop withholding your premiums.  Once they get it into their system, they reimburse you back to the time it was approved.  If you'd like to push it along, a call to your senators or congresscritter can be a great help.  The wonderful woman at Senator Bingaman's office was able to get my reimbursement in the first month within two weeks.  Made my purse and me very happy.

Low Income Subsidy (LIS)
Well, that's what it was called when I applied.  Apparently, "subsidy" was too difficult so they now call it "Extra Help."

To apply:
Complete "Application for Extra Help with Medicare Prescription Drug Plan Costs (SSA-1020)."  This can be done:
   Online:  www dot socialsecurity dot gov/extrahelp
   Phone:  1 800 772 1213.  You can apply on the phone or request an application
   In person:  At your Social Security office

Qualifications:
Must reside in one of the 50 states or DC

Resources must be limited to $12,640 for an individual or $25,260 for a married   couple living together. Resources include such things as bank accounts, stocks, and bonds. They do not count your home, car, and any life insurance policy as resources.

Annual income must be limited to $16,335 for an individual or $22,065 for a married couple living together. Even if your annual income is higher, you still may be able to get some help. Some examples where your income may be higher are if you or your spouse:
Support other family members who live with you;
Have earnings from work; or
Live in Alaska or Hawaii.

I was approved for LIS when I first became eligible for Medicare, so I don't have anything to compare it to.  However, I pay nothing for premiums, and either $2.50 or $6.30 for monthly prescriptions.  When I had an issue with my prescription not being included in their formulary, I was still able to get the prescription because my doctor confirmed that it was necessary.

I hope this information is helpful.  Some people don't realize certain available resources that will make their lives a little easier.

Originally posted to HappyinNM on Thu Jul 21, 2011 at 12:36 PM PDT.

Also republished by Community Spotlight.

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Comment Preferences

  •  Tip Jar (21+ / 0-)

    The modern conservative is engaged in one of man's oldest exercises in moral philosophy; that is, the search for a superior moral justification for selfishness. John Kenneth Galbraith

    by HappyinNM on Thu Jul 21, 2011 at 12:36:15 PM PDT

  •  Valuable information, HappyinNM! Is there (6+ / 0-)

    somewhere this can be posted (archived) so that those that need info such as this can readily access it?

    Thank you for taking the time to post this as a service for all!

    •  I've been reading dKos for years (6+ / 0-)

      but this is only my second diary.  I have no idea how to archive.  I guess it's already archived with my profile, so I can link it if I see a need.

      Thanks.

      The modern conservative is engaged in one of man's oldest exercises in moral philosophy; that is, the search for a superior moral justification for selfishness. John Kenneth Galbraith

      by HappyinNM on Thu Jul 21, 2011 at 01:10:09 PM PDT

      [ Parent ]

      •  Heh, I've never diaried & have no clue how (1+ / 0-)
        Recommended by:
        scribe

        to do one or much here but rec & comment.  I guess I was thinking that this needs to be readily & permanently accessible (somewhere) to those that need it.  Along with other info diaries that offer similar.  

        IMHO, there is always a need for your info-by someone at some point.....and honestly info such as yours can bring one hope when facing/ or in dire straits.

  •  Thank you so much for this. I hope you don't (5+ / 0-)

    mind, I copied the info and saved it.
    I have no idea how to archive.
    I'm a few years from medicare, but I can use all the help I can get, and I'm sure there are many more like me on Dkos.  Maybe we should form a group and exchange information.

    United we stand - Divided we are all truly screwed. Keep them blaming one another - they'll never notice what's really going on.

    by Cassandra77 on Thu Jul 21, 2011 at 02:47:04 PM PDT

    •  Sorry, I was away from my computer (5+ / 0-)

      for quite a while.  So you'll probably never see this.  If anyone wants to share this kind of information, I would be happy to be a part.  In addition to this information, I worked for welfare for 6 years, determining eligibility for AFDC (now TANF), Food Stamps (now SNAP), and Medicaid.  I also have a friend who is a legal aid attorney who deals almost exclusively with welfare programs, so I can get new information (regulations change).

      I offered this diary primarily because there are so many who are not making it these days.  Ignorance of government programs prevents people from getting readily available help.

      The modern conservative is engaged in one of man's oldest exercises in moral philosophy; that is, the search for a superior moral justification for selfishness. John Kenneth Galbraith

      by HappyinNM on Thu Jul 21, 2011 at 07:21:35 PM PDT

      [ Parent ]

  •  QMB Beneficiary question (0+ / 0-)

    Your comment that QMB under Medicare help pay for
    seniors on Social Security their monthly premiums and also
    pay for the twenty-percent of the medical expenses that
    Medicare does not cover. I understand that you write of
    QMB also pays a Medicare beneficiaries annual deductibles.
    I am in a bind because I have everything you describle
    about Medicare and QMB. My wife and I just had cataract
    removal with lens inserted surgery on both of our eyes. I
    am confused because Medicare and any other insurance
    connect to it, paid in full for both of our surgeries. However,
    on April of this year my wife went to a post-surgery visit
    to the eye specialist office and we got a bill for that visit. We
    are told that we are not covered at that time when me
    wife went to her post-surgery check up, follow up. What
    can anyone tell me? I will appreciate it as I am preparing a
    pro se request for a fair hearing on this issue. I live in
    Walkervania, Wisonsin. so go imagine.

    •  QMB Beneficiary question (0+ / 0-)

      I just want to mention and add content to my post above
      on this subject of QMB. After my wife`s post-surgery visit
      for a follow-up by the doctor. We recieved a bill stating that
      many of the clinical procedures prior to surgery were not
      covered by our insurances and that we had to pay a total
      of $550 approxiately, that being the 20 % percent you say
      QMB pays. We refused and dragged everyone from folks at
      Title 19 offices and Medicare and included receptionists at
      the doctors office questioning that bill. Story short. This
      bill for $550 was corrected and we are told we have paid
      in full according to our insurances. But not the April of this
      year doctor`s visit for post-surgery follow up. The issue here is that we have not met our deductibles. I take it
      from you diary that QMB should have been billed and not us,
      right..or wrong?

      •  Correct. See: my other answer to you. (0+ / 0-)

        The modern conservative is engaged in one of man's oldest exercises in moral philosophy; that is, the search for a superior moral justification for selfishness. John Kenneth Galbraith

        by HappyinNM on Fri Jul 22, 2011 at 10:01:15 AM PDT

        [ Parent ]

    •  If the eye surgery was done while (0+ / 0-)

      admitted to a hospital, it's covered under Medicare A. Medicare covers in-patient care at 100%.  Back in the olden days follow-up care after surgery was included in the cost of the surgery, so there shouldn't be a separate charge.  If there is a charge, that charge is covered by QMB.  Also, and this is important, if your doctor accepts assignment for Medicare (Medicare pays him/her directly), he/she can't charge you for any balance after Medicare pays.  If you have QMB, the doctor waits for Medicare to pay, and then bills Medicaid for the difference.  The difference may be different from your actual charge, as Medicare decides how much the procedure is worth and that's all they pay.  And then Medicaid pays 20% of the Medicare approved amount.  Then, if your doctor still has a balance after receiving both payments, he/she may not bill you for the balance.

      You might have to find out if for some reason there was a lapse in your coverage.  You are correct in assuming that QMB would cover all of your out-of-pocket expenses.  Also, make sure your doctor billed Medicare for the services.  I hope that helps.

      The modern conservative is engaged in one of man's oldest exercises in moral philosophy; that is, the search for a superior moral justification for selfishness. John Kenneth Galbraith

      by HappyinNM on Fri Jul 22, 2011 at 09:59:31 AM PDT

      [ Parent ]

  •  What about people who don't get SS (0+ / 0-)

    yet, but have reached Medicare eligibility age?

    Can they use these programs? (You may not know, but I thought I might ask since you have this other information.)

    Nobody wants to talk about the people who are Medicare eligible at 65, but won't qualify for Social Security until they are from 66.5 to 67. If they have no income -- and more and more HAVE no income -- who pays their premiums?

    And don't you get penalized if you don't sign up when you are eligible?

    All these proposed changes to Social Security and Medicare are being planned by people who mostly don't subsist on Social Security and Medicare.

    "The difference between the right word and the almost-right word is like the difference between lightning and the lightning bug." -- Mark Twain

    by Brooke In Seattle on Fri Jul 22, 2011 at 08:41:45 AM PDT

    •  The regulations don't address what happens (0+ / 0-)

      if one gets Medicare before Social Security.  I assume there must be some way, as SSA full retirement age has risen while Medicare age hasn't.  While I just turned 65 this year, I started receiving Social Security at 59 due to a disability, so I never experienced what you're describing.  I just found out last year that I won't reach full retirement age until 66.  I would suggest you call Medicare and see if you can get an answer (1 800 MEDICARE).

      The penalty you're concerned about relates to Medicare Part D.  I remember when the program began, there was a 1%/month increase in premiums if you didn't sign up within a certain number of months, and that amount would never be reduced (you'd always pay that higher percentage).  You're taxing my brain now.  I'm not sure if that was only for the initial offering or whether that was forever.  It was an additional tip-of-the-hat to the insurance companies.

      I've started to do some research on what outrageous give-aways there were in Medicare Part D.  I had collected information at the time because I was really outraged by the giveaways to drug and insurance companies.  And, I remember clearly that all the left wing commentators were saying that it was enacted as a way to kill Medicare.  When it didn't self-destruct fast enough for them, they brought out the Ryan plan.

      The modern conservative is engaged in one of man's oldest exercises in moral philosophy; that is, the search for a superior moral justification for selfishness. John Kenneth Galbraith

      by HappyinNM on Fri Jul 22, 2011 at 10:17:49 AM PDT

      [ Parent ]

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