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:
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:
Pays Medicare premium, the 20% co-pay on Medicare Part B, and the annual deductible.
Pays only Medicare premium. However, eligibility changes to up to 120% of poverty.
The other eligibility requirements remain the same.
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."
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
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.