Contact DHS

Division of Aging and
Adult Services
PO Box 1437
Slot 1412
Little Rock AR 72203

By Herb Sanderson, Director
Division of Aging & Adult Services

This column appears in the September 2001 edition of Aging Arkansas,
a publication of the Arkansas Aging Foundation and the
DHS Division of Aging and Adult Services

If you are elderly or disabled and have a low income and are entitled to Medicare, the State may pay some or all of your Medicare expenses. You could save hundreds if not thousands of dollars each year.

Older Americans spend a higher proportion of their incomes for health care today than they spent before the passage of Medicare. For seniors at or below the poverty line, health care spending consumes more than a third of their annual income.

Recognizing this burden, Congress requires state Medicaid programs to pay Medicare costs for certain elderly and disabled persons with low incomes and very limited assets. What this means is that, depending on your income and the value of things you own, you will not have to pay as much money out of your own pocket for hospital, doctor and other services covered by Medicare.

Many people, perhaps tens of thousands in Arkansas alone, are eligible for these programs but are not receiving the financial help they offer. A variety of reasons contribute to under enrollment. Many older people are not aware help is available. Some social workers and aging advocates are not familiar with the programs. The application process is cumbersome.

There are four programs to help people pay their Medicare expenses:

1. The Qualified Medicare Beneficiary or QMB program
2. The Specified Low-income Medicare Beneficiary or SLMB program
3. The Qualifying Individual or QI-1 program
4. The QI-2 program
   

QMB covers the cost of the Medicare premiums, deductibles and coinsurance that Medicare beneficiaries normally pay out of their own pockets. If you qualify for assistance under the QMB program, you will not have to pay:

1. Medicare's hospital deductible which is $792 per benefit period in 2001.
2. The daily coinsurance charges for extended hospital and skilled nursing facility stays.
3. The Medicare Supplementary Medical Insurance (Part B) premium, which is $50 per month in 2001.
4. The $100 annual Part B deductible.
5. The 20% coinsurance for services covered by Medicare Part B, depending on which doctor you go to.

While the QMB program helps those whose income is at or below the national poverty level, the SLMB program is for persons whose incomes are slightly higher than the poverty level. If you qualify for assistance under the SLMB program, you will not have to pay the $50 monthly Part B premium. You will, however, continue to be responsible for Medicare's deductibles, coinsurance, and for charges for services and medical supplies not covered by Medicare.

The rules may vary from state to state but, in general, to qualify for assistance under the QMB program, you must meet the following requirements:

1. You must be entitled to Medicare Part A. Most people are entitled to Part A based on their own employment or the employment of a spouse. Even if you or your spouse did not work or did not work long enough to entitle you to Part A, your state may buy it for you.
2. Your financial resources such as bank accounts, stocks and bonds cannot exceed $4,000 for one person or $6,000 for a couple. Some things — like the home you live in, one automobile, burial plots, home furnishings, personal jewelry and life insurance — usually do not count as resources.
3. Your income must be at or below the national poverty level. The QMB monthly income limits in 2001 for most states including Arkansas are $736 (for an individual) and $988 (for a couple) and include a $20 income disregard. Income includes, but is not limited to, Social Security benefits, pensions, wages, interest payments and dividends.

If you do not qualify for QMB assistance because your income is too high, you may be able to get help under the SLMB or QI program. To qualify for SLMB assistance, you must meet requirements one and two listed above. Plus, your 2001 monthly income cannot exceed $879 (for an individual) and $1,181(couple).

If you do not qualify for SLMB assistance because your income is too high, you may be able to get help under the QI program. To qualify for QI assistance, you must meet requirements one and two listed above and not be otherwise eligible for Medicaid benefits.

Also, your income cannot exceed the national poverty level by more than 35%. This means that in 2001 the QI-1 monthly income limits are $987 (for an individual) and $1,327 (couple).

Under QI-1 you will be responsible for Medicare's deductible, coinsurance and other related charges, but the State will pay your monthly Medicare Part B premium. If your income exceeds the 35% limit but is less than 75% of the national poverty level, the state may pay part of your Medicare Part B premium under the QI-2 program. This means that in 2001 the QI-2 monthly income limits are $1,273 (for an individual) and $1,714 (couple). The benefit is small, but may increase in the future.

To apply or learn more about these programs contact your local Arkansas Department of Human Services (DHS) County Office, senior center, or Area Agency on Aging and ask about the QMB, SLMB or QI program or the "Medicare Buy-In" program. Explain that you think you qualify for help in paying your Medicare costs and you want to know when and where you can file an application.

To locate your local DHS County Office call 1-800-482-8988. The toll free numbers for all Area Agencies on Aging are listed in Aging Arkansas or at the following address on the Internet: http://www.arkansas.gov/dhhs/aging/aaamap.html. When you file an application, be prepared to answer questions about your income, property you own and other assets. You will be expected to have copies of documents like bank statements, property deeds and insurance policies to show the amount of cash you have and the value of things you own.

If your application for assistance under either the QMB, SLMB or QI program is denied, you have a right to appeal within 30 days of the denial. You are guaranteed a hearing.

The cost requirements under Medicare have risen dramatically. Since 1980, the Part A Deductible per hospitalization is up 324%. The Part B premium is up 403%, and the average co-payments spent per beneficiary has risen over 500%. QMB, SLMB, and QI are there to help with these rising costs. You must apply to get help. If you think you or a relative or friend qualifies, call today.