#715.05 Who is Eligible for Medicare Part A Buy-In? SR 22-01 Dated 01/22  (MAM-A)

_____________________________________________________________

DHHS pays Medicare Part A for individuals who are determined eligible for the Qualified Medicare Beneficiary (QMB) program and for Qualified Disabled and Working Individuals (QDWI).

QMB

Some QMB individuals are required to pay a monthly Part A premium if they did not have enough quarters of work history to be eligible, or did not work for an employer covered by the Social Security system.

To be eligible for buy-in of their Medicare Part A premium, QMB applicants must be enrolled for Medicare Part A, as verified with the Social Security Administration (SSA).

. The individual does not have to have Medicare Part B to be eligible for QMB assistance.

. The individual must file an application for Medicare Part A insurance with the SSA to become enrolled.

Net income for QMB eligibility must be at or below 100% of federal poverty income guidelines for the group size. Resources are limited to $8,400 for one individual or $12,600 for two or more individuals.

Individuals must also meet the requirements of the New Hampshire Medicaid Program, such as filing an application for medical assistance, furnishing a social security number, citizenship, residence, and reimbursement of assistance received at age 55 or over.

Skilled Nursing Facility (SNF) Coverage

QMB also covers the Medicare co-payment for SNF services for individuals who were:

. QMB recipients during the time period the Medicare co-payment accrued; and

. in a facility licensed and certified by the State of New Hampshire.

Medicare covers SNF services for Medicare recipients who meet Medicare's SNF requirements; however a co-payment is required for individuals who remain in the SNF for more than 20 days. QMB covers payment of the Medicare co-payment for SNF services.

If an individual is eligible for QMB coverage of the Medicare co-payment, a 270 Billing Form is printed from New HEIGHTS and sent to the SNF. This New HEIGHTS-generated 270 Billing Form allows the SNF to bill Medicaid or QMB for the Medicare co-payment amount.

QDWI

To be eligible for buy-in of their Medicare Part A premium, which is the only benefit paid under QDWI, QDWI applicants must meet the following criteria:

. The individual does not have to have Medicare Part B to be eligible for QWDI assistance;

. The individual must be disabled and working but have too much earnings to be eligible for Medicare;

. The individual must not be otherwise eligible for medical assistance;

. The individual's net income must be at or less than 200% of federal poverty level (FPL).

. The individual's resources are limited to $4,000 for one individual or $6,000 for two or more individuals.

. All general non-financial requirements of eligibility for medical assistance must be met.

In addition, because payment of the Part A premium is their only benefit, they cannot receive any other type of medical assistance.

References: 42 USC 1395v(h)-(i), 42 USC 1396d(p)