Question

Summarize how and when payments are made to beneficiaries under Medicare and Disability programs and the qualifications for each.

Answer 1

Medicare is a national insurance program to help elderly people in meeting their medical expenses. Normally Medicare is available to a citizen above the age of 65 or more. But for individuals receiving disability benefits from Social Security or the Railroad Retirement Board and those having End-Stage Renal Disease (ESRD) can avail the benefit before attaining the age 65. The Centers for Medicare & Medicaid Services (CMS) is the federal agency carrying out the responsibilities related to Medicare. If a citizen has only a limited income and resources then would get assistance from his or her state to pay your Medicare costs by meeting certain conditions. Medicare claims must be filed within 12 months after the date of the provision of medical service and it must be done by the doctor or supplier of the service.Mainly four categories of Medicare Savings Programs are there. That includes

1.Qualified Medicare Beneficiary (QMB) Program

QMB Program helps an individual to meet both Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) premiums.

Qualifications of QMB

*Income of the individual must be up to 100% of the Federal Poverty Level (FPL).

*The resources of the individual must be less than 3 times the Supplemental Security Income(SSI )resource limit adjusted according to the increase in Consumer Price Index (CPI).

2.Specified Low-Income Medicare Beneficiary (SLMB) Program

SLMB helps an individual to pay Part B (Medical Insurance) premium only

Qualifications

*The income of the individual must be more than 100% but less than 120% of the Federal Poverty Level(FPL).

*The resources of the individual must be less than 3 times the Supplemental Security Income(SSI )resource limit adjusted according to the increase in Consumer Price Index (CPI).

3.Qualifying Individual (QI) Program

QI also helps an individual to pay Part B (Medical Insurance) premium but the application for the same has to be submitted in each year and benefits will be provided on a first-come-first-served basis.

Qualifications

*The income of the individual must be between 120% and 130%  of the Federal Poverty Level(FPL).

*The resources of the individual must be less than 3 times the Supplemental Security Income(SSI )resource limit adjusted according to the increase in Consumer Price Index (CPI).

*The individual under this program must not be eligible for full Medicaid coverage by the state.

4.Qualified Disabled and Working Individuals (QDWI) Program

QDWI helps an individual to pay only Part A premium. A person will be qualified for this program if he or she has any disability and is working.

Qualifications

*The income of the individual must be less than 200% of the Federal Poverty Level(FPL).

*The resources of the individual must be less than 2 times the Supplemental Security Income(SSI )resource limit adjusted according to the increase in Consumer Price Index (CPI).