Federal law requires that state Medicaid programs pay Medicare coinsurance, deductibles and premiums for certain elderly and disabled people through a program called the Medicare Savings Program. These individuals are designated as Qualified Medicare Beneficiaries (QMBs), Specified Low-Income Medicare Beneficiaries (SLMBs), Qualified Individuals (QIs) or Qualified Disabled Working Individuals (QDWIs), and must meet the following eligibility criteria to receive assistance with Medicare-related costs:
- Be entitled to Medicare
- Be low income
- Be 65 years of age or older, or younger than 65 years of age and entitled to Medicare
- Have few personal resources
Medicare Savings Programs primary coverage categories include the following:
- QMB-Only – The member’s benefits are limited to payment of the member’s Medicare Part A (if member is not entitled to free Part A) and Part B premiums, as well as deductibles and coinsurance or copayment for Medicare-covered services only. Claims for services not covered by Medicare are denied as Medicaid noncovered services. When the Indiana Health Coverage Programs (IHCP) Eligibility Verification System (EVS) identifies a member as having only Qualified Medicare Beneficiary coverage (without also having Full Medicaid or Package A coverage), the provider should contact Medicare to confirm medical coverage.
- QMB-Also – The member’s benefits include payment of the member’s Medicare premiums, deductibles, and coinsurance or copayment on Medicare-covered services plus Traditional Medicaid benefits. When the EVS identifies a member as having Qualified Medicare Beneficiary coverage and also Full Medicaid or Package A coverage, claims for services not covered by Medicare must be submitted to the IHCP as regular Medicaid claims and not as crossover claims.
- SLMB-Only – The member’s benefits are limited to payment of the member’s Medicare Part B premium only. Providers should tell the member that the service is not a Medicaid-covered service for a member who has only SLMB coverage. When the EVS identifies a member as having only Specified Low Income Medicare Beneficiary coverage (without also having Full Medicaid or Package A coverage), the provider should contact Medicare to confirm medical coverage.
- SLMB-Also – The member’s benefits include payment of the member’s Medicare Part B premium in addition to Traditional Medicaid benefits. When the EVS identifies a member as having Specified Low Income Medicare Beneficiary coverage and also Full Medicaid or Package A coverage, Medicaid claims for services not covered by Medicare must be submitted to the IHCP as regular Medicaid claims and not as crossover claims.
- QI – The member’s benefit is payment of the member’s Medicare Part B premium. The EVS identifies this coverage as Qualified Individual.
- QDWI – The member’s benefit is payment of the member’s Medicare Part A premium. The EVS identifies this coverage as Qualified Disabled Working Individual.