For Professionals: Low-Income Help

Qualified Low-Income Beneficiaries Can Apply for Premium-Free Medicare Between Jan 1 Mar 31

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Jan 31, 2012

Many people over 65 who have limited incomes may qualify for free Medicare Part A and B without knowing it. Through a program called Qualified Medicare Beneficiariy (QMB), Medi-Cal (California’s Medicaid program) will pay Medicare Part A and B premiums as well as Part A and B deductibles and copayments for people who qualify. This can lead to a savings of well over $6,750* a year. For someone with low income and assets, this program makes all the difference as to whether or not they have Medicare coverage.

When to apply for QMB depends on whether an individual already has Medicare Part A and B. If you already have Medicare Parts A and B, you can apply for QMB anytime through your local California Department of Health Care Services (DHCS) county office.

If you do not have Part A, or Part A and B, you may apply for QMB during the General Enrollment Period (GEP) from January 1 to March 31 each year if your Medicare Initial Enrollment Period has passed. (The Medicare Initial Enrollment Period (IEP) is a 7-month period. For people who are getting Medicare because they are turning 65, the IEP starts 3 months before and ends 3 months after the month a person turns 65. For people who are getting Medicare due to a disability, the IEP starts 3 months before and ends 3 months after the 25th month a person receives Social Security Disability Insurance.) If you apply for QMB during the GEP and qualify, your Medicare coverage becomes effective July 1. Below outlines the 2 simple steps to enroll in Medicare Parts A and B and QMB.

Step 1: Apply for Medicare at your local Social Security Administration office

If you don’t have Medicare Part A or B and your IEP is over, you can apply for Part A and/or B of Medicare during the annual GEP.

If you or your spouse is not entitled to premium- free Part A ($451 per month in 2012), which is “earned” through working at least 40 quarters, or 10 years , state in writing on your Medicare application that you want "Conditional Medicare" under the Qualified Medicare Beneficiary (QMB) program. This means you only want to receive Medicare Part A on the condition that QMB will pay for your Medicare Part A premium.

Also, make sure when you leave the Social Security office, you have proof that you applied for Medicare “Hospital Insurance” (Part A) and Medicare “Medical Insurance” (Part B).

In addition, remember that if you speak no or limited English, the Social Security Administration is required to provide you with an interpreter if you need one. If you have problems with this when speaking to someone at SSA either over the phone or in the office, ask them to look up the Social Security policy about providing interpreters at GN 00203.011 Special Interviewing Situations: Limited English Proficiency (LEP) or Language Assistance Required.

Step 2: Apply for QMB Benefits at your local Department of Health Care Services office

After you apply for Medicare, within 60 days you should receive a notice that you are entitled to Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) and that your coverage begins in July. Once you receive this notice, bring it with you to your county's DHCS office to apply for QMB. If you already receive Medi-Cal, you don’t need to complete a new application. Your Medi-Cal caseworker should be able to immediately enroll you into QMB. If you are not on Medi-Cal, the caseworker should take your QMB application as well as screen you for any other State benefit programs for which you may qualify. The caseworker may also request information from you, like current banks statements, verification of any life insurance or burial insurance, etc. DHCS should process your QMB and/or Medi-Cal applications within 45 days.

Note: If you are eligible for QMB or other Medicare Savings Programs such as Specified Low Income Beneficiary (SLMB) or Qualified Individual (QI), you are also eligible to receive "Extra Help" (or the Low-Income Subsidy (LIS) program) for your Part D Medicare prescription-drug costs.
In sum, if you apply for both Medicare and QMB during the GEP from January 1 – March 31 and you qualify, your Medicare benefits and accompanying QMB benefits to cover your Medicare premiums, deductibles and coinsurance will begin July 1st. See our Low-Income Help section for details on what QMB covers and information on other Medicare Savings Programs.

* This $6,750 rounded figure comes from adding 12 months of full Part A premiums ($5,412), 12 months of Part B premiums ($1,200) and the Part B annual deductible ($140). The savings could be substantially more if someone uses multiple Medicare-covered services, or substantially less if someone uses few services and already has premium-free Part A.

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