The Qualified Medicare Beneficiaries (QMB) program is for people who receive Part A Medicare and whose income is below 100% of poverty. This program pays Medicare co-payments and co-insurance amounts for medical services covered by Medicare,  including the co-payments for Medicare-approved skilled nursing home care. It also pays the Medicare Part B premiums for eligible clients. This program does NOT pay for any services NOT covered by Medicare.   The income limit, after allowable deductions, is 100% of the Federal Poverty Level, which is typically adjusted annually. The Federal Poverty Level is available on the Internet at http://aspe.hhs.gov/poverty  

Income Eligibility Limits in Monthly Amounts     (as of April 2005)            

Household Size  *Monthly Income   

1     . . . . . . . . . . .    $   798
2     . . . . . . . . . . . .  $1,070                       

*Deductions

Countable Income is gross income minus exemptions, allowable disregards, deductions, and earned income expenses. The disregards and deductions are different for each Medicaid program. This means that the “countable income” to decide eligibility for one program will be different than the “countable income” used to decide eligibility for another program. In general, you may deduct $20.00 general income exclusion; $65.00 and 1/2 of the remaining gross earned income;  Health and accident premiums, and impairment-related work expenses.  Income too high?  Consider the Special Low-Income Medicare Beneficiary Program.  Also, see NOTE at bottom of page.

Spenddown

Spenddown is NOT allowed.

Asset Limits

 1 person  -  $4,000.00
 2 Persons  - $6,000.00

Retroactive Coverage

Medicaid will NOT cover Medicare premiums nor medical costs prior to the month of application.

NOTE: Federally Qualified Health Centers are clinics that offer low-cost medical care.  It does not matter whether the person qualifies for Medicaid or has health insurance.  The cost of care is based on income.  There is a list of health centers in the brochure "Exploring Medicaid".  The brochure comes in two versions depending on where a person lives. One version of Exploring Medicaid is for people living in the Wasatch Front (Salt Lake, Utah,  Davis, Weber, and Morgan Counties).  The other version of Exploring Medicaid is for people who live in other areas of the state. In either version, look for telephone numbers for Federally Qualified Health Centers in the Resource section of the brochure.

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