Melissa Justice, Trust Director

1-800-382-9100

317-977-2375

mjustice@arcind.org

If your son or daughter receives Medicare, he or she might be eligible to participate as a qualified medicare beneficiary (QMB). If eligible, the money he or she (or you) currently pay for Medicare premiums, deductibles, and coinsurance (several hundred dollars a year) can be used in other ways, because Medicaid can pay these costs.

In order for Medicaid to pay Medicare premiums, deductibles, and coinsurance under the QMB category, your child must be entitled to Medicare Part A. Also, he or she can have only a limited amount of income and resources. For the QMB program these limits exceed those typically allowed for Medicaid. If your child is single, he or she can have a maximum monthly income of $739, and financial assets of no more than $4,000. If your child is married, with no children, his/her combined family income can be $995 a month; combined financial assets can total no more than $6,000.

Several sources of income are excluded from consideration in the QMB determination. Your child's SSI, for example, is excluded. Also excluded is the first $65 a month of your child's earned income, plus one-half of all remaining net earned income. In addition, $20 in unearned or earned income is disregarded.

If your child meets the QMB requirements, Medicaid can pay the following costs:

1. The monthly premium for Medicare Part B. In 2003, this premium is $58.70 a month.

2. The monthly premium for Premium Hospital Insurance under Medicare Part A. Most individuals are entitled to free Part A. In 2003, those that aren't pay $316 a month.

3. Medicare Part A and B deductibles and coinsurance.

A deductible is an initial dollar amount which Medicare does not pay. Coinsurance is your share of expenses for covered services above the deductible.

Medicare Part A is hospital insurance. In 2003, the deductible for Part A coverage is $840 per spell of illness, plus $210 per day for days 61 through 90, and $420 per day for days 91 through 150 (the lifetime reserve days). Medicaid will pay this deductible for persons that meet the QMB requirements.

Medicaid will also pay the coinsurance payment for patients in skilled nursing facilities who meet the QMB requirements. In 2003, the first 20 days in a skilled nursing facility are paid entirely by Medicare. No coinsurance payment is required. For the remaining 80 days, Medicare pays everything except $105 a day. The patient pays the $105. This is the coinsurance. The coinsurance can be paid by Medicaid if the patient meets QMB requirements.

Medicare Part B helps pay for doctors' bills and other medical services. A person is automatically enrolled in Part B when he or she enrolls in Part A, unless they state they don't want it.

In 2003, when someone uses Part B, he or she must pay the first $100 (the deductible) of charges approved by Medicare. After that, Part B generally pays 80% of the amount approved for covered services. The individual pays the remaining 20%. This 20% is the coinsurance. Medicaid can pay the deductible and coinsurance for persons that meet QMB requirements.

If your son or daughter meets the QMB criteria, contact the County Office of the Department of Family and Children to apply for Medicaid. Medicaid is more comprehensive than Medicare. Several medical needs, such as dentures, eyeglasses, and hearing aids are not covered under Medicare, but can possibly be covered under Medicaid. Eligibility for QMB will also be determined under the same application.