Mandatory Coverage of Certain Medicare Cost-Sharing Groups

Mandatory Coverage of Certain Medicare Cost-Sharing Groups The Division of Medicaid covers the following Medicare cost-sharing groups. A. Qualified Medicare Beneficiaries (QMB) must be entitled to Medicare Part A and have income that does not exceed one hundred percent (100%) of the federal poverty level (FPL). Medical assistance is limited to payment of Medicare cost-sharing expenses that includes premiums, co-insurance and deductible charges. The only exception to the requirement of entitlement to Medicare Part A is for individuals entitled to Medicare Part B-ID. B. Specified Low-Income Medicare Beneficiaries (SLMB) must be entitled to Medicare Part A and have income that exceeds one hundred percent (100%) of the FPL but does not exceed one hundred twenty percent (120%) of the FPL. Medical assistance for this group is limited to payment of Medicare Part B premiums or Medicare Part B-ID premiums. C. Qualifying Individuals (QI) must be entitled to Medicare Part A and have income that exceeds one hundred twenty percent (120%) of the federal poverty level but does not exceed one hundred thirty-five percent (135%) of the FPL. 1. Medical assistance for this group is limited to payment of Medicare Part B premiums under a federal allotment of funds or Medicare Part B-ID premiums. 2. Eligibility for coverage as a QI is dependent on the availability of federal funds. D. Payment of the Medicare Part D pharmacy plan premium is applicable to the Medicare cost- sharing groups of QMB, SLMB and QI provided the beneficiary enrolls in a benchmark pharmacy plan. Benchmark or zero dollars ($0) premium plans are subject to change each calendar year based on plans that choose to participate within the state of Mississippi. E. Qualified Disabled and Working Individuals must be entitled to Medicare Part A and have income that does not exceed two hundred percent (200%) of the FPL whose return to work results in the loss of coverage for Medicare. Medical assistance is limited to payment of the Part A premium. F. The Division of Medicaid certifies eligibility for all of the Medicare cost-sharing groups.