SAN LUIS OBISPO COUNTY Senior Information Guide

Financial Matters
Qualifi ed Medicare Benefi ciary or “QMB,”
Specifi ed Low-Income Medicare Benefi ciary
“SLMB” and Qualifying Individual Programs
The Qualifi ed Medicare Benefi ciary (QMB) and the
Specifi ed Low-Income Medicare Benefi ciary (SLMB)
programs were created by federal law requiring that
State Medicaid (Medi-Cal) programs pay Medicare
costs for certain elderly and disabled persons with low
incomes and very limited assets.
An individual who has Medi-Cal in addition to Medicare
is already getting the QMB benefi t. Eligible individuals
do NOT have to pay the monthly Medicare premium,
the deductible for Part A Hospital and Part B Medical
benefi ts, the daily coinsurance charges for hospital stays
beyond 60 days, the co-payments for skilled nursing
care beyond 20 days and the 20 percent coinsurance for
Medicare-covered services.
In most cases, if you are eligible for the QMB benefi t,
you DO NOT need to purchase additional health insurance.
To be eligible for the QMB benefi t, you must be eligible
for Medicare (age 65 or older; or have been a disabled
benefi ciary under Social Security or the Railroad Retirement
Board for more than 24 months; or on kidney
dialysis; or received a kidney transplant) and have an income
in 2007 of less than $850.83 per month if you are
single. A married couple must have an income less than
$ 1,140.83. per month in 2007. Income includes Social
Security plus any other income sources. These maximum
amounts change April 1 each year.
To be eligible your fi nancial resources, such as bank
accounts, stocks and bonds, cannot exceed $4,000 for
one person or $6,000 for a couple. The home in which
you live, one automobile, burial plot, home furnishings,
personal jewelry and life insurance usually do not count
as resources.
If you do not qualify for QMB assistance because your
income is too high, you may be able to get help under the
SLMB program. The SLMB program is for persons whose
incomes are slightly higher than the national poverty
level, but not more than 20 percent higher. In 2007 the
income level for one person is $1,021 a month and for a
couple it is $ 1,369 a month. If you qualify for assistance
under the SLMB program, the State is required to pay
the Medicare Part B monthly premium for you. You will
continue to be responsible for Medicare’s deductibles
and coinsurance and for charges for health care services
and items not covered by Medicare.
Another program allows greater income limits and may
pay all or part of the Medicare premiums. This program
is known as Qualifying Individual (QI). The QI income
limit for one person is $1,148.83 and $1,540.13 for a
couple. If you have questions about these programs,
46 2007-2009 SAN LUIS OBISPO COUNTY SENIOR INFORMATION GUIDE
contact the County Department of Social Services. The
amount of income you may have and be eligible for the
QMB & SLMB programs will increase in future years.
If you have income over the current dollar amounts,
you should continue to check to see if you have become
eligible. If you think you may be eligible for the QMB,
SLMB, or QI benefi ts, contact the County Department of
Social Services.
Health Insurance Counseling
Health Insurance Counseling and Advocacy Program
(HICAP) offers free information and assistance with understanding
Medicare benefi ts and rights, solving medical
billing problems, fi ling claims and appeals, and comparing
supplemental and Long-term Care (LTC) insurance policies
and managed care options. Information can be received
over the phone or in person. Trained volunteer counselors,
registered by the California Dept. of Aging-HICAP, are available
at local community sites to provide assistance. Call for
more information or an appointment, 800-434-0222.
Hospital Health Insurance Counseling &
Billing Services
If you are concerned about your ability to pay a hospital
or other health care provider, talk with the Business Offi
ce or Business Manager to set up a payment plan.
Planning for Long Term-Care Needs
The California Partnership is another option available
to persons who are planning their long-term care
needs. The project is a partnership between the State
of California, the private insurance companies, and the
consumer.
The purpose of the California Partnership is to 1) help
the consumer protect against catastrophic long-term
care costs; 2) improve the quality of long-term care insurance;
3) improve the quality of consumer information
on risks of needing long-term care, ways to fi nance care,
and the role of long-term care insurance; 4) determine
the marketability of state-approved insurance for the
middle income populations; 5) reduce the rate of spend
down to Medi-Cal and reduce the public expenditures
caused by long-term care expenses; 6) help people
maintain control of their own lives.
All long-term care policies marketed in California must
meet certain consumer standards established by state
law. The California Partnership policies have additional
standards that must be met to be marketed under the
partnership project. All Partnership policies must use the
same set of criteria to determine eligibility for benefi ts.
There are minimum daily benefi ts guaranteed to provide
meaningful coverage. Automatic infl ation protection is
mandatory. Independent care management agencies must
provide assessment and care plans for the consumer to
access coverage. There are limitations on future rate