Code of Maine Rules
10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES
144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL
Chapter 332 - MAINECARE ELIGIBILITY MANUAL
Part 8 - MEDICARE SAVINGS PROGRAM [BUY-IN]
Section 144-332-8-4 - COVERAGE TIERS

Universal Citation: 10 ME Code Rules ยง 144-332-8-4

Current through 2024-38, September 18, 2024

Section 4.1 : Qualified Medicare Beneficiary (QMB)

I. Eligibility Requirements for QMB

A Qualified Medicare Beneficiary is an individual who:

A. is entitled to Medicare Part A or voluntarily enrolled in Medicare Part A;

B. effective July 1, 2024 has income equal to or less than 185% of FPL; and

C. may have assets. Effective January 1, 2024, there is no asset test.

II. Description of QMB Benefits
A. Medicaid pays the cost of Medicare Part A and/or B premiums, as well as satisfying Medicare Part A and B deductibles and coinsurances (See Appendix A).

B. An individual may be eligible for QMB and Medicaid at the same time.

C. Coverage begins the month after the month in which an eligibility decision is made that the individual is eligible as a QMB. There is no three-month retroactive period.

Section 4.2 : Specified Low Income Medicare Beneficiary (SLMB)

The rules in this Section apply through June 30, 2024.

I. Eligibility Requirements for SLMB

A Specified Low Income Medicare Beneficiary is an individual who:

A. is entitled to Medicare Part A or is voluntarily enrolled in Medicare Part A;

B. has income over 150% of the Federal Poverty Level (FPL) and equal to or less than 170% of FPL; and

C. may have assets. Effective January 1, 2024, there is no asset test.

II. Description of SLMB Benefits
A. Medicaid pays the cost of Medicare Part B premium (see Appendix A).

B. An individual may be eligible for SLMB and Medicaid at the same time; and

C. Coverage begins the month of application, retroactive to three months (but not prior to 1/1/93).

Section 4.3 : Qualifying Individual (QI)

I. Eligibility Requirements for QI

A Qualifying Individual is an individual who:

A. is entitled to Medicare Part A or is voluntarily enrolled in Medicare Part A;

B. effective July 1, 2024 has income more than 185% of the Federal Poverty Level (FPL) but less than 250% FPL; and

C. may have assets. Effective January 1, 2024, there is no asset test.

II. Description of QI Benefits
A. Medicaid pays the cost of the Medicare Part B premium.

B. The individual cannot receive Medicaid coverage and this benefit at the same time; and

C. coverage begins the month of application up to three months retroactive but no earlier than 1/1/98.

Section 4.4 : Qualified Disabled and Working Individual (QDWI)

I. Eligibility Requirements for QDWI

A Qualified Disabled and Working Individual is one who:

A. is entitled to Medicare Part A;

B. is not eligible for Medicaid;

C. has lost entitlement to Social Security disability benefits due to excess income from wages;

D. has countable income equal to or less than 200% of the FPL; and

E. has countable assets less than or equal to $4000.

II. Description of QDWI Benefits
A. Medicaid pays the cost of the Medicare Part A Premium.

B. Coverage begins the month of application, up to three months retroactive.

Disclaimer: These regulations may not be the most recent version. Maine may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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