Most individuals who are age 65 or older get Medicare Part A. They do not have to pay for it if they or their spouses have worked 40 qualifying quarters. If they do not have enough work credits to get Medicare Part A for free, they may buy Part A and Part B.
NOTE: Since January 1, 1994, there has been both a standard and a reduced Part A premium rate.
If an individual has to pay the Medicare Part A premium, DHS will pay it through Buy-In only if the individual is one of the following:
A Qualified Medicare Beneficiary (QMB).
QMB'S include the following:
Healthy Horizons recipients—If an individual is paying the Part A premium, the CAO will enroll him or her in Buy-In. If an individual does not have Medicare and needs to apply for Part A to become eligible for Medicare, the CAO will tell the individual to contact SSA.
NOTE: Individuals who get NMP and MNO benefits are also eligible for Buy-In of Part A if they meet the Healthy Horizons eligibility conditions.
SSI recipients.
D-50 (GA recipients) and D-00, if eligible for Medicare.
Qualified disabled working individuals (QDWI). SSA will identify a QDWI, provide a letter confirming that the individual is a QDWI, and tell the individual to contact the CAO.
NOTE: A QDWI is eligible for payment of the Part A premium only. A QDWI is not eligible for any other MA benefits. The CAO will have the individual complete an application.
An individual must meet all of the following conditions to be eligible as a QDWI:
Be under age 65.
Continue to be disabled according to SSA disability rules, except for employment.
Have income within 200 percent of the Federal Poverty Income Guidelines (FPIGs).
Have resources within the following resource limits:
|
Family Size |
Resource Limit |
|
1 |
$4,000 |
|
2 |
$6,000 |
Have exhausted nine months of the Social Security trial work period and fifteen months of the Social Security extended period of eligibility.
The following individuals are not eligible for payment of Part A:
Specified Low-Income Medicare Beneficiaries (SLMBs)---DHS pays the monthly Part B Medicare premium. SLMBs may be eligible for other MA services (for example – MAWD and Home and Community-Based Services).
Qualifying individuals (QIs)— DHS pays the monthly Part B Medicare premium. QIs cannot get other MA services.
Updated February 14, 2012, Replacing November 3, 2010