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From Families USA
January, 1999

The Medicare Buy-In


Medicare buy-in benefits were created by Congress to help low-income Medicare beneficiaries pay their share of Medicare premiums, and in some instances, deductibles and copayments. Medicare beneficiaries are eligible for different buy-in programs depending on their incomes. The programs, described below, are known as QMB (Qualified Medicare Beneficiaries); SLMB (Specified Low Income Medicare Beneficiary); and QI-1 and QI-2 (Qualified Individuals 1 and 2).

The following chart will help you determine which category of assistance you might be eligible to receive. Remember that if you are not getting buy-in assistance, your Medicare premiums of $45.50 per month ($546.00 per year) are deducted from your social security check. Add this amount to your social security check to figure out whether your current annual income is within the guidelines listed below:

INCOME ELIGIBILITY FOR BUY-IN PROGRAMS

ProgramIndividualsCouples
QMBUp to $8,292 a year ($691/month)Up to $11,100 a year ($925/month)
SLMB$8,293-9,900 ($692-825/mo)$11,101-13,260 ($926-1,105/mo)
QI-1$9,901-11,112 ($826-926/mo)$13,261-14,892 ($1,106-1,241/mo)

Note: If you are working, some of your earned income is not counted - it is "disregarded". Working persons with permanent disabilities may also be entitled to assistance with Medicare Part A premiums under another program, Qualified Working Disabled Individuals.

Resource Limits

To participate in any of the buy-in programs described above you must have assets that are less than $4,000 dollars for an individual or $6,000 for a couple. The value of your home, most of the value of your car, life insurance, home furnishings, jewelry, or burial spaces are not counted toward the resource limits.

QMB: Qualified Medicare Beneficiary

If you are a Medicare beneficiary and your income is less than $8,292 for an individual or $11,100 for a couple and you meet certain resource limits described on the front of this brochure, you are eligible for the Qualified Medicare Beneficiary Program (QMB). This program pays for Medicare Part A (Hospital Insurance) and Medicare Part B (Supplemental Medical Insurance) premiums, deductibles, and copayments.

QMB pays for the following costs:

bulletPart A Deductible$768 per benefit period*
bulletPart B Premium$546.00 a year, or $45.50 a month
bulletAnnual Part B Deductible$100.00
bullet Annual Part B Copayments$513.38 (1998 average per beneficiary)

*A benefit period begins when you are admitted to the hospital and ends when you have been out of the hospital or a skilled nursing facility for 60 straight days.

SLMB: Specified Low Income Medicare Beneficiary

If your income is between $8,292 and $11,100 (individual) or $11,101 and $13,260 (couple) and you meet the resource eligibility limits described on page one, you are eligible for SLMB.

SLMB pays for:

Part B Premium
$546.00 a year, or $45.50 a month

QI-1 and QI-2: Qualified Individuals

Persons with slightly higher incomes (below $11,112 for an individual and $14,892 for a couple) may also be eligible for payment of their Part B premiums on a first-come, first-served basis under a block grant. This block grant program is known as "QI-1" for "Qualified Individuals 1." (A second group of Qualified Individuals with slightly higher incomes, QI-2s, are eligible for assistance with a small portion of their premium costs, but the dollar value of this assistance is very low.)

How To Apply

If you think you may be eligible, contact the local office where you apply for Medicaid and Welfare. To get this number, call 1-800-638-6833. You can also call the nearest State Health Insurance Advisory Program (SHIAP); the phone numbers are listed inside this brochure. If you need help obtaining the benefit from the Medicaid office, the SHIAP can assist you.

STATE HEALTH INSURANCE ADVISORY PROGRAMS (SHIAPs)

Alabama
770 WashingtonAve., Suite 470
RSA Plaza Building
Montgomery, AL 36130
Tel: (800) 243-5463
(334) 242-5743

Alaska
3601 C Street, Suite 310
Anchorage, AK 99503
Tel: (800)478-6065
(907) 269-3666

Arizona
1789 W. Jefferson Street
Phoenix, AZ 85007
Tel: (800) 432-4040

Arkansas
1200 West 3rd Street
Little Rock, AR 72201-1904
Tel: (800) 852-5494

California
1600 K Street
Sacramento, CA 95814
Tel: (800) 434-0222

Colorado
1560 Broadway, Suite 850
Denver, CO 80202
Tel: (800) 544-9181
(303) 894-7499, Ext. 356

Connecticut
2 Hartford Square West, #101
Hartford, CT 06106
Tel: (800) 994-9422
(860) 724-6443

Delaware
841 Silver Lake Blvd.
Dover, DE 19904
Tel: (800) 336-9500
(302) 739-6266

District of Columbia
2136 Penn. Ave., NW, 1st Floor
Washington, DC 20052
Tel: (202) 676-3900

Florida
4040 Esplanade Way, Suite 260
Tallahassee, FL 23299-7000
Tel: (800) 963-5337
(850) 414-2060

Georgia
Dept. Of Human Resources
2 Peachtree St., NW, Rm 18.403
Atlanta, GA 30303
Tel: (800) 669-8387
(404) 657-5334

Hawaii
Executive Office on Aging
250 S. Hotel St., Suite 107
Honolulu, HI 96813
Tel: (808) 586-7299

Idaho
700 W. State Street, 3rd Fl.
Boise, ID 83720-0043
Tel: (208) 334-4350

Illinois
320 W. Washington St., 4th Fl.
Springfield, IL 62767
Tel: (800) 548-9034
(217) 785-9021

Indiana
311 West Washington St., #300
Indianapolis, IN 46204-2787
Tel: (800) 452-4800
(317) 232-5299

Iowa
330 Maple Street
Des Moines, IA 50319-0065
Tel: (800) 351-4664
(515) 281-6867

Kansas
PO Box 3850
Wichita, KS 67201
Tel: (800) 860-5260
(316) 337-7386

Kentucky
275 E. Main Street
Frankfurt, KY 40621
Tel: (502) 564-7372

Louisiana
P.O. Box 94214
Baton Rouge, LA 70804-9214
Tel: (800) 259-5301

Maine
35 Anthony Avenue
Augusta, ME 04333-0011
Tel: (800) 750-5353
(207) 624-5335

Maryland
301 W. Oreston Street, #1007
Baltimore, MD 21201
Tel: (800) 243-3425

Massachusetts
1 Ashburton Place, 5th Fl.
Boston, MA 02108
Tel: (800) 882-2003
(617) 727-7750

Michigan
6105 West St. Joseph, #209
Lansing, MI 48917-4850
Tel: (800) 803-7174

Minnesota
444 Lafayette Road, 4th Fl.
St. Paul, MN 55155-3843
Tel: (800) 333-3433

Mississippi
750 N. State Street
Jackson, MS 39202
Tel: (800) 948-3090

Missouri
505 Hobbs Rd., #100
Jefferson City, MO 65109
Tel: (800) 390-3330

Montana
PO Box 4210
Helena, MT 59604
Tel: (800) 332-2272

Nebraska
941 O Street, #400
Lincoln, NE 68508
Tel: (402) 471-2201

Nevada
340 N. 11th St., #114
Las Vegas, NV 89101
Tel: (800) 307-4444
(702) 486-4602

New Hampshire
169 Manchester Street
Concord, NH 03301
Tel: (800) 852-3388

New Jersey
P.O. Box 807
Quakerbridge Plaza Bldg. 12B
Trenton, NJ 08625-0807
Tel: (800) 792-8820

New Mexico
La Villa Rivera Bldg.
224 E. Palace Ave.
Santa Fe, NM 87501
Tel: (800) 432-2080

New York
2 Empire State Plaza, 4th Fl.
Albany, NY 12223-1251
Tel: (800) 333-4114
(212) 869-3850
(212) 333-5511
(518) 474-5731

North Carolina
111 Seaboard Avenue
Raleigh, NC 27604
Tel: (800) 443-9354

North Dakota
600 East Boulevard
Bismarck, ND 58505-0320
Tel: (800) 247-0560

Ohio
2100 Stella Court
Columbus, OH 43215-1067
Tel: (800) 686-1578

Oklahoma
3814 North Santa Fe
Oklahoma City, OK 73118
Tel: (800) 763-2828
(405) 521-6628

Oregon
350 Winter St., NE, Rm 440-2
Salem, OR 97310
Tel: (800) 722-4134
(503) 947-7984

Pennsylvania
400 Market Street
Rachel Carson State Office Bldg.
Harrisburg, PA 17101
Tel: (800) 783-7067

Rhode Island
160 Pine Street
Providence, RI 02903
Tel: (800) 322-2880
(401) 222-2880

South Carolina
202 Arbor Lake Drive, # 301
Columbia, SC 29223-4554
Tel: (800) 868-9095
(803) 253-6177

South Dakota
700 Governors Drive
Pierre, SD 57501-2291
Tel: (800) 822-8804
(605) 773-3656

Tennessee
500 James Robertson Parkway
4th Floor
Nashville, TN 37243-0574
Tel: (800) 525-2816

Texas
1949 IH 35 South
Austin, TX 78741
Tel: (800) 252-9240

Utah
120 North 200 West
Salt Lake City, UT 84103
Tel: (801) 538-3910

Vermont
Northeastern VT Area Agency on Aging
180 Portland Avenue
St. Johnsbury, VT 05819
Tel: (800) 642-5119
(802) 748-5182

Virginia
700 Centre
700 E. Franklin Street, 10th Fl.
Richmond, VA 23219-2327
Tel: (800) 552-3402
(804) 662-9333

Washington
P.O. Box 40256
Olympia, WA 98504-0256
Tel: (800) 397-4422
(360) 407-0383

West Virginia
State Capitol Complex
Holy Grove
1900 Kanawha Blvd., East
Charleston, WV 25305-3317
Tel: (304) 558-3317

Wisconsin
214 N. Hamilton Street
Madison, WI 53703
Tel: (800) 242-1060
(608) 267-3201

Wyoming
PO Box BD
Riverton, WY 82501
Tel: (800) 856-4398

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