Section 477-27-004 - MEDICARE BUY-INThe Medicare buy-in programs assist those eligible for both Medicare and Medicaid cover the costs of Medicare.
004.01ELIGIBILITY REQUIREMENTS. The eligibility requirements of the Medicare buy-in programs are listed below. Specific requirements vary according to the program. An individual must:(A) Be a resident of Nebraska;(B) Be a United States citizen or qualified non-citizen;(C) Receive, or be eligible to receive, Medicare benefits; and(D) Meet the income and resource requirements of the program.004.02QUALIFIED MEDICARE BENEFICIARIES. Qualified Medicare Beneficiaries (QMBs) are Medicare recipients with low income. A Qualified Medicare Beneficiary (QMB) may be eligible to receive Medicaid benefits under another category. 004.02(A)BENEFITS. Qualified Medicare Beneficiaries (QMBs) receive a buy-in of the Medicare premium, as well as payment of any Medicare co-pays or deductibles.004.02(B)EFFECTIVE DATE. Qualified Medicare Beneficiary (QMB) begins the month after the month in which eligibility is determined.004.02 (C)INCOME AND RESOURCE LIMITS. Qualified Medicare Beneficiaries (QMBs) must have income at or below 100% of the Federal Poverty Level (FPL). The resource limit for a Qualified Medicare Beneficiary (QMB) is located at 477-000-012. The resource guideline is adjusted annually. Income is counted in accordance with 477 NAC 22. Resources are counted in accordance with 477 NAC 23. 004.02(C)(i)AGED, BLIND, AND DISABLED QUALIFIED MEDICARE BENEFICIARIES. Individuals who are eligible for Medicare and who are also eligible to receive Medicaid in the aged, blind, and disabled (ABD) category will automatically qualify as a Qualified Medicare Beneficiary. The joint benefit is referred to as the aged, blind, and disabled Qualified Medicare Beneficiary (ABD/QMB).004.02(C)(ii)MEDICARE SAVINGS PROGRAM QUALIFIED MEDICARE BENEFICIARY. Individuals who have excess resources for the aged, blind, and disabled (ABD) category may still be eligible to receive the Qualified Medicare Beneficiary (QMB) benefit if within the resource limit for the Qualified Medicare Beneficiary (QMB) program. These individuals are only eligible for the Medicare buy in, payment of co-pays, and deductibles. This benefit is referred to as the Medicare Savings Program Qualified Medicare Beneficiary (MSP/QMB).004.03SPECIFIED LOW INCOME MEDICARE BENEFICIARIES (SLMB). Specified Low Income Medicare Beneficiaries (SLMBs) are Medicare recipients who have income just above the level of a Qualified Medicare Beneficiary (QMB). 004.03(A)BENEFITS. Specified Low Income Medicare Beneficiaries (SLMBs) only receive payment of the Medicare Part B premium. An individual may be eligible as a Specified Low Income Medicare Beneficiary (SLMB) and as medically needy in the same month.004.03(B)EFFECTIVE DATE. Eligibility for a Specified Low Income Medicare Beneficiary (SLMB) is determined from the date of the application. Eligibility may be determined for up to three months before the date of application, if the individual was eligible for those months and requests the benefit.004.03(C)INCOME AND RESOURCES. A Specified Low Income Medicare Beneficiary must have income above 100% of the Federal Poverty Level (FPL) but at or below 120% of the Federal Poverty Level (FPL). Income and resources are determined for only a one or two person household. The resource limit for this eligibility group is located at 477-000012, and is adjusted annually. Income is counted in accordance with 477 NAC 22. Resources are counted in accordance with 477 NAC 23.004.04QUALIFIED INDIVIDUALS (QI-1). A Qualified Individual (QI-1) has income just above the limit of an eligible Specified Low Income Medicare Beneficiary (SLMB). 004.04(A)BENEFITS. A Qualified Individual (QI-1) is only eligible for the payment of the Medicare Part B premium.004.04(B)EFFECTIVE DATE. Eligibility for a Qualified Individual (QI-1) is determined from the date of application. Eligibility for up to three months before the month of application may be available if the individual was eligible and the month is within the current calendar year.004.04(C)INCOME AND RESOURCES. A Qualified Individual (QI-1) must have income above 120% of the Federal Poverty Level (FPL) but at or below 135% of the Federal Poverty Level. Income and resources are determined for only a one or two person household. The resource limit for this eligibility group is located at 477-000-012, and is adjusted annually. Income is counted in accordance with 477 NAC 22. Resources are counted in accordance with 477 NAC 23.004.04(D)PROHIBITION ON OTHER BENEFITS. A Qualified Individual (QI-1) cannot be eligible for Medicaid coverage under any other category in the same month that the individual is eligible as a Qualified Individual (QI-1). The individual must choose between either Medicaid coverage for medical costs or the Qualified Individual (QI-1) benefit, but cannot have both.477 Neb. Admin. Code, ch. 27, § 004
Amended effective 9/28/2021