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Specified Low Income Medicare Beneficiary (SLMB)

Specified Low Income Medicare Beneficiary (SLMB) & Qualified Individual Program (QI) pay your Medicare Part B insurance premiums for Part B participants who have trouble paying premiums.

Eligibility

These are state programs, similar to medical assistance, for people who need help paying for Medicare services.

  • You must be eligible for Medicare Part A (even if not currently enrolled)
  • But NOT financially eligible for medical assistance
  • And have limited income and assets
Income Eligibility

 (Apply $20 income disregard - see note below)
There are two levels of monthly income:

 

SLMB
(100-120%-
annual federal
poverty guidelines)

QI
(120-135% of
annual federal
poverty guidelines)
Individual $930-$1,117 $1,117-$1,255
Couple $1,260-$1,513 $1,513-$1,701

Note: $20 may be subtracted from the individual's or couple's gross income; if the $20 subtraction reduces the income to the number listed above, then the individual or couple probably qualifies for the benefit.

The Specified Low-Income Medicare Beneficiary (SLMB) benefits are revised annually by the Health Care Financing Administration (HCFA), the federal agency that administers the program. These figures are usually updated in April of each year and can be found in the Federal Register, the official government source for administrative changes.

Asset Eligibility

Assets not over:
Individual: $8,180
Couple:    $13,020

  • These limits apply to personal assets including cash, bank accounts, stocks and bonds
Apply at
  • Department of Social Services.  Find your local DSS Office
  • You must apply every year for these benefits.
  • Application
  • If you meet the eligibility requirements, your application will be granted on a first come first serve basis, with priority given to those who received benefits the previous year.
Appeals
  • You can appeal any denial, termination, or reduction of benefits
  • Appeals must be filed in writing at the DSS office.  It is best to file it in person and to get a receipt showing that you filed the appeal.
  • Appeals must be filed within 90 days of the action, or you cannot appeal.
  • If you file within 10 days of notice that benefits are being terminated or reduced, they will continue until the decision.  If you do not appeal within 10 days, the termination or reduction will happen.

 

Other Programs
Sources of Law

Federal Law:   42 U.S.C. §§ 1396a(a)(10)(E), 1396(p)

Federal Regulations: 5 CFR Pt. 900, Subpt. F, App. A (Medicaid must be enacted) 42 C.F.R. 417

Federal Policy Materials:  The Federal Medicare Web Page, has questions and answers, help and general information.

State Law: Md. Ann Code  Health-General Art §§ 2-104(b), 15-103, and 15-105

State Regulations: COMAR 10.09.24 et seq.


Is this legal advice?

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