These programs pay for some of the cost of Medicare for seniors and people with disabilities who are not otherwise eligible for Medical Assistance. People receiving Medicare pay a monthly premium that is usually deducted from their Social Security check. For 2018 the standard monthly premium is $134 (or higher depending on income), but some people pay less—around $130/month. They also pay co-payments for doctor visits and a deductible for hospitalization. The types of costs covered by the Medicare Premium Assistance Program is determined by the applicant’s income level as shown in the chart below.
Who Qualifies?
- People that have Medicare Part A (elders receiving Social Security Retirement benefits; people who have received Social Security Disability benefits for two years).
- Must be citizen or qualified immigrant. Eligible immigrants include: refugee or person granted asylum. Lawful Permanent Residents (LPRs) who entered the U.S. before 8/22/96 or if entered on/after 8/22/96 must be in status for at least 5 years. In addition, immigrants who were in lawful status in the U.S. before 8/22/96 and lived in RI at some time before 7/1/97 may be eligible for coverage.
Income and Resource Limits
The resource limit is $7,390 for an individual and $11,090 for a couple. The home in which the person lives and a car used to get to medical treatment does not count.
*While the resource limit ($7,390) for the Qualified Medicare Beneficiary Program (QMB) is higher than the resource limit ($4,000) for the Medical Assistance (MA) low-income Aged/Disabled program, the income limits are the same. MA provides more comprehensive coverage, including prescriptions. MA can also pay for the Medicare premiums, co-pays, and deductibles. Therefore, people will generally want to apply for Medical Assistance, and not just QMB, as long as their resources are within the MA limit ($4,000/individual).
How to Apply
You can apply by submitting a paper application which you can download at: https://tinyurl.com/RI-DHS-2-2018. You can also request a paper application from a DHS office or by calling: 1-855-697-4347.
A decision must be made within 30 days of application. If denied, the person can file a written appeal within 30 days of the date on the notice.
RI Legal Services (1-800-662-5034) may provide assistance to families who are denied benefits. You can also contact RIREACH for assistance (401-270-0101).
Monthly Income Guidelines
Medicare Premium Payment Programs (2018)
| Program | Individual Income Limit | Couple Income Limit | Coverage |
|---|---|---|---|
| Qualified Medicare Beneficiary (100% FPL) | $1,032 | $1,416 | Medicare premiums, co-pays and deductibles |
| Specified Low Inc Beneficiary (120% FPL) | $1,234 | $1,695 | Medicare Part B Premium |
| Qualifying Individual (135% FPL) | $1,386 | $1,905 | Medicare Part B Premium (limited # of eligibles) |
*Note Income limits include the $20 disregard for unearned income.
