Specified Low Income Medicare Beneficiary (SLMB) & Qualified Individual (QI)

Specified Low Income Medicare Beneficiary program (SLMB) and the Qualified Individual program (QI) program are state programs that helps pay for Medicare Part B (Medical Insurance) premiums for people who have Part A (Hospital insurance) and limited income and resources.

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What are the Specified Low Income Medicare Beneficiary (SLMB) & Qualified Individual (QI) programs?

The State of Maryland may assist you in paying for your Medicare premiums. Specified Low Income Medicare Beneficiary program (SLMB) and the Qualified Individual program (QI) program are state programs that helps pay for Medicare Part B (Medical Insurance) premiums for people who have Part A (Hospital insurance) and limited income and resources.

These two state programs only pay for your monthly Medicare Part B medical insurance premium.

 

Eligibility

For both programs, you must:

  • be eligible for Medicare Part A (even if not currently enrolled);
  • NOT be financially eligible for medical assistance (Medicaid); and
  • have limited income and assets.

 

Income Eligibility

For the SLMB Program, the 2021 individual monthly income limit is $1,308, and the married couple monthly income limit is $1,762.

For the QI Program, the 2021 individual monthly income limit is $1,469, and the married couple monthly income limit is $1,980.

$20 income disregard: If the $20 subtraction from the individual's or couple's gross income reduces the income to the number listed above, then the individual or couple probably qualifies for the benefit.

Check the Medicare website for the latest amounts. The Center for Medicare and Medicaid Services (CMS), the federal agency that administers the program, revises the SLMB benefits annually. 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

The resources limits in 2021 is $7,970 for individuals and $11,960 for a married couple. Check the Medicare website for the latest amounts.

  • These limits apply to personal assets including cash, bank accounts, stocks, and bonds.
  • Countable resources do not include your primary home, one car, a burial plot, up to $1,500 for burial expenses if you have put that money aside, life insurance with a cash value less than $1,500, furniture, and other household and personal items.

 

Applying

You must apply every year. You can apply in-person at your local department of social services office, online at https://www.marylandhealthconnection.gov/, or by calling the Maryland Health Benefits Exchange Consolidated Service Center. The toll free number is (855) 642-8572 or TTY (855) 642-8573.  You can download a copy of the application on the Maryland Department of Human Resources Medical Assistance page.

QI applications are granted on a first-come, first-served basis, with priority given to people who got QI 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.

 

Sources of Law

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

Federal Regulations: Code of Federal Regulations, Title 42 § 417

The Federal Medicare website has detailed information and resources.

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

State Regulations: Code of Maryland Regulations, 10.09.24 et seq.