The Bay Area Reporter - Friday, April 23, 1999
Thomas P. McCormack

PWAs with SSDI and other income under $947 monthly will see a $45.50 Medicare Part B premium, which was being deducted, restored to their checks once the Specified Low Income Medicare beneficiary (SLIMB) and Qualified Individual (I) QI (I) programs begin paying it for them.

Those with SSDI and other income under $707 per month will not only get the premium paid for them and have the $45.50 restored to their SSDI checks -- the Qualified Medicare Beneficiary (QMB) program will also pay the $768 hospital admission deductible, the $100 annual doctor bill deductible, and the 20 percent of doctor and outpatient bills that Medicare doesn't cover.

Both SLIMB/QI (I) and QMB are run by state Medicaid programs through local welfare offices -- not Social Security offices -- even though they involve federal Medicare benefits. To be eligible for both SLIMB/QI (I) and QMB, one can have assets up to $4,000, an automobile and a lived-in home of any value. An additional $1,500 in savings is permitted if it's kept separately from other money and the applicant plans to use it for burial.

Applications are taken at local welfare offices, not at Social Security branches. Those applying should bring birth certificates, bank account and other asset records, deeds, mortgages, auto registrations, and driver's license or other proof of identity and residency. Most importantly, applicants need to show their Medicare cards and the latest letter from Social Security establishing what their SSDI benefit total is. (Call 800-772-1213 for a new one if you've lost the letter.)

In computing eligibility, it's the total SSDI amount that counts against the $947 and $707 income levels. SSDI checks only show the net amount -- after the $45.50 has been deducted. So, in computing total income, one must add the $45.50 Medicare Part H deduction back onto the net SSDI check amount.

Applicants for SLIMB or QMB at the welfare office now can bring a $45.50 increase in total income for those who qualify -- and coverage of Medicare deductibles and co-payments as well for those who get the more generous QMB coverage.

And if you're back at work or thinking about it

SSDI beneficiaries can keep their Medicare even if they return to work -- and they should do so, even if they secure employer health coverage. When you have a serious illness, two health insurance policies in force beat only one, and, besides, Medicare covers some things private coverage doesn't, and it won't lapse (like the employer plan will if you are laid off or become too sick to work again). Medicare coverage is available û for a lifetime, even after returning to work -- act long as one continues to have the condition which originally qualified one for SSDI.

For those who are working, QMB and SLIMB/QI (I) disregard (that is, don't count) $65 and half the rest of gross earnings per month, and out-of-pocket medical expenses you pay yourself, before comparing your net countable income to their eligibility levels. This means that someone who has given up SSDI to resume work can have gross monthly earnings of $1,939 or more and still get SLIMB/QI (I) to pay his $45.50 premium. And to get QMB to pay the premium and also deductibles and co-payments, one can have total monthly wage of $1,459 or more.

And, after 45 months back at work, Medicare Part A starts charging a premium too ($170 if you paid FICA payroll taxes for at least 7.5 years over your whole working life, or $309 if you paid those taxes for less time before you became disabled). But those with gross monthly earnings under $2,831 or more can have the welfare office's Qualified Disabled Working Individual (QDWI) program pay their Part A premiums when they come due.

Getting coverage for drugs and other items not covered by Medicare, QMB, or SLIMB/QI (I)

Medicare, QMB, or SLIMB/QI (I) won't help with prescription drugs or care outside the Medicare benefit package. Medicaid does so -- for those who are eligible. Those applying for QMB or SLIMB/QI (I) at welfare offices in California, Connecticut, the District of Columbia, Florida, Maine, New Jersey, and Rhode Island should remember that Medicaid levels there are as high as -- or almost as high as -- the QMB levels. So it would pay to ask for "full" Medicaid (called MediCal in California) as well, while applying for QMB or SLIMB/QI (I).

Those who can't qualify for Medicaid might be eligible for their state's AIDS Drug Assistance Program (ADAP), which has much higher income limits. Call (800) 432-AIDS to find out how to contact your state's ADAP program. But if persons with HIV can't get the coverage or the drugs they need from Medicaid or ADAP û and they live in Connecticut, Illinois, Maine, Maryland, or New Jersey -- there are state generic drug assistance programs, which also use income levels higher than Medicaid's. (These states' general drug programs are separate from ADAP; they're for all needy disabled people and predate the AIDS crisis). Call the city or county aging office (even if you're not elderly) to get details about these separate drug programs in these five states.

For those not covered by any of these programs, the AIDS Treatment Data Network (800-734-7104) has a list of free AIDS drug programs run by distributors; the Pharmaceutical Manufacturers' Association (202-835-3400) and the Senate Aging committee (202-224-5364) have lists of free programs for all kinds of drugs run by the industry, and patients' doctors can order free prescriptions for those who have no other way to pay.

Thomas McCormack handled Medicare and Medicaid with the Health Care Financing Administration, authored the AIDS Benefits Handbook (Yale University Press), and did public benefits advocacy for the National Association of People With AIDS (NAPWA), the Maryland Disability Entitlement Advocacy Program and Affording Care. He now works with the Title II Community AIDS National Network.
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