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Larimer County Human Services

Qualified Medicare Beneficiary (QMB)

Benefits

For persons enrolled in Medicare Part A (hospital insurance), whose income and resources are within the program guidelines, this program, under State Medicaid, will provide payment of Medicare premiums and co insurance, and for deductibles for Medicare-covered services.

Medicaid will pay:

monthly PREMIUMS for Medicare coverage (currently the amount deducted from your check as established by Social Security)
Medicare DEDUCTIBLES (the yearly deductible for Part B Medicare services such as office visits, lab, X-ray services and Part A deductible if you are hospitalized).
Medicare CO-INSURANCE (the 20% per service charge which you have to pay for most medical services)

Medicaid will only pay for medical services that are benefits of Medicare. PRESCRIPTIONS ARE NOT A BENEFIT OF THE QMB PROGRAM.

The QMB recipient must show the medical provider his/her Medicare card and his/her Medicaid card.

Medicaid and Medicare combined, will automatically pay for monthly premiums, co-insurance and deductibles.

The QMB recipient only pays a small fee for certain medical expenses, known as Medicaid co-payment. Call the “HOTLINE” AT (303) 866-3513 or 1-800-221-3943 for more information.

Medicaid coverage will begin the month after the county approves the application. After when you are approved for QMB, it will take about 90 days for payments to be accepted by Medicare. You will be reimbursed for any Medicare premiums you made during this transition period.

Eligibility Requirements

To qualify for QMB benefits you must:

Be currently eligible for Medicare "hospital insurance" (PART A),
Have a gross monthly income below the established program income limits.

NOTE: QMB income limits change each year based on federal guidelines. Contact your County Department of Human Services for more information. Income is anything, which can be used to purchase food, clothing, or shelter. Some examples include wages, social security, pensions, child support and unemployment benefits.
Have resources below $4000 for individuals and $6000 for couples,

Resources are whatever money remains unspent from a prior month. Some examples include cash, checking and savings accounts, stocks, bonds, some insurance policies and secondary property.

Remember:
The home, a car, personal belongings, household goods, some burial policies, and some life insurance policies are EXEMPT. They are NOT COUNTED as a part of your resources.
Be a U.S. Citizen or permanent legal alien, and
Be a resident of Colorado

How to Apply

To apply for QMB, you must complete a packet of information. Please call 498-6300 if you would like this packet mailed to you. You will need several documents to verify information. And you may need to come in for a face to face interview.

If you need assistance filling out the application, you can come to one of the offices listed below and someone from our department can assist you. Bring as many of the verification documents as possible.

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