23 Miss. Code. R. 101-1.10 - Mandatory Coverage of Certain Medicare Cost-Sharing Groups
The Division of Medicaid covers the following Medicare cost-sharing groups.
A. Qualified
Medicare Beneficiaries (QMB) must be entitled to Medicare Part A and have
income that does not exceed one hundred percent (100%) of the federal poverty
level (FPL). Medical assistance is limited to payment of Medicare cost-sharing
expenses that includes premiums, co-insurance and deductible charges.
B. Specified Low-Income Medicare
Beneficiaries (SLMB) must be entitled to Medicare Part A and have income that
exceeds one hundred percent (100%) of the FPL but does not exceed one hundred
twenty percent (120%) of the FPL. Medical assistance for this group is limited
to payment of Medicare Part B premiums.
C. Qualifying Individuals (QI) must be
entitled to Medicare Part A and have income that exceeds one hundred twenty
percent (120%) of the federal poverty level but does not exceed one hundred
thirty-five percent (135%) of the FPL.
1.
Medical assistance for this group is limited to payment of Medicare Part B
premiums under a federal allotment of funds.
2. Eligibility for coverage as a QI is
dependent on the availability of federal funds.
D. Payment of the Medicare Part D pharmacy
plan premium is applicable to the Medicare cost-sharing groups of QMB, SLMB and
QI provided the beneficiary enrolls in a benchmark pharmacy plan. Benchmark or
zero dollars ($0) premium plans are subject to change each calendar year based
on plans that choose to participate within the state of Mississippi.
E. Qualified Disabled and Working Individuals
must be entitled to Medicare Part A and have income that does not exceed two
hundred percent (200%) of the FPL whose return to work results in the loss of
coverage for Medicare. Medical assistance is limited to payment of the Part A
premium.
F. The Division of
Medicaid certifies eligibility for all of the Medicare cost-sharing
groups.
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