1 Tex. Admin. Code § 359.103 - Qualified Medicare Beneficiary Program
(a) Authorized under
42 U.S.C.
1396a(a)(10)(E)(i), the
Qualified Medicare Beneficiary (QMB) Program pays Medicare premiums,
deductibles, and coinsurance for a person who meets the requirements of this
section. A person receiving Medicaid may also receive QMB benefits if the
person meets the requirements of this section.
(b) To be eligible for QMB coverage, a person
must:
(1) be entitled to benefits under
Medicare Part A;
(2) meet income
requirements in
42
U.S.C. 1396d(p), except for:
(A) payments made from or interest earned on
a tuition savings program under §
358.388 of this title (relating to
Tuition Savings Programs);
(B)
payments made from or interest earned on an Achieving a Better Life Experience
(ABLE) account under §
358.389 of this title (relating to
Achieving a Better Life Experience Program); and
(C) income earned on a school-based savings
program under §
358.390 of this title (relating to
School-Based Savings Program).
(3) meet resource requirements in
42
U.S.C. 1396d(p), except for:
(A) funds used to establish a tuition savings
program under §
358.356 of this title (relating to
Tuition Savings Programs);
(B)
funds used to establish an ABLE account and funds held in an ABLE account under
§
358.357 of this title (relating to
Achieving a Better Life Experience Program); and
(C) funds held in a school-based savings
program under §
358.358 of this title (relating to
School-Based Savings Program).
(c) A person is not eligible for QMB coverage
if the person:
(1) is in the custody of penal
authorities as defined in
42
C.F.R. 411.4(b);
or
(2) is over 20 years of age and
under 65 years of age and resides in an institution for mental
diseases.
(d) A person's
QMB eligibility begins on the first day of the month after the month the person
is certified for QMB benefits.
(e)
A person with QMB coverage is not eligible for three months prior medical
coverage.
Notes
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