OAR 461-135-0730
Specific Requirements; QMB, SMB, SMF
(1)
The following requirements apply to QMB-BAS:(a)
To qualify for QMB-BAS, an individual must be receiving Medicare hospital insurance under Part A. This includes an individual who must pay a monthly premium to receive coverage.(b)
A client who qualifies for QMB-BAS is not eligible to receive the full range of the Department’s medical services. QMB-BAS benefits are limited to payments toward Medicare cost-sharing expenses. These expenses are:(A)
Medicare Part A and Part B premiums; and(B)
Medicare Part A and Part B deductibles and coinsurance up to the Department’s fee schedule.(2)
The following requirements apply to QMB DW:(a)
To qualify for the QMB-DW program, an individual must be eligible for Part A of Medicare as a qualified worker with a disability under Section 1818A of the Social Security Act (42 USC 1395i-2a). This is an individual under age 65 who has lost eligibility for Social Security disability benefits because the individual has become substantially gainfully employed, but can continue to receive Part A of Medicare by paying a premium.(b)
A QMB-DW client is eligible only for payment of premiums for Part A of Medicare. If the client is eligible for any other medical assistance program the client is not eligible for QMB-DW.(3)
The following requirements apply to QMB SMB:(a)
To qualify for QMB SMB, an individual must be receiving Medicare hospital insurance under Part A. This includes an individual who must pay a monthly premium to receive coverage.(b)
A client who qualifies for QMB SMB is not eligible to receive the full range of the Department’s medical services. QMB SMB benefits are limited to payment of Medicare Part B premiums.(4)
The following requirements apply to QMB-SMF:(a)
To qualify for QMB-SMF, an individual must be receiving Medicare hospital insurance under Part A. This includes an individual who must pay a monthly premium to receive coverage.(b)
A client who is otherwise eligible for another Medicaid program offered by the Department or the Oregon Health Authority is not eligible for QMB-SMF.(c)
A client who qualifies for QMB-SMF is not eligible to receive the full range of the Department’s medical services. QMB-SMF benefits are limited to payment for Medicare Part B premiums.(d)
The QMB-SMF program is subject to an enrollment cap based on the federal allocation. If the enrollment in this program exceeds the federal allocation, the program may be closed.
Source:
Rule 461-135-0730 — Specific Requirements; QMB, SMB, SMF, https://secure.sos.state.or.us/oard/view.action?ruleNumber=461-135-0730.