The Medicare Premium Assistance Program is for certain people eligible for Medicare. It is administered by the Ohio Department of Job and Family Services (ODJFS) as a part of the Medicaid program. Sometimes it is also called the "Medicare Buy-In" program.
The Medicare Premium Assistance Program offers three types of assistance. These types are:
The income guidelines and asset limits for these programs are listed below.
Monthly Income Guidelines (Effective March 1, 2008)
Individual Income Limit
Couple Income Limit
QMB
$887 or less
$1,187 or less
SLMB
$888 - $1,060
$1,188 - $1,420
QI-1
$1,061 - $1,190
$1,421 - $1,595
*Income based on 2008 Federal Poverty Level - adjustments made yearly; Standards listed prior to $20 Income disregard
Asset Limits
Individual Asset Limit
Couple Asset Limit
$4,000
$6,000
The Medicare covered costs for each assistance type are listed below:
Medicare Covered Costs
Covered Portion
QMB
Medicare Part A & B Premiums
Medicare Deductible
Medicare Coinsurance
SLMB
QI-1
Medicare Part B Premium
Who is eligible for these three types of assistance?
1. A Qualified Medicare Beneficiary (QMB) is a Medicare consumer who is eligible for payment of his/her Medicare premium(s), coinsurance and deductibles. QMB is for individuals who:
are eligible for Medicare Part A (hospital insurance);
have countable monthly income (Figure 1) that does not exceed 100% of the federal poverty level (FPL)
meet the asset limit requirements (Figure 2), and;
meet the general eligibility requirements for Medicaid (e.g. social security enumeration, citizenship, residency, etc...).
An individual may be dually eligible for QMB and other Medicaid programs, such as Medicaid for the Aged, Blind or Disabled; Spenddown Medicaid; or Home and Community based Waiver Services. Per federal regulation, the QMB program does not provide retroactive payments to participants.
2. A Specified Low-Income Medicare Beneficiary (SLMB) is a Medicare consumer who is eligible for payment of their Medicare Part B (Supplemental Medical Insurance) premium only. To be eligible for SLMB, a consumer must:
eligible for Medicare Part A (hospital insurance);
have countable income (Figure 1) that is over 100% FPL but less than or equal to 120% FPL;
meet the asset limit requirements (Figure 2), and;
meet the general eligibility requirements for Medicaid.
Retroactive SLMB payments are available for up to three months prior to the month of application. In addition, an individual may be dually eligible, for SLMB and other Medicaid programs, such as Healthy Families; Medicaid for the Aged, Blind or Disabled; Spenddown Medicaid; or Home and community Based Waiver Services.
3. A Qualified Individual-1 (QI-1) is a Medicare consumer who is eligible for payment of their Medicare Part B (Supplemental Medical Insurance) premium only. QI-1 is for individuals who:
have countable monthly income (Figure 1) between 120% and 135% FPL;
meet the asset limit requirements (Figure 1), and;
meet the general eligibility requirements for Medicaid.
Retroactive QI-1 payments are available for up to three months prior to the month of application, but not prior to January 1st of each year. Also, an individual may be dually eligible for the QI-1 program and Delayed or Pay-In Spenddown Medicaid. (Refer to Medicaid for the Aged, Blind and Disabled section for more information about Spenddown Medicaid.)
In addition, the QI-1 program is 100% federally funded. This may, but has not to date, result in a limited number of eligible individuals in a given year.
How can I get more information and an application?
For an application, please go to the 'Forms & Waivers' section of this website. For more information about the Medicare Premium Assistance Program, you may visit the Office of Ohio Health Plan's web site at http://jfs.ohio.gov/ohp/
Applications are also available at your local county department of job and family services or by calling the Medicaid Consumer Hotline (toll-free) at 1-800-324-8680 or TDD 1-800-292-3572. No face-to-face interview is required. Simply complete the application and mail it to your local county department of job and family services.
Lorain County residents may call 440-323-5726 or 440-244-4150 to request an application be mailed to you. Ask for the Intake Screening department.
Lorain County Job & Family Services
42485 North Ridge Road
Elyria, Ohio 44035-1057
Phone: 440-323-5726
Lorain: 440-244-4150
Fax: 440-323-3422
TTY/TDD: 440-284-4125
Child Support Office: 440-284-4401
The Medicare Premium Assistance Program is for certain people eligible for Medicare. It is administered by the Ohio Department of Job and Family Services (ODJFS) as a part of the Medicaid program. Sometimes it is also called the "Medicare Buy-In" program. 