Medicare Cost Sharing Programs

Medicare Cost Sharing Programs help ineligible beneficiaries pay for certain costs and charges associated with the Medicare Program. The three specific programs funded by the State of Illinois are the Qualified Medicare Beneficiaries (QMB) program, the Special Low Income Medicare Beneficiaries (SLIB) program, and the Qualified Individual (QI-1) program.

These programs are administered through the Illinois Department of Human Services (IDHS) and they are all commonly known at the IDHS local offices as QMB. Individuals can apply for these programs at the local IDHS office or by visiting the IDHS website. Eligibility critieria and scope and the benefits available under these programs are detailed below.

Qualified Medicare beneficiaries (QMB)

What Medicare covers

For more information on what is covered by Medicare, visit Medicare.gov.

Eligibility

A person is eligible for QMB coverage if they:

• Currently receive Medicare Part A benefits
• Meet general non-financial factors of eligibility - Social Security number, proof of citizenship, proof of residency, and assignment of medical support rights
• Have income and assets as discussed below

A person can apply for QMB benefits at their local IDHS office. If they are denied QMB, they can appeal through the local office under the appeal rules applicable to DHS. PM 01-07-00

QMB benefits begin the first month following the month in which they are determined eligible for the program.

Income limits

To qualify for QMB, a person's income must be below a certain amount. Medicare.gov has the most recent numbers.

Asset limits

To be eligible for QMB coverage, a person's "countable resources" currently must be below a certain amount. See the chart labeled "resources" at the bottom of this page on the DHS website. 

"Countable resources" do not include a home. But they do include, a car, a burial plot, up to $1,500 for burial expenses if they have been set aside, furniture, or other household or personal items.

If a person has assets below the standard assets for the Aid to the Aged, Blind, or Disabled (AABD) and are otherwise eligible for Medicaid benefits, they will receive both full Medicaid and QMB.

QMB benefits are subject to collection by DHS from liens on real property like a house and land owned by beneficiaries who have been in a medical institution for at least 120 days. See PM 23-09-00. QMB benefits are also subject to collection from the estate of a deceased person or their spouse.

Specified low-income medicare beneficiary (SLIB)

Low-income individuals with income too high for QMB may be eligible for the Specified Low-Income Medicare Beneficiaries (SLIB) program because the income level for SLIB goes up to 120% of the federal poverty guidelines.

Benefits

SLIB benefits are more limited than QMB. They cover only:

• Medicare Part B premiums

Eligibility

Persons are eligible for SLIB coverage if they:

• Are current Medicare Part A beneficiaries - Part A benefits must have started
• Provide eligibility documentation - Social Security number, proof of citizenship, proof of residency, and assignment of medical support rights
• Have income and assets as discussed below

SLIBs receive no other benefits than the payment of the Part B premium. However, persons eligible for SLIB may participate in the Department of Revenue's Pharmaceutical Assistance Program.

Local offices decide if a person in a spend down or applying for medical is eligible for SLIB. A person who is denied SLIB may appeal through the local office under the appeal rules applicable to DHS. PM 01-07-00

SLIB eligibility may be retroactive to 3 months before the month of application.

Income limits

To qualify for SLIB, a person's income must be less than 120% of the federal poverty level.

Asset limits

The SLIB asset standard is the same as the QMB asset standard (PM 06-12-01-a) in the QMB section above.

For AABD clients, the State of Illinois has no claim against the estate of a SLIB only client and will not place liens against that client's real property for institutional care beyond the 120 day mark.

Qualified individuals program (QI-1)

Qualified Individuals-1 (QI-1) must meet all the eligibility requirements for QMB, except countable income must be more than 120% of the federal poverty level and equal to or less than 135% of the federal poverty level. Under QI-1, an individual is only eligible to have the Medicare Part B premiums paid.

The local office decides if a person in spend down or applying for medical is eligible for QI-1. A person who is denied QI-1 may appeal through the local office under the appeal rules applicable to DHS. PM 01-07-00

For AABD clients, the State of Illinois has no claim against the estate of a client who only receives QI-1.