Topic: Medicare
Qualified Disabled and Working Individual (QDWI) – means individuals who have lost their Title II Social Security benefits due to excess earnings, but have been allowed to retain Medicare coverage. Policy regarding this term is located at: Public Assistance Procedures (SoonerCare): 340:65-3-1. Determination of eligibility. SoonerCare (Medicaid)[ABD]: 317:35-1-2. Definitions; 317:35-5-63. Agency responsible for determination of […]
Medicare – -means the federally funded health insurance program also known as Title XVIII of the Social Security Act. It consists of four separate programs. Part A is Hospital Insurance, Part B is Medical Insurance, Part C is Medicare Advantage Plans, and Part D is Prescription Drug Coverage. Policy regarding this term is located at: […]
Buy-In – means the procedure whereby the Oklahoma Health Care Authority pays the person’s Medicare premium.
Definition of QI-1
Specified Low-Income Medicare Beneficiary (SLMB) Program to pay Medicare Part B premiums for those whose income is above the QMBP standard. Person must be enrolled in Part A Medicare and paying any associated fees if they have them Persons on one of the LTC medical programs (ADvantage, Nursing Home, DDS) can also be eligible for […]
Qualified Medicare Beneficiary Plus (QMBP) 317:35-7-40 Program to provide SoonerCare services to people considered aged, blind or disabled who have too much income to be eligible for the SSP. Can pay Medicare Part A and Part B premiums/fees for those who have them – commonly known as buy-in. For a new certification, medical benefit can […]
Medicaid applicants must disclose to OHCA any resources available to pay for care. This includes private insurance, government benefits (such as Medicare, CHAMPUS or TriCare) and worker’s compensation. All disclosed insurance policies must be entered on the TPL tab in FACS, except for Medicare which should not be entered but should be noted in FACS case […]
Aged, Blind, or Disabled individuals may be eligible for various programs and benefits.