End Stage Renal Disease (ESRD) Medicare

What is ESRD Medicare and what assistance DHS can offer

Buy-In – How Does the Buy-in Work?

Buy-in is certified (QMB, SLMB, or QI-1) and OKDHS sends Buy-In (accretion) requests to CMS in Baltimore, MD. Client must be on Medicare, or going on the next month, before a Buy-In benefit can be coded on the case. If a worker adds a client to a buy-in benefit when the client is not yet […]

Medicare Information

Medicare has four parts each covering something different. Part A: covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. People who have worked 40 quarters do not pay a premium. Those who have not worked 40 quarters, like many SSI recipients, will have to pay a significant […]

Qualified Medicare Beneficiaries Plus (QMBP)

Qualified Medicare Beneficiaries Plus (QMBP) – means certain aged, blind or disabled individuals who may or may not be enrolled in Medicare Part A, meet the Medicaid QMBP income and resource standards and meet all other Medicaid eligibility requirements.  When approved for QMBP, Medicaid pays for Medicare premiums, deductibles, and co-insurance.  Policy regarding this term […]

Buy-In

Buy-In – means the procedure whereby the Oklahoma Health Care Authority pays the person’s Medicare premium.

Qualified Individuals – Group 1 (QI-1)

Definition of QI-1

Specified Low Income Medicare Beneficiary (SLMB)

Specified Low-Income Medicare Beneficiary (SLMB) 317:35-7-43 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 […]

Qualified Medicare Beneficiary Plus (QMBP)

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 […]