(a) Authorized under 42 U.S.C. §1396a(a)(10)(E)(i),
the Qualified Medicare Beneficiary (QMB) Program pays Medicare premiums,
deductibles, and coinsurance for a person who meets the requirements
of this section. A person receiving Medicaid may also receive QMB
benefits if the person meets the requirements of this section.
(b) To be eligible for QMB coverage, a person must:
(1) be entitled to benefits under Medicare Part A;
(2) meet income requirements in 42 U.S.C. §1396d(p),
except for:
(A) payments made from or interest earned on a tuition
savings program under 358.388 of this title (relating to Tuition Savings
Programs);
(B) payments made from or interest earned on an Achieving
a Better Life Experience (ABLE) account under §358.389 of this
title (relating to Achieving a Better Life Experience Program); and
(C) income earned on a school-based savings program
under §358.390 of this title (relating to School-Based Savings
Program).
(3) meet resource requirements in 42 U.S.C. §1396d(p),
except for:
(A) funds used to establish a tuition savings program
under §358.356 of this title (relating to Tuition Savings Programs);
(B) funds used to establish an ABLE account and funds
held in an ABLE account under §358.357 of this title (relating
to Achieving a Better Life Experience Program); and
(C) funds held in a school-based savings program under §358.358
of this title (relating to School-Based Savings Program).
(c) A person is not eligible for QMB coverage if the
person:
(1) is in the custody of penal authorities as defined
in 42 C.F.R. §411.4(b); or
(2) is over 20 years of age and under 65 years of
age and resides in an institution for mental diseases.
(d) A person's QMB eligibility begins on the first
day of the month after the month the person is certified for QMB benefits.
(e) A person with QMB coverage is not eligible for
three months prior medical coverage.
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Source Note: The provisions of this §359.103 adopted to be effective September 1, 2009, 34 TexReg 5516; amended to be effective February 3, 2013, 38 TexReg 366; amended to be effective November 20, 2016, 41 TexReg 9004 |