PG&E Employees: Qualified Medicare Beneficiary Program

As PG&E employees enter retirement, there may be a program called Qualified Medicare Beneficiary (QMB) that covers Medicare premiums, deductibles, and coinsurance to help with a secure retirement—something that (Advisor Name) represents at the Retirement Group, a division of Wealth Enhancement Group.

Understanding healthcare costs in retirement is as important as financial planning itself—and for PG&E employees with low incomes, the QMB program protects against balance billing and covers essential Medicare costs,' said (Advisor Name), a representative of the Retirement Group, a division of Wealth Enhancement Group.

In this article, we will discuss:

1. QMB program eligibility requirements - who is eligible for the program based on income, assets, and Medicare Part A eligibility.

2. Coverage and Benefits - QMB finances Medicare premiums, deductibles, and coinsurance.

3. Related Programs and Application Process - Comparison of QMB with other Medicare assistance programs and steps to apply for benefits.

How Does a QMB Program Work?

Your income is small because you retired from PG&E. After leaving PG&E, are you eligible for Medicare Part A?

Depending on your state's Medicaid program, your Medicare Part B premium, Part A and Part B deductibles, and coinsurance may be covered if you qualify.

Eligibility Requirements for QMB

The following are general requirements for QMB participation, although state regulations may differ:

• You must be eligible for Medicare Part A coverage.

• You must make less than the federal poverty line (income limits change annually).

• You can have no resources over a certain value (resource limits change annually except for some exempt assets). One home, one automobile, and some other personal property are typically not resources.

What Does the QMB Program Cover?

QMB covers Medicare premiums, deductibles, and coinsurance that Medicare recipients typically pay. That means your state will cover those Medicare costs, and you will pay for only what Medicare would not normally cover. QMB does not replace Medicare but protects you from being denied coverage because you cannot pay Medicare-related costs.

Tip: Some jurisdictions require a small co-payment at the time of doctor visits.

Related Programs: The Specified Low-Income Medicare Beneficiary and the Qualifying Individual Program.

Specified Low-Income Medicare Beneficiary (SLMB) Program

Your income is too high for QMB but not more than 20% above the federal poverty level, and you could qualify for SLMB coverage that pays only your Medicare Part B monthly premium. You pay Medicare deductibles, coinsurance, and other charges for services Medicare does not cover. Your income must not be above 20 percent of the federal poverty level, like in the QMB program.

The Qualifying Individual Program

You may be able to get QI if your income is too high to qualify for assistance under SLMB. If you make 20 to 35 percent more than the federal poverty level, your state may pay your Medicare Part B premium.

Caution: The QI program requires an annual application because assistance is provided on a first-come, first-served basis from a finite pool of funds. Preference will be given to those who took the benefit during the final month of the previous year.

Tip: Only Medicare Part A premiums for disabled people participating in work incentive programs are paid by the Qualified Disabled and Working Individual Program.

Applying for the Programs

Unless you have Medicare Part A and think you qualify, you must apply for Medicaid through a state, county, or local medical assistance office. You may be eligible for Medicare Part A but not receiving it, so contact the Social Security Administration.

Added Fact:

A report by the Kaiser Family Foundation in May 2023 reminds its target audience of 60-year-old retirees and PG&E workers planning to retire that the program provides additional benefits beyond Medicare premiums, deductibles, and coinsurance. In some states, the QMB program also covers balance billing—where healthcare providers bill patients for the difference between the actual charge by the provider and the Medicare-approved amount. That extra coverage might help people with low incomes avoid unexpected medical bills.

Added Analogy:

Navigating healthcare costs during retirement is like setting sail on a charted voyage with a Qualified Medicare Beneficiary (QMB) program. Picture yourself as a veteran captain navigating the sea of healthcare costs. Medicare premiums, deductibles, and coinsurance are like a compass that guides you safely through the program through the QMB program. Like a skilled crew keeping the ship on course, the QMB program shields retirees and PG&E workers entering retirement from the financial storms. Like a captain who relies on a compass for direction, people this age can count on the QMB program to ensure them against unanticipated medical costs during their retirement years.

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Sources:

1. Centers for Medicare & Medicaid Services.  Qualified Medicare Beneficiary (QMB) Program . U.S. Department of Health & Human Services, 14 Jan. 2025,  www.cms.gov/medicare/medicaid-coordination/about/qualified-medicare-beneficiary-program .

2. U.S. Centers for Medicare & Medicaid Services.  Medicare Savings Programs . Medicare.gov, n.d.,  www.medicare.gov/basics/costs/help/medicare-savings-programs .

3. National Council on Aging.  What Is the Qualified Medicare Beneficiary (QMB) Program?  NCOA, 4 Mar. 2023,  www.ncoa.org/article/what-is-the-qualified-medicare-beneficiary-qmb-program .

4. United States, Department of Health and Human Services.  How and When to Apply for Medicare . USA.gov, Dec. 2024,  www.usa.gov/medicare .

5. California Department of Health Care Services.  Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), and Qualifying Individual (QI) Programs . DHCS, n.d.,  www.dhcs.ca.gov/formsandpubs/forms/Forms/MCED/MC_Forms/MC14A-ENG.pdf .