This is a clone of the Texas Administrative Code (TAC) for educational purposes. It is not the official version and should not be used for legal purposes. Site created Wed, 21 May 2025 21:16:36 GMT
(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.