The QMB Program

              State of Illinois
Rod R. Blagojevich, Governor
Illinois Department of Healthcare
and Family Services
Barry S. Maram, Director
THE QMB PROGRAM
ARE YOU ELIGIBLE FOR MEDICARE?
THEN YOU SHOULD KNOW...
...that you may also be eligible for the Qualified
Medicare Beneficiary (QMB) program.
QMB benefits include:
• Payment of Medicare Part A monthly premiums
when applicable.
• Payment of Medicare Part A deductible and
co-insurance amounts.
• Payments of Medicare Part B monthly premiums
and annual deductible.
• Payment of Medicare Part B 20% co-insurance
amounts.
You may be eligible if:
• You receive Medicare Part A,
• Your income must not be more than $867/month for
one person or $1,167/month for a couple (These
amounts change every April), and
• Your assets do not exceed $4,000 for yourself or
$6,000 if you have one or more dependents living
with you.
How Do I Apply?
Visit the local Department of Human Services (DHS)
Family Community Resource Center (FCRC) nearest you,
and a caseworker will help you apply for the QMB
Program. Or request an application by calling or writing to
your local FCRC.
You will need a copy of your Medicare card or a letter
notifying you that you are eligible for Medicare.
After you apply, your FCRC will inform you in writing if you
qualify for QMB benefits.
If you have any questions or need more information, call
the DHS Helpline at 1-800-843-6154 (voice), Monday
through Friday (except state holidays), between 8:30 a.m.
and 5:00 p.m. Persons using a teletypewriter (TTY) can
call 1-800-447-6404. The call is free.
HFS 3352-S (R-04-08)
Printed by the Authority of the State of Illinois
P.O. 34000-29, Copies 3,000.
IISG08-971
State of Illinois
Rod R. Blagojevich, Governor
Illinois Department of Healthcare
and Family Services
Barry S. Maram, Director
THE QMB PROGRAM
ARE YOU ELIGIBLE FOR MEDICARE?
THEN YOU SHOULD KNOW...
...that you may also be eligible for the Qualified
Medicare Beneficiary (QMB) program.
QMB benefits include:
• Payment of Medicare Part A monthly premiums
when applicable.
• Payment of Medicare Part A deductible and
co-insurance amounts.
• Payments of Medicare Part B monthly premiums
and annual deductible.
• Payment of Medicare Part B 20% co-insurance
amounts.
You may be eligible if:
• You receive Medicare Part A,
• Your income must not be more than $867/month for
one person or $1,167/month for a couple (These
amounts change every April), and
• Your assets do not exceed $4,000 for yourself or
$6,000 if you have one or more dependents living
with you.
How Do I Apply?
Visit the local Department of Human Services (DHS)
Family Community Resource Center (FCRC) nearest you,
and a caseworker will help you apply for the QMB
Program. Or request an application by calling or writing to
your local FCRC.
You will need a copy of your Medicare card or a letter
notifying you that you are eligible for Medicare.
After you apply, your FCRC will inform you in writing if you
qualify for QMB benefits.
If you have any questions or need more information, call
the DHS Helpline at 1-800-843-6154 (voice), Monday
through Friday (except state holidays), between 8:30 a.m.
and 5:00 p.m. Persons using a teletypewriter (TTY) can
call 1-800-447-6404. The call is free.
HFS 3352-S (R-04-08)
Printed by the Authority of the State of Illinois
P.O. 34000-29, Copies 3,000.
IISG08-971
State of Illinois
Rod R. Blagojevich, Governor
Illinois Department of Healthcare
and Family Services
Barry S. Maram, Director
THE QMB PROGRAM
ARE YOU ELIGIBLE FOR MEDICARE?
THEN YOU SHOULD KNOW...
...that you may also be eligible for the Qualified
Medicare Beneficiary (QMB) program.
QMB benefits include:
• Payment of Medicare Part A monthly premiums
when applicable.
• Payment of Medicare Part A deductible and
co-insurance amounts.
• Payments of Medicare Part B monthly premiums
and annual deductible.
• Payment of Medicare Part B 20% co-insurance
amounts.
You may be eligible if:
• You receive Medicare Part A,
• Your income must not be more than $867/month for
one person or $1,167/month for a couple (These
amounts change every April), and
• Your assets do not exceed $4,000 for yourself or
$6,000 if you have one or more dependents living
with you.
How Do I Apply?
Visit the local Department of Human Services (DHS)
Family Community Resource Center (FCRC) nearest you,
and a caseworker will help you apply for the QMB
Program. Or request an application by calling or writing to
your local FCRC.
You will need a copy of your Medicare card or a letter
notifying you that you are eligible for Medicare.
After you apply, your FCRC will inform you in writing if you
qualify for QMB benefits.
If you have any questions or need more information, call
the DHS Helpline at 1-800-843-6154 (voice), Monday
through Friday (except state holidays), between 8:30 a.m.
and 5:00 p.m. Persons using a teletypewriter (TTY) can
call 1-800-447-6404. The call is free.
HFS 3352-S (R-04-08)
Printed by the Authority of the State of Illinois
P.O. 34000-29, Copies 3,000.
IISG08-971