02/01/2023
Summary:
- This manual release provides guidance and clarification related to conditional enrollment for Medicare Part A and the payment of Hospital Insurance Benefits (HIB) by the Department.
To be eligible for the Qualified Medicare Beneficiary (QMB) program, an individual must be a current Medicare Part A beneficiary or conditionally enrolled for Medicare Part A.
An individual ineligible for free Medicare Part A may also utilize the conditional enrollment process. The conditional enrollment process allows a person to apply for Medicare Part A with the Social Security Administration (SSA) for Medicare Part A with coverage beginning only if they are determined to be eligible for QMB. Conditional Part A enrollments can be identified by the status code Z99- This person is not entitled to Part A which will appear in the Part A HIB Buy-In Payer position for the SOLQ response.
The Department will pay the HIB premium for QMBs who are not eligible for free Medicare Part A. The individual must be enrolled or conditionally enrolled in HIB before the Department takes over the payment of premiums. Premiums are paid effective for the month of QMB eligibility, which is the month after the month of the QMB eligibility determination. Payment continues as long as the person is eligible for QMB benefits.
Manual Revisions:
[signed copy on file]
Grace B. Hou
Secretary, Illinois Department of Human Services (no heading, italicized)
Theresa Eagleson
Director, Illinois Department of Healthcare and Family Services (no heading, italicized)
