Specified Medicare Beneficiary (SLMB) (S05)

Created on: 
Apr 21 2016

See ACES Screens and Online Pages for an example of pages or screens used in this chapter.

What is the Specified Medicare Beneficiary (S05) medical program?

The S05 medical is a Medicare Savings Program that pays Medicare Part B premiums for qualified clients. For more information on this program, see Apple Health eligibility manual - Apple Health Medicare Savings Programs & Medicare Buy-In Programs.

Who is eligible to receive Specified Medicare Beneficiary (S05) medical?

A person who meets the following criteria may be eligible for S05 Medical:

  • Is eligible for or receiving Medicare;
  • Has countable income greater than 100% but less than 120% of the Federal Poverty Level (FPL) and countable resources at or below the resource standards.

For more information, see:

How long is the Specified Medicare Beneficiary (S05) medical certification period?

Eligibility for S05 begins the first of the month the client becomes eligible for Part B coverage and is certified for 12 months. For more information, see Apple Health eligibility manual - WAC 182-504-0025 Medicare savings program certification periods.

What if the client’s countable income exceeds 120% of the Federal Poverty Level (FPL)?

The pending Qualified Medicare Beneficiary (S03) trickles to the Qualified Individual (S06) medical program when:

For more information, see Apple Health eligibility manual - WAC 182-517-0300 Federal Medicare savings and state-funded Medicare buy-in programs.

Online Processing

How do I screen Specified Medicare Beneficiary (S05) medical?

An S05 Assistance Unit (AU) is initially screened in as a Qualified Medicare Beneficiary (S03) AU following the instructions in How do I screen Qualified Medicare Beneficiary (S03) medical?

How do I process a pending Specified Medicare Beneficiary (S05) Assistance Unit (AU)?

To process a pending S05 AU follow the steps in How do I process a pending Qualified Medicare Beneficiary (S03) Assistance Unit (AU)?

Note: If eligible the S03 AU trickles to S05 when it is finalized

Mainframe Processing

How do I screen Specified Medicare Beneficiary (S05) medical?

An S05 Assistance Unit (AU) is initially screened in as a Qualified Medicare Beneficiary (S03) AU following the instructions in How do I screen Qualified Medicare Beneficiary (S03) medical?

How do I process a pending Specified Medicare Beneficiary (S05) Assistance Unit (AU)?

To process a pending S05 AU follow the steps in How do I process a pending Qualified Medicare Beneficiary (S03) Assistance Unit (AU)?

Note: If eligible the S03 AU trickles to S05 when it is finalized.

 

See ACES Screens and Online Pages for an example of pages or screens used in this chapter.