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The following chart describes the various categories of individuals who, collectively, are known as dual eligibles. Medicare has two basic coverages: Part A, which pays for hospitalization costs; and Part B, which pays for physician services, lab and x-ray services, durable medical equipment, and outpatient and other services. Dual eligibles are individuals who are entitled to Medicare Part A and/or Part B and are eligible for some form of Medicaid benefit. | Type of Medicaid Benefit | Dual Eligible Category | Part A Premium | Part B Premium | Medicare cost-sharing | Full Medicaid Benefits | Medicaid Only | No | Yes | No | Yes | QMB | Yes | Yes | Yes | No | QMB Plus | Yes | Yes | Yes | Yes | SLMB | No | Yes | No | No | SLMB Plus | No | Yes | No | Yes | QI | No | Yes | No | No | QDWI | Yes | No | No | No |
Description of Dual Eligible Medicare Beneficiary GroupsMedicaid Only: Eligible for Medicaid benefits, categorically, or through optional coverage groups such as medically needy or special income levels for institutionalized or home and community-based waivers, but do not meet the income or resource criteria for QMB or SLMB. Federal financial participation (FFP) is Federal medical assistance percentage (FMAP). Qualified Medicare Beneficiary (QMB)*: Entitled to Medicare Part A, income of 100% FPL or less, and resources that do not exceed twice the SSI limit ($4,000 for an individual, and $6,000 for a couple). FFP is FMAP. Specified Low-income Medicare Beneficiary (SLMB)*: Entitled to Medicare Part A, income above 100% FPL but less than 120% FPL, and resources that do not exceed twice the SSI limit ($4,000 for an individual, and $6,000 for a couple). FFP is FMAP. Qualifying Individual (QI): Entitled to Medicare Part A, income at least 120% FPL but less than 135% FPL, and resources that do not exceed twice the SSI limit ($4,000 for an individual, and $6,000 for a couple) and not otherwise eligible for Medicaid benefits. FFP is 100% Federal. Qualified Disabled and Working Individual (QDWI): Lost Medicare Part A benefits due to return to work, but is eligible to enroll in and purchase Medicare Part A. Must have income of 200% FPL or less and resources that do not exceed twice the SSI limit ($4,000 for an individual, and $6,000 for a couple) and not otherwise eligible for Medicaid benefits. FFP is FMAP. *QMB Plus and SLMB Plus categories were created when Congress changed eligibility criteria for QMBs and SLMBs to eliminate the requirement that QMBs and SLMBs could not otherwise qualify for Medicaid. Dual Eligible Income Limits Based on the Percentage of Federal Poverty Level The 2005 and 2006 Medicare/Medicaid dual eligible income limits based on the percentage of the Federal Poverty Level may be downloaded from the bottom of this page. In addition, the HHS website for the Federal Poverty Guidelines may also be accessed. (See related links inside CMS at the bottom of page.)
Page Last Modified: 12/14/2005 12:00:00 AM
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