TABLE C-1Medicaid Eligibility and Benefits by Type of Dual-Eligible Beneficiary

Type Full or partial Medicaid benefits Federal income and asset (individual/couple) limits for eligibility in 2021 Benefits
Medicare Savings Program (MSP) beneficiaries
Qualified Medicare beneficiary (QMB)Partial: QMB only
  • At or below l00% FPL
  • 7,970 / $11,960
Entitled to Medicare Part A, eligible for Medicaid only under MSP, and qualify for Medicaid payment of:
  • Medicare Part A premiums (if needed)
  • Medicare Part B premiums
  • At state option, certain premiums charged by Medicare Advantage plans
  • Medicare deductibles, coinsurance, and copayments (except for nominal copayments in Part D, the Medicare drug program)
Full: QMB plus
  • At or below 100% FPL
  • 2,000 / $3,000
Entitled to Medicare Part A, eligible for Medicaid under a mandatory or optional pathway in addition to MSP, and qualify for Medicaid payment of:
  • Medicare Part A premiums (if needed)
  • Medicare Part B premiums
  • At state option, certain premiums charged by Medicare Advantage plans
  • Medicare deductibles, coinsurance, and copayments (except for nominal copayments in Part D)
  • All Medicaid-covered services
Specified low-income Medicare beneficiary (SLMB)Partial: SLMB only
  • 101%–120% FPL
  • 7,970 / $11,960
Entitled to Medicare Part A, eligible for Medicaid only under MSP, and qualify for Medicaid payment of:
  • Medicare Part B premiums
Full: SLMB plus
  • 101%–120% FPL
  • 2,000 / $3,000
Entitled to Medicare Part A, eligible for Medicaid under a mandatory or optional pathway in addition to MSP, and qualify for Medicaid payment of:
  • Medicare Part B premiums
  • At state option, certain premiums charged by Medicare Advantage plans
  • Medicare deductibles, coinsurance, and copayments (except nominal copayments in Part D); state may elect to pay only for Medicare services covered by Medicaid
  • All Medicaid-covered services
Qualifying individual (QI)Partial
  • 121%–135% FPL
  • 7,970 / $11,960
Entitled to Medicare Part A, eligible for Medicaid only under MSP, and qualify for Medicaid payment of:
  • Medicare Part B premiums
Qualified disabled and working individuals (QDWI)Partial
  • At or below 200% FPL
  • 4,000 / $6,0002
Lost Medicare Part A benefits because of their return to work but eligible to purchase Medicare Part A, eligible for Medicaid only under MSP, and qualify for Medicaid payment of:
  • Medicare Part A premiums
Non-MSP beneficiaries
Other full-benefit dual-eligible beneficiariesFull
  • Income limit varies, but generally at or below 300% of the federal Supplemental Security Income benefit rate (about 225% FPL for an individual)
  • 2,000 / $3,000
Eligible under a mandatory or optional Medicaid pathway, not eligible for MSP, and qualify for Medicaid payment of:
  • At state option. certain premiums charged by Medicare Advantage plans
  • Medicare deductibles, coinsurance, and copayments (except for nominal copayments in Part D); state may elect to pay only for Medicare services covered by Medicaid
  • All Medicaid-covered services

SOURCE: MedPAC, 2022.

From: Appendix C, Chapter 3 Tables

Cover of Expanding Behavioral Health Care Workforce Participation in Medicare, Medicaid, and Marketplace Plans
Expanding Behavioral Health Care Workforce Participation in Medicare, Medicaid, and Marketplace Plans.
National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Health Care Services; Committee on Strategies to Improve Access to Behavioral Health Care Services through Medicare and Medicaid; Perera U, Godwin A, Polsky D, editors.
Washington (DC): National Academies Press (US); 2024 Oct 7.
Copyright 2024 by the National Academy of Sciences. All rights reserved.

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