Seniors & Medicare and Medicaid Enrollees

Medicaid provides health coverage to more than 4.6 million low-income seniors, nearly all of whom are also enrolled in Medicare. Medicaid also provides coverage to 3.7 million people with disabilities who are enrolled in Medicare. In total, 8.3 million people are "dually eligible" and enrolled in both Medicaid and Medicare, composing more than 17% of all Medicaid enrollees. Individuals who are enrolled in both Medicaid and Medicare, by federal statute, can be covered for both optional and mandatory categories.

What Medicaid Covers for Medicare Enrollees

Medicare has four basic forms of coverage:

  • Part A: Pays for hospitalization costs
  • Part B: Pays for physician services, lab and x-ray services, durable medical equipment, and outpatient and other services
  • Part C: Medicare Advantage Plan (like an HMO or PPO) offered by private companies approved by Medicare
  • Part D: Assists with the cost of prescription drugs

Medicare enrollees who have limited income and resources may get help paying for their premiums and out-of-pocket medical expenses from Medicaid (e.g. MSPs, QMBs, SLBs, and QIs). Medicaid also covers additional services beyond those provided under Medicare, including nursing facility care beyond the 100-day limit or skilled nursing facility care that Medicare covers, prescription drugs, eyeglasses, and hearing aids. Services covered by both programs are first paid by Medicare with Medicaid filling in the difference up to the state's payment limit.

2017 Dual Eligible Standards
(Based on Percentage of Federal Poverty Level)

Qualified Medicare Beneficiary (QMB):

Monthly Income Limits: (100% FPL + $20)*

  Individual Couple
All States and DC
(Except Alaska & Hawaii)
$1,025 $1,374
Alaska $1,275 $1,711
Hawaii $1,175 $1,576
Asset Limits $7,390 $11,090

*$20 = Amount of the Monthly SSI Income Disregard

Specified Low-Income Medicare Beneficiary (SLMB):

Monthly Income Limits: (120% FPL + $20)*

  Individual Couple
All States and DC
(Except Alaska & Hawaii)
$1,226 $1,644
Alaska $1,526 $2,049
Hawaii $1,406 $1,887
Asset Limits $7,390 $11,090

*$20 = Amount of the Monthly SSI Income Disregard

Qualifying Individual (QI):

Monthly Income Limits: (135% FPL + $20)*

  Individual Couple
All States and DC
(Except Alaska & Hawaii)
$1,377 $1,847
Alaska $1,715 $2,303
Hawaii $1,580 $2,121
Asset Limits  $7,390 $11,090

*$20 = Amount of the Monthly SSI Income Disregard

Qualified Disabled Working Individual (QDWI):

Monthly Income Limits: (200% FPL + $20)*
(Figures include additional earned income disregards)

  Individual Couple
All States and DC
(Except Alaska & Hawaii)
$4,105 $5,499
Alaska $5,105 $6,849
Hawaii $4,705 $6,309
Asset Limits $4,000 $6,000

*$20 = Amount of the Monthly SSI Income Disregard