2015 Federal Poverty Level Standards: Dual Eligible Eligibility Criteria for Medicare and Medicaid Enrollees

The Centers for Medicare and Medicaid Services (CMS) released an informational bulletin (01/29/2015) regarding the 2015 updates to the federal poverty guidelines. By law these updates are applied to eligibility criterion for programs such as Medicaid and the Children’s Health Insurance Program (CHIP). The 2015 Dual Eligible standards have also been updated based on the percentage of Federal Poverty Level. The following information is as posted by Medicaid.gov. 

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.

2015 Dual Eligible Standards
(Based on Percentage of Federal Poverty Level)

Qualified Medicare Beneficiary (QMB):

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

All States and DC (Except Alaska & Hawaii):	$1,001 – Individual   $1,348 – Couple
Alaska:	$1,247 – Individual   $1,680 – Couple
Hawaii:	$1,150 – Individual   $1,548 – Couple
Asset Limits:	$7,280 – Individual  $10,930 – Couple

*$20 = Amount of the Monthly SSI Income Disregard

Specified Low-Income Medicare Beneficiary (SLMB):

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

All States and DC (Except Alaska & Hawaii):	$1,197 – Individual   $1,613 – Couple
Alaska:	$1,492 – Individual   $2,012 – Couple
Hawaii:	$1,375 – Individual   $1,853 – Couple
Asset Limits:	$7,280 – Individual  $10,930 – Couple

*$20 = Amount of the Monthly SSI Income Disregard

Qualifying Individual (QI):

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

All States and DC (Except Alaska & Hawaii):	$1,345 – Individual   $1,813 – Couple
Alaska:	$1,676 – Individual   $2,261 – Couple
Hawaii:	$1,545 – Individual   $2,083 – Couple
Asset Limits:	$7,280 – Individual  $10,930 – Couple

*$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)

All States and DC (Except Alaska & Hawaii):	$4,009 – Individual   $5,395 – Couple
Alaska:	$4,992 – Individual   $6,725 – Couple
Hawaii:	$4,602 – Individual   $6,195 – Couple
Asset Limits:	$4,000 – Individual   $6,000 – Couple

*$20 = Amount of the Monthly SSI Income Disregard