Table 1 - Eligibility Categories and Assistance with Medicare Part A and Part B CostsThis section summarizes the eligibility categories for dually eligible individuals, including the degree to which individuals in each category receive assistance with Medicare Parts A and B premiums and cost sharing. Each eligibility category is mutually exclusive.CategoryMonthly Income as of 2021*Assets as of 2021* Covers Part A premium (when applicable)Covers Part B premiumCovers Parts A & B cost sharingFull Medicaid coverage**QMB onlyIndividual:Individual:XXX***$1,094;$7,970;MarriedMarriedCouple:Couple:$1,472$11,960QMB plusIndividual:Individual:XXX***X$1,094;$7,970;MarriedMarriedCouple:Couple:$1,472$11,960SLMB onlyIndividual:Individual:X$1,308;$7,970;MarriedMarriedCouple:Couple:$1,762$11,960SLMB plusIndividual:Individual:XVaries by X$1,308;$7,970;stateMarriedMarried*****Couple:Couple:$1,762$11,960QIIndividual:Individual:X$1,469;$7,970;MarriedMarriedCouple:Couple:$1,980$11,960QDWIIndividual:Individual:X$4,379;$4,000;MarriedMarriedCouple:Couple:
3CategoryMonthly Income as of 2019*Assets as of 2019*Covers Part A premium (when applicable)Covers Part B premiumCovers Parts A & B cost sharingFull Medicaid coverage**$5,892$6,000Full –benefit Medicaid(only)**Determined by stateDetermined by stateVaries by state****Varies by state ***** X* The income and resource limits for the MSPs are released annually by the Centers for Medicare & Medicaid Services (CMS). The income limit for QDWI includes an earned income disregard of $65. The asset limit calculation for QMBs, SLMBs, and QIs is 3 times the SSI resource limit, adjusted annually by increases in the Consumer Price Index (effective January 1, 2010). States can effectively raise the federal floor for income and resources standards under the authority of section 1902(r)(2) of the Social Security Act, which generally permits state Medicaid agencies to disregard income and/or resources that are counted under certain standard financial eligibility methodologies. Some states have used the authority of section 1902(r)(2) of the Act to eliminate any resource criteria for the MSP groups.** “Full-benefit” Medicaid coverage generally refers to coverage for a range of items and services, beyond coverage for Medicare premiums and cost-sharing, that certain individuals are entitled to when they qualify under certain eligibility categories included in the State Medicaid Plan (state plan). Individuals who are QMB/SLMB “plus” receive full-benefit Medicaid in addition to Medicare cost-sharing and premiums coverage. Individuals who receive full-benefit Medicaid only are entitled to Medicare Part A and/or enrolled in Part B, and qualify for full-benefit Medicaid benefits, but not the QMB or SLMB programs*** While individuals enrolled in QMB do not pay Medicare deductibles, coinsurance, or copays, they may have a small Medicaid copay for certain Medicaid-covered services. **** States pay the Part B premiums if they include all Medicaid categories in their Part B buy-in coverage group.. ***** Beneficiary pays no more than amount allowed by the state plan for services covered by both Medicare and Medicaid. Also, all Medicare providers (regardless of Medicaid participation) must accept the Medicare-allowed amount as payment in full for Part B services furnished to dual eligible beneficiarie