This information should help Medicare counselors advise Medicare beneficiaries who qualify for full dual Medicare-Medicaid eligibility or for QMB status as to what their options are. Counselors should also keep in mind the Affordable Care Act (ACA) provision, effective January 1, 2013, that requires Medicaid programs to pay the Medicare rate for many primary care services rendered by family physicians, internists and pediatricians in 2013 and 2014. This provision overrides the information provided in the “Pay 100% of Cost Sharing?” columns.

2012 Dual Eligible (D/E) and Qualified Medicare Beneficiary (QMB) Information by State

Which State Medicaid Programs Pay Physicians 100% of a D/E or QMB’s Cost Sharing?

Which State Medicaid Programs Will Pay a D/E or QMB’s Medicare Advantage Premium?

(Note: The cost sharing data is summarized from the MACPAC’s March 2013 “Report to the Congress on Medicaid and CHIP,” which can be accessed at http://www.macpac.gov/reports, while the oremium data comes from the Kaiser Commission on Medicaid and the Uninsured’s October 2012 report “Medicaid Today; Preparing for Tomorrow – A Look at State Medicaid Program Spending, Enrollment and Policy Trends,” which can be found on the Kaiser Family Foundation website www.kff.org.)

                                     Pay              Pay                                    Pay                Pay
                                     100%         Medicare                           100%          Medicare
                                    of Cost    Advantage                        of Cost      Advantage
   State                       Sharing?   Premium?         State        Sharing?      Premium?   

Alabama                      Never     Varies         Montana               Never  Unknown

Alaska                         Never       No              Nebraska              Always     Yes

Arizona                     Never    Unknown       Nevada                   Never       No

Arkansas                    Always    No               New Hampshire     Never      No

California                    Never       No               New Jersey            Never       No

Colorado                     Never      No               New Mexico           Never       No

Connecticut               Never  Unknown        New York                Unique   Yes

Delaware                     Never     No                North Carolina       Never      Yes

District of Columbia  Never     No                North Dakota         Never       No

Florida                        Never  Varies               Ohio                        Never       No

Georgia                       Never   Yes                 Oklahoma              Always      No

Hawaii                        Always   No                Oregon                    Never      No

Idaho                           Never   Yes                 Pennsylvania         Never      No

Illinois                       Never Unknown          Rhode Island          Never     No

Indiana                       Never    No                 South Carolina       Never     Yes

Iowa                          Always   No                 South Dakota       Always     Yes

Kansas                       Never    No                  Tennessee             Never      Yes

Kentucky                   Never    No                  Texas                     Never      Yes

Louisiana                   Never    No                  Utah                       Never       No

Maine                        Always No                  Vermont              Always      No

Maryland                   Never   No                  Virginia                 Never       No

Massachusetts         Never   No                  Washington        Never        No

Michigan                   Never   No                  West Virginia      Never       No

Minnesota              Never Unknown            Wisconsin           Never       No

Mississippi            Always    No                   Wyoming           Always      No

Missouri                Always     No

This information should help Medicare counselors advise Medicare beneficiaries who qualify for full dual Medicare-Medicaid eligibility or for QMB status as to what their options are.  Counselors should also keep in mind the Affordable Care Act (ACA) provision, effective January 1, 2013, that requires Medicaid programs to pay the Medicare rate for many primary care services rendered by family physicians, internists and pediatricians in 2013 and 2014.  This provision overrides the information provided in the “Pay 100% of Cost Sharing?” columns.

2013 Income and Resource Levels for the Medicare Savings Programs

Medicare Savings Programs, sometimes abbreviated as “MSP,” are discussed in full beginning on page 16 of Managing Your Medicare. Remember that you apply for the Medicare Savings Programs with your state’s Medicaid program, and that states’ exceptions and disregards for the income limits given below, not to speak of their differing interpretations and waivers as to what does or doesn’t count as income, means that if you are anywhere near the limits shown below, you should always apply. (The income limits are somewhat higher than these in both Alaska and Hawaii.)

The resource limits are also shown (these are the same for all states), but again, states have differing interpretations as what counts or doesn’t count as a resource, and some states impose NO resource limit. Note that the resource limits shown below do NOT include the burial allowance of $1,500 (individual) or $3,000 (couple), but are often shown with these added in.

For the Qualified Medicare Beneficiary (QMB) program (which pays your Part B monthly premium, your Part A and Part B deductibles and your Part B coinsurances), your income must be at or below 100 percent of the federal poverty level, which is now:

For an individual, $11,490 annually, or $958 monthly.
For a couple, $15,510 annually, or $1,293 monthly.
For each additional person in a family, add $4,020 annually, or $335 monthly.

The resource limits are $7,080 for an individual and $10,620 for a couple.


For the Specified Low-Income Medicare Beneficiary (SLMB) program (which pays your Part B monthly premium), your income must be at or below 120 percent of the federal poverty level, which is now:

For an individual, $13,788 annually, or $1,149 monthly.
For a couple, $18,612 annually, or $1,551 monthly.
For each additional person in a family, add $4,824 annually, or $402 monthly.

The resource limits are $7,080 for an individual and $10,620 for a couple.


For the Qualifying Individual (QI) program (which pays your Part B monthly premium), your income must be at or below 135 percent of the federal poverty level, which is now:

For an individual, $15,512 annually, or $1,293 monthly.
For a couple, $20,939 annually, or $1,745 monthly.
For each additional person in a family, add $5,427 annually, or $452 monthly.

The resource limits are $7,080 for an individual and $10,620 for a couple.


For the Qualified Disabled & Working Individuals (QDWI) program (which pays your Part A monthly premium), your income must be at or below 200 percent of the federal poverty level, which is now:

For an individual, $22,980 annually, or $1,915 monthly.
For a couple, $31,020 annually, or $2,585 monthly.
For each additional person in a family, add $8,040 annually, or $670 monthly.

The resource limits are $4,000 for an individual and $6,000 for a couple.