What Does Qualifying Individual Group 1 Mean in Medicaid?

A Qualifying Individual Group 1, or QI-1, is a low-income eligibility category under the Medicare Savings Program. QI-1 eligible beneficiaries receive help with part of their Medicare expenses through state Medicaid programs. This benefit was federally funded and set to expire at the end of 2010, but President Obama signed a bill extending the program through 2011. You can check eligibility, apply for benefits and find out more about the program at a local Department of Human Services.


Basic Eligibility

You must be enrolled in or entitled to Medicare Part A hospital insurance to qualify for assistance. If you are not eligible for free Medicare Part A benefits based on work history, spousal work history, disability or other qualifying criteria, you may be eligible for Medicare A if you pay a monthly premium. When determining eligibility, a social worker first verifies your income and household status to see if you qualify for full Medicaid coverage. Individuals able to receive full Medicaid benefits are not eligible for QI-1 assistance.


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Income Limits

You may be eligible for QI-1 enrollment if your income is between 120 and 135 percent of the Federal Poverty Level. As of 2010, you may qualify for benefits if your monthly income does not exceed $1,239 for individuals or $1,660 for couples. Alaska and Hawaii have higher income limits. Additionally, you may have resources valued at $6,600 for individuals or $9,910 for couples. Resources include but are not limited to stocks, bonds, bank accounts and cash. Your home, most household items, burial plots and vehicles meeting state-established value limits do not count toward your resource limit.



With QI-1, Medicaid pays your Medicare Part B premiums. As of 2010, Medicare Part B premiums are $96.40 to $110.50 monthly. Individuals enrolled in a Medicare Saving Program are automatically eligible to enroll in the Extra Help program. Extra Help offers assistance with part of your prescription costs. As of 2011, your co-pay for generic drugs is $2.50 and brand name prescriptions may cost up to $6.30 under the plan.



You must reapply for QI-1 status each year to continue to receive benefits. The program is federally funded through block grants allocated to each state and resources are limited. Apply early, as once funds are exhausted for a given year, enrollment is closed. Priority is given to individuals who were enrolled the previous year.