Medicaid provides health insurance to United States citizens and legal aliens meeting income and asset limits. Medicare offers health-care coverage to adults 65 or older, disabled individuals and people with end-stage and permanent renal disease. Individuals with income and assets below a specified amount may qualify for dual coverage from both programs. There are several eligibility groups and benefits — including Medicare premium coverage — depending on individual income and other qualifications.
Qualified Medicare Beneficiary members may be entitled to Medicaid assistance with Medicare Part A and B deductibles, Medicare Part B premiums, co-insurance fees, possible Medicare Part A premiums and other health-care benefits. QMB candidates must be eligible for Medicare Part A. The income limit for QMB coverage is at or below 100 percent of the Federal Poverty Level (FPL).
Individuals eligible for the Specified Low-Income Medicare Beneficiary Program qualify for Medicare Part B premium assistance and other health-care coverage if they qualify for full Medicaid benefits under other eligibility requirements. Applicants must be eligible for Medicare Part A and have an income between 100 and 120 percent of the FPL.
The Qualifying Individual Program only covers Medicare Part B premium payments. Medicare Part A eligible individuals may qualify for Q-I benefits if their income is between 120 and 135 percent of the FPL and they are not eligible for Medicaid coverage under another program. The Q-I is limited by block grants each year and once the funds are depleted in a particular state, the program cannot accept new members until the following year.
The Qualified Disabled and Working Individual plan offers Medicare Part A premium coverage to disabled individuals who lose Medicare Part A due to employment and are required to pay for Medicare Part A enrollment. QDWI candidates must be ineligible for regular Medicaid benefits. The income limit for benefits is at or below 200 percent of the FPL.
Federal Poverty Level
The Federal Poverty Level is a guideline issued by the United States Department of Health and Human Services each year. The guideline aids government agencies in determining eligibility for a range of assistance programs. As of 2011, the annual FPL for the contiguous 48 states is $10,890 for one person and $14,710 for couples. The 2011 annual FPL for Alaska residents is $13,600 for singles and $18,380 for couples. Hawaii guidelines are $12,540 for individuals and $16,930 for couples.