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Seniors & Medicare & Medicaid
Enrollees

Medicaid provides health coverage to 7.2 million low-income seniors who are also enrolled in Medicare. Medicaid also provides coverage to 4.8 million people with disabilities who are enrolled in Medicare. In total, 12 million people are "dually eligible" and enrolled in both Medicaid and Medicare, composing more than 15% 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.

2025 Dual Eligible Standards
(Based on Percentage of Federal Poverty Level)
Qualified Medicare Beneficiary (QMB):

Monthly Income Limits: (100% FPL + $20)*
QMB.png
Specified Low - Income Medicare Beneficiary (SLMB):

Monthly Income Limits: (120% FPL + $20)*
SLMB.png
Qualifying Individual (QI):

Monthly Income Limits: (135% FPL + $20)*
QI.png
Qualified Disabled Working Individual (QDWI):

Monthly Income Limits: (200% FPL + $20)*
(Figures include additional earned income disregards)
QDWI.png
*$20 = Amount of the Monthly SSI Income Disregard

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Disclaimer: The information provided on this website is for general educational purposes about Medicare Advantage (Part C), Medicare Part D, and related services. Costs, copays, coinsurance, benefits, and coverage rules vary by plan, provider network, and service area. You must continue to pay your Medicare Part B premium.

Me and Medicare LLC is a privately owned and operated insurance agency and is not affiliated with or endorsed by the U.S. government or the federal Medicare program.

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Currently we represent [X] organizations which offer [Y] products in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

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