Medicaid & Dual-Eligible Levels at a Glance

What "dual eligible" means

Someone who qualifies for both Medicare and Medicaid is dual eligible. Medicaid is a joint federal-state program for lower-income Americans, administered by each state within federal rules. For dual-eligible people, Medicaid can help pay Medicare premiums and cost-sharing — and, for those with full Medicaid, much more.

These categories determine which D-SNP (Dual Eligible Special Needs Plan) a person can join. See Special Needs Plans — D-SNP, C-SNP & I-SNP.

The Medicare Savings Programs (MSPs)

Four programs help pay Medicare costs based on income (as a percentage of the FPL) and assets. The "+ $20" reflects a standard monthly income disregard.

Qualified Medicare Beneficiary (QMB) — ~100% FPL + $20

Medicaid pays the Part A (if any) and Part B premiums *and* covers Medicare deductibles, coinsurance, and copays. (Providers can't bill a QMB for those Medicare cost-shares.) The most comprehensive MSP help.

Specified Low-Income Medicare Beneficiary (SLMB) — ~120% FPL + $20

Medicaid pays the Part B premium.

Qualifying Individual (QI) — ~135% FPL + $20

Medicaid pays the Part B premium (limited funding; first-come basis).

Qualified Disabled & Working Individual (QDWI) — ~200% FPL + $20

Medicaid pays the Part A premium for certain working people under 65 who lost premium-free Part A after returning to work.

2026 monthly income limits (48 states + DC; estimates)

*(QDWI figures include additional earned-income disregards. Alaska and Hawaii have higher limits. The "$20" is the standard monthly SSI income disregard.)*

Full vs. partial benefits

• Partial-benefit duals get help only with Medicare premiums/cost-sharing through an MSP: QMB-only, SLMB-only, QI, QDWI.
• Full-benefit duals get the full package of state Medicaid services on top of Medicare help: QMB+, SLMB+ (an MSP plus full Medicaid), and FBDE (Full-Benefit Dual Eligible) — a catch-all for full-Medicaid people who don't fall under an MSP.

What Medicaid covers (varies by state)

States must cover certain mandatory services (e.g., inpatient/outpatient hospital, physician, lab and X-ray, nursing facility) and may cover optional services (e.g., dental, prescription drugs, physical therapy, vision/eyewear, prosthetics). Because states design their own programs, eligibility and benefits vary widely from state to state.

Important guidance

• These categories affect D-SNP eligibility and how much help a person gets with Medicare costs.
• Agents should not enroll consumers in Medicaid unless trained; direct people to their state Medicaid agency at Medicaid.gov.
• Always verify current-year figures and state-specific rules — the numbers above are estimates that change annually.

See also: Special Needs Plans — D-SNP, C-SNP & I-SNP, Medicare Basics — Parts A, B, C & D, Medicare & ACA Enrollment Windows.