Medical Eligibility Overview
| QUALIFIED MEDICARE BENEFICIARY (QMB): The client must be entitled to or enrolled in Medicare Part A. Income limits are over 100 percent of the Federal Poverty Level (FPL). Under QMB, DSHS pays for Medicare Part A, Part B, deductibles, copayments, as well as Medicare managed care premiums. | ||||||||||||||||||||||||
| SPECIAL LOW-INCOME MEDICARE BENEFICIARY (SLMB): The client must be eligible for or be enrolled in Medicare Part A. Income limits are over 100 percent of the Federal Poverty Level (FPL) but under 120 percent of the FPL. Under SLMB, DSHS pays the client’s Medicare Part B premium only. | ||||||||||||||||||||||||
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QUALIFIED INDIVIDUAL-1 (QI-1): The client must be eligible
for or enrolled in Medicare Part A and not eligible for any other Medicaid coverage. Income limits are from 120 percent of the Federal Poverty level (FPL) to 135 percent FPL. Under QI-1, DSHS pays the client's Medicare Part B premium only. |
QUALIFIED DISABLED WORKING INDIVIDUAL (QDWI): The client must be entitled or enrolled in Medicare Part A as a working disabled person who has exhausted premium-free Part A and whose SSA disability benefits ended because his or her earnings exceeded SSA’s gainful activity limits. Income limits are based on 200 percent of the Federal Poverty Level (FPL). DSHS pays the client’s Medicare Part A premium only. Persons considering this program may also benefit from information about the Healthcare for Workers with Disabilities program. | |||||||||||||||||||||||
Effective
April 1, 2009:
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Page modified: November 2009
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