Revision 19-2; Effective June 1, 2019

 

Eligibility as a Qualified Medicare Beneficiary (QMB)

Medicare Entitlement

Must be entitled to Medicare Part A.

Income — Maximum gross monthly income

  • $1,041 Individual
  • $1,410 Couple

Income can equal the maximum gross monthly income or be less than this limit. Use the couple income limit when both spouses are applying for the same program. If both are not eligible, use the individual income limit to test eligibility for each spouse separately. A portion of the spouse's income may also be considered as part of the applicant's income.

Income limit amounts do not include the $20 general income disregard.

What counts as income?

  • Social Security benefits
  • Railroad retirement benefits
  • State or local retirement benefits
  • Interest or dividends
  • Gifts or contributions
  • Civil service annuities
  • Veterans benefits
  • Private pension benefits
  • Royalty and rental payments
  • Earnings or wages
  • Value of food, clothing or shelter paid by someone else

Resources — Maximum countable resources

  • $7,730 Individual
  • $11,600 Couple

What is a resource?

  • Bank accounts and certificates of deposit (CDs)
  • Real property
  • Life insurance policies
  • Burial funds
  • Individual retirement accounts (IRAs)
  • Stocks and bonds
  • Oil/gas/mineral rights
  • Jewelry and antiques
  • Cars and other vehicles
  • Boats and recreational vehicles

What can be excluded?

  • Texas homestead where a person lives that they consider their principal place of residence
  • Life insurance, if the face value is $1,500 or less
  • Separately identifiable burial funds of $1,500 (less any excluded life insurance or irrevocable arrangement for burial) for the applicant and the applicant's spouse
  • Car
  • Burial spaces

Benefits

QMB covers Medicare premiums (both Parts A and B), deductibles and coinsurance fees for Medicare services. As a QMB, a person does not get regular Medicaid benefits. The state sends a special identification card to people who are eligible for QMB for them to show their medical service providers.

 

Eligibility as Specified Low-Income Medicare Beneficiaries (SLMB)

Medicare Entitlement

Must be entitled to Medicare Part A.

Income

The income range for a person is equal to a minimum monthly amount of $1,041.01 to a maximum monthly amount of less than $1,249.

The income range for a couple is equal to a minimum monthly amount of $1,410.01 to a maximum monthly amount of less than $1,691.

Use the couple income range when both spouses are applying for the same program. If both are not eligible, use the individual income range to test eligibility for each spouse separately. A portion of the spouse's income may also be considered as part of the applicant's income.

Income limit amounts do not include the $20 general income disregard.

What counts as income?

  • Social Security benefits
  • Railroad retirement benefits
  • State or local retirement benefits
  • Interest or dividends
  • Gifts or contributions
  • Civil service annuities
  • Veterans benefits
  • Private pension benefits
  • Royalty and rental payments
  • Earnings or wages
  • Value of food, clothing or shelter paid by someone else

Resources — Maximum countable resources

  • $7,730 Individual
  • $11,600 Couple

What is a resource?

  • Bank accounts and CDs
  • Real property
  • Life insurance policies
  • Burial funds
  • IRAs
  • Stocks and bonds
  • Oil/gas/mineral rights
  • Jewelry and antiques
  • Cars and other vehicles
  • Boats and recreational vehicles 

What can be excluded?

  • Texas homestead where a person lives that they consider their principal place of residence
  • Life insurance, if the face value is $1,500 or less
  • Separately identifiable burial funds of $1,500 (less any excluded life insurance or irrevocable arrangement for burial) for the applicant and the applicant's spouse
  • Car
  • Burial spaces

Benefits

SLMB covers only the payment of Medicare Part B premiums. An SLMB-eligible person does not get regular Medicaid benefits or a monthly medical identification card.

 

Eligibility for the Qualifying Individuals Program (QI-1)

Entitlement

  • Must be entitled to Medicare Part A.
  • Must not otherwise be receiving Medicaid.

Income

The income range for a person is equal to a minimum monthly amount of $1,249.01 to a maximum monthly amount of less than $1,406.

The income range for a couple is equal to a minimum monthly amount of $1,691.01 to a maximum monthly amount of less than $1,903.

Use the couple income range when both spouses are applying for the same program. If both are not eligible, use the individual income range to test eligibility for each spouse separately. A portion of the spouse's income may also be considered as part of the applicant's income.

Income limit amounts do not include the $20 general income disregard.

What counts as income?

  • Social Security benefits
  • Railroad retirement benefits
  • State or local retirement benefits
  • Interest or dividends
  • Gifts or contributions
  • Civil service annuities
  • Veterans benefits
  • Private pension benefits
  • Royalty and rental payments
  • Earnings or wages
  • Value of food, clothing or shelter paid by someone else

Resources — Maximum countable resources

  • $7,730 Individual
  • $11,600 Couple

What is a resource?

  • Bank accounts and CDs
  • Real property
  • Life insurance policies
  • Burial funds
  • IRAs
  • Stocks and bonds
  • Oil/gas/mineral rights
  • Jewelry and antiques
  • Cars and other vehicles
  • Boats and recreational vehicles

What can be excluded?

  • Texas homestead where a person lives that they consider their principal place of residence
  • Life insurance, if the face value is $1,500 or less
  • Separately identifiable burial funds of $1,500 (less any excluded life insurance or irrevocable arrangement for burial) for the applicant and the applicant's spouse
  • Car
  • Burial spaces

Benefits

QI-1 covers only the payment of Medicare Part B premiums. A QI-1-eligible person does not get regular Medicaid benefits or a medical identification card. A person cannot receive QI-1 benefits if receiving benefits under any other Medicaid-funded program.

 

Qualified Disabled and Working Individuals Program (QDWI)

Entitlement

  • Must be entitled to enroll in Medicare Part A.
  • Must be under age 65 and not otherwise receiving Medicaid.

Income — Maximum gross monthly income

  • $2,082 Individual
  • $2,819 Couple

Income can be less than or equal to the maximum limit. Use the couple income limit when both spouses are applying for the same program. If both are not eligible, use the individual income limit to test eligibility for each spouse separately. A portion of the spouse's income may also be considered as part of the applicant's income.

Income limit amounts do not include the $20 general income disregard.

What counts as income?

  • Social Security benefits
  • Railroad retirement benefits
  • State or local retirement benefits
  • Interest or dividends
  • Gifts or contributions
  • Civil service annuities
  • Veterans benefits
  • Private pension benefits
  • Royalty and rental payments
  • Earnings or wages
  • Value of food, clothing or shelter paid by someone else

Resources — Maximum countable resources

  • $4,000 Individual
  • $6,000 Couple

What is a resource?

  • Bank accounts and CDs
  • Real property
  • Life insurance policies
  • Burial funds
  • IRAs
  • Stocks and bonds
  • Oil/gas/mineral rights
  • Jewelry and antiques
  • Cars and other vehicles
  • Boats and recreational vehicles

What can be excluded?

  • Texas homestead where a person lives that they consider their principal place of residence
  • Life insurance, if the face value is $1,500 or less
  • Separately identifiable burial funds of $1,500 (less any excluded life insurance or irrevocable arrangement for burial) for the applicant and the applicant's spouse
  • Car
  • Burial spaces

Benefits

QDWI covers only Medicare Part A premiums. A QDWI-eligible person does not get regular Medicaid benefits or a medical identification card.