Dual Eligible Medicare Beneficiary Groups by Benefits

1. Qualified Medicare Beneficiaries Only*: Eligible for Medicaid payment of Medicare premium, deductible, coinsurance and copayment amounts (except for Medicare Part D).
2. Qualified Medicare Beneficiaries Plus**: Entitled to all benefits available to a QMB, as well as all benefits available under the State Medicaid plan.
3. Specified Low-Income Medicare Beneficiaries Only*: Eligible for payment of Medicare Part B premiums only.
4. Specified Low-Income Medicare Beneficiaries Plus**: Entitled to all benefits available to an SLMB, as well as all benefits available under the State Medicaid plan.
5. Qualifying Individuals: Eligible for payment of Medicare Part B premiums only; however, expenditures are 100% federally funded and total expenditures are limited by statute.
6. Qualified Disabled Working Individuals: Eligible for Medicaid payment of Medicare Part A premiums only.
7. Full Benefit Dual Eligibles: Eligible for Medicaid either categorically or through optional coverage groups.

Notes: * These beneficiaries do not qualify for any additional Medicaid benefits, **These individuals often qualify for full Medicaid benefits by meeting the Medically Necessary standards, or through spending down excess income to the Medically Needy level.
Source: Centers for Medicare & Medicaid Services
Source URL: http://www.cms.gov/Outreach-and-Education/Medicare-Learning-...

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