People eligible for both Medicare and Medicaid, known as dual eligibles, typically meet the following criteria:
- They qualify for Medicare, which generally includes people age 65 or older, younger individuals with certain disabilities, or those with End-Stage Renal Disease (ESRD) or ALS (Lou Gehrig’s disease)
- They also meet Medicaid eligibility requirements, which are based on low income and limited resources, and vary by state. Medicaid eligibility often includes low-income families, pregnant women, children, people with disabilities, and older adults with limited financial means
Dual eligibility can occur in several ways, including:
- Older adults (65+) who have limited income and resources.
- Individuals under 65 with disabilities who qualify for Medicare due to disability and also meet Medicaid’s income and resource limits.
- People who qualify for Medicare Savings Programs (MSPs), which help pay Medicare premiums and cost-sharing if income and resources are below certain thresholds.
- Those enrolled in full-benefit Medicaid and Medicare, receiving comprehensive coverage from both programs
Specific categories for dual eligibility include:
- Qualified Medicare Beneficiary (QMB): Income below 100% of the federal poverty level (FPL) and limited resources; Medicaid covers Medicare Part A and B premiums.
- Specified Low-Income Medicare Beneficiaries (SLMBs): Income between 100% and 120% of FPL; Medicaid helps with Part B premiums.
- Qualifying Individuals (QIs): Income between 120% and 135% of FPL; Medicaid assists with Part B premiums.
- Qualified Disabled and Working Individuals (QDWIs): Disabled individuals who return to work; Medicaid may cover Part A premiums if income and resources limits are met.
- Full-benefit Medicaid recipients who also have Medicare Parts A and/or B
In summary, eligibility for both Medicare and Medicaid requires meeting Medicare’s age or disability criteria plus qualifying for Medicaid based on state-specific income and resource limits, often reflecting low income and financial need
