HI 00815: State Enrollment of Eligible Individuals
TN 8 (03-05)
A. Background
The monthly income limits for the Medicare Savings Programs (MSPs) are based on a percentage of the Federal Poverty Level (FPL) rates that are published each year in the Federal Register. All of the 2018 rates listed below include the $20 general income exclusion. This allows interviewers to compare gross income to the monthly income limits to make a quick assessment of potential eligibility.
The monthly income limits shown are effective from January 1, 2018 through December 31, 2018.
B. Policy
The Qualified Disabled Working Individual (QDWI) rate is based on the maximum countable earned income an individual or couple may have and qualify for. We have factored in both the Supplemental Security Income (SSI) $20 general income exclusion and the SSI earned income exclusion ($65 plus ½ the remainder); these SSI exclusions are used in the MSPs. The QDWI limits assume that people who ask about this program are likely to be working.
If someone asks about the other MSPs (QMB, SLMB, QI) and has earned income, apply the SSI earned income exclusions.
Please remember that only the State can determine if an individual qualifies for coverage under one of the MSPs. Even if individuals or couples are slightly over the income or resource limit, refer them to the State. States have some flexibility in excluding some income and resources. You should be aware that several States may even disregard all resources for individuals or couples in certain categories. The new 2018 — 2019 asset resource limits are also reflected below.
NOTE: CMS rounds up to the nearest dollar when computing the monthly income limits.
C. Procedure
1. QMB Monthly Income Limits for 2018 (up to 100% FPL+ $20)*
|
Individual |
Couple |
|
|
All States except Alaska and Hawaii. |
$1,032 |
$1,392 |
|
Alaska |
$1,285 |
$1,735 |
|
Hawaii |
$1,184 |
$1,598 |
|
Asset Limits |
$7,560 |
$11,340 |
See HI 00801.139 and TC 23001.050.
2. SLMB Monthly Income Limits for 2018 (less than 120% FPL+ $20)*
|
Individual |
Couple |
|
|
All States except Alaska and Hawaii: |
$1,234 |
$1,666 |
|
Alaska |
$1,538 |
$2,078 |
|
Hawaii |
$1,416 |
$1,913 |
|
Asset Limits |
$7,560 |
$11,340 |
See TC 23001.060.
3. QI Monthly Income Limits for 2018 (less than 135% FPL+ $20)*
|
Individual |
Couple |
|
|
All States except Alaska and Hawaii: |
$1,386 |
$1,872 |
|
Alaska |
$1,715 |
$2,336 |
|
Hawaii |
$1,591 |
$2,150 |
|
Asset Limits |
$7,560 |
$11,340 |
See TC 23001.070.
4. QDWI Monthly Income Limits for 2018 (up to 200% FPL+ $65+$20)*
($65= monthly SSI earned income exclusion.)
|
Individual |
Couple |
|
|
All States except Alaska and Hawaii: |
$4,132 |
$5,572 |
|
Alaska |
$5,145 |
$6,945 |
|
Hawaii |
$4,739 |
$6,395 |
|
Asset Limits |
$4,000 |
$6,000 |
* $20 = monthly SSI general income exclusion.
See HI 00801.170 and TC 23001.080.