Types of Medicaid

Medicare/Medicaid Terminology

Dual Eligible (DE): encompasses all Medicare beneficiaries who receive Medicaid assistance, including those who receive the full range of Medicaid benefits, those who receive assistance only with Medicare premiums (A and/or B) and those who the state protects from cost sharing. The categories include QMB, QMB+, SLMB, SLMB+, QI, QDWI and FBDE (Medicaid Only).

Full Dual Eligible: Full Duals receive assistance from Medicaid with Medicare Premiums and/or cost sharing and also qualify to receive Medicaid benefits that are covered by Medicaid that are not covered by Medicare (typically includes unlimited routine transportation, dentures, eyeglasses, hearing aids, Long Term Care benefits, etc.). Full Dual categories include QMB+, SLMB+ and FBDE.

Partial Dual Eligible: Partial Duals are beneficiaries with somewhat higher income and asset levels who are not eligible for full Medicaid, but are eligible for more limited Medicaid coverage. These beneficiaries qualify for assistance with Medicare premiums and (for QMB) cost sharing. Partial dual categories include QMB, SLMB, QI and QDWI.

Medicaid Only (FBDE): (Non‐QMBs): Individuals entitled to Medicare and eligible for full Medicaid benefits (typically, categorically, or through optional coverage groups such as medically needy or special income levels for institutionalized or home and community‐based waivers) but not as a QMB (do not meet the income or resource criteria for QMB or SLMB). Payment of Medicare Part B premiums is optional. States provide Full Medicaid Benefits and in some states cover Medicare Cost Sharing. These may be listed in contracts as Medicaid/Medicare or FBDE (Full Benefit Dual Eligible).

Qualified Medicare Beneficiary (QMB): Entitled to Medicare Part A with income not exceeding 100% of the Federal poverty level, and resources not exceeding twice the SSI limit. Eligibility for Medicaid is limited to payment of Medicare Part A and Part B premiums and Medicare deductibles and coinsurance for Medicare services provided by Medicare providers. Medicaid covers Part A
Premium, Part B Premium and Medicare Cost Sharing.

Qualified Medicare Beneficiary Plus (QMB Plus): Same as QMB and also eligible for full Medicaid benefits for Medicaid services provided by Medicaid providers. Medicaid covers Part A Premium, Part B Premium, Medicare Cost Sharing and Full Medicaid Benefits.

Specified Low‐income Medicare Beneficiary (SLMB): Entitled to Medicare Part A with income above 100% FPL but less than 120% FPL, and resources that do not exceed twice the SSI limit. Medicaid covers the Part B Premium Only.