What Does the QI1 Medicaid Program Cover?

Medicaid, a joint federal and state program, provides health coverage to millions of Americans with limited income and resources. Within this expansive program, specific initiatives exist to assist Medicare beneficiaries with certain costs. The Qualified Individual 1 (QI1) program is one such initiative, falling under the umbrella of Medicare Savings Programs (MSPs). It aims to alleviate financial burdens for eligible individuals by covering specific Medicare expenses.

What is QI1 Medicaid

The QI1 Medicaid program, or “Qualified Individual 1,” is a Medicare Savings Program. Its purpose is to offer financial assistance to Medicare beneficiaries with low incomes who do not qualify for full Medicaid benefits. The program specifically targets the cost of Medicare Part B premiums, helping individuals who struggle with these monthly fees.

This federally funded program operates with state Medicaid agencies. The state pays the Medicare Part B premium directly on behalf of the eligible individual. This direct payment ensures beneficiaries do not have to worry about the premium being deducted from their Social Security checks, thereby increasing their net monthly income. The QI1 program is distinct from full Medicaid, focusing solely on premium assistance rather than comprehensive healthcare coverage.

Who Qualifies for QI1 Medicaid

To qualify for the QI1 program, individuals must meet specific income and resource criteria, along with other general requirements. Applicants must be enrolled in Medicare Part A, which covers hospital insurance. Individuals already eligible for full Medicaid benefits or other Medicare Savings Programs, such as Qualified Medicare Beneficiary (QMB) or Specified Low-Income Medicare Beneficiary (SLMB), typically have their premium costs covered elsewhere and do not need to apply for QI1.

The income limits for QI1 are tied to a percentage of the Federal Poverty Level (FPL). For 2025, an individual’s monthly income must be greater than 120% but less than or equal to 135% of the FPL. For instance, typical monthly income limits for a single individual might range from approximately $1,565 to $1,761, while for a married couple, it could be between $2,115 and $2,380. These figures can vary slightly based on state-specific adjustments and certain income disregards.

Applicants must also meet resource limits. For 2025, these limits are generally around $9,660 for an individual and $14,470 for a married couple. Certain assets are excluded from these calculations, including the applicant’s primary residence, one vehicle, burial plots, and up to $1,500 set aside for burial expenses. Money in checking or savings accounts, stocks, bonds, and certain retirement accounts are usually counted as resources. Even if an individual’s income or resources appear slightly above these limits, it is often advisable to apply, as state variations might still allow for eligibility.

Specific Coverage Provided by QI1

The QI1 Medicaid program provides a specific and limited scope of coverage. Its sole function is to pay for the Medicare Part B monthly premium. For most beneficiaries in 2025, this premium is $185 per month, translating to an annual savings of $2,220 for eligible individuals. This payment is handled directly by the state, ensuring the premium is not deducted from the beneficiary’s Social Security benefit.

QI1 is not a substitute for comprehensive health insurance. It does not cover Medicare Part A premiums, though most individuals do not pay a premium for Part A. It also does not cover Medicare deductibles, co-insurance, or co-payments for medical services. While the Part B premium is paid, beneficiaries remain responsible for out-of-pocket costs for doctor visits, hospital stays, medical supplies, or other services covered by Medicare Parts A and B.

The program does not cover Medicare Part D prescription drug plan premiums, deductibles, or co-payments. It also does not provide coverage for medical services typically covered by full Medicaid, such as doctor visits, hospital stays, or prescription drugs. If a beneficiary has Original Medicare (Parts A and B) and qualifies for QI1, their total monthly premium for Original Medicare would effectively become $0 if they also have premium-free Part A. QI1 applies only to Original Medicare and does not affect Medicare Advantage (Part C) or Medigap plans.

Beneficiaries approved for QI1 may be eligible for retroactive reimbursement for Part B premiums. Medicaid may pay back premiums paid up to three months before the QI1 enrollment effective date, provided the individual met eligibility guidelines during those prior months. This retroactive coverage is limited to premiums paid within the same calendar year as the QI1 coverage. Qualification for QI1 can also automatically qualify individuals for the Medicare Part D Low-Income Subsidy (LIS), also known as “Extra Help,” which assists with prescription drug costs.

Applying for QI1 Benefits

The application process for QI1 benefits begins by contacting your state’s Medicaid agency or local Department of Social Services. Application forms are available online through state government websites, or they can be requested by phone or in person. Some states may offer a simplified application specifically for Medicare Savings Programs.

When applying, gather documentation to verify income, resources, and Medicare enrollment. Proof of income includes recent pay stubs, tax returns, or statements from Social Security, pensions, or other retirement programs. For resources, bank statements for checking and savings accounts, and information on stocks, bonds, or other investments are commonly required. You will also need your Medicare card to confirm Part A enrollment.

Once the application and supporting documents are complete, they can be submitted through online portals, mail, or in-person at a local office. After submission, a processing timeframe of 30 to 45 days is common, though this can vary by state. The agency may request additional information or clarification. Applicants receive notification of the decision, either approval or denial, by mail. Reapply for QI1 benefits annually, as eligibility is determined on a yearly basis.