Page 5

MAABD MAABD MAABD MAABD MAABD MAABD MAABD MAABD MAABD MAABD MAABD MEDICARE BENEFICIARIES 0% - 100% FPL QMB 100% - 120% FPL SLMB 120% - 135% FPL QI1 135% - 175% FPL QI2 200% FPL QDWI 4/09 Individual $903.00 Couple $1,214.00 Individual $903.01 – 1,083.00 Couple $1,214.01 – $1,457.00 Individual $1,083.01 – $1,218.00 Couple $1,457.01 – $1,639.00 Individual $1,805.00 Couple $2,428.00 4/11 Individual $908.00 Couple $1,226.00 Individual $908.01 – $1,089.00 Couple $1,226.01 – $1,471.00 Individual $1,089.01 – $1,225.00 Couple $1,471.01 – $1,655.00 Individual $1,815.00 Couple $2,452.00 4/12 Individual $931.00 Couple $1,261.00 Individual $931.01 – $1,117.00 Couple $1,261.01 – $1,513.00 Individual $1,117.01 – $1,257.00 Couple $1,513.01 – $1,703.00 Individual $1,862.00 Couple $2,522.00 4/13 Individual $958.00 Couple $1293.00 Individual $958.01 - $1149.00 Couple $1293.01 - $1551.00 Individual $1149.01 - $1293.00 Couple $1551.01 - $1745.00 Individual $1915.00 Couple $2,585.00 4/14 Individual $973.00 Couple $1,311.00 Individual $973.01 - $1,167.00 Couple $1,311.01 - $1,573.00 Individual $1,167.01 - $1,313.00 Couple $1,573.01 - $1,770.00 Individual $1,945.00 Couple $2,622.00 4/15 Individual $981.00 Couple $1,328.00 Individual $981.01 - $1,177.00 Couple $1,328.01 - $1,593.00 Individual $1,177.01 - $1,324.00 Couple $1,593.01 - $1,792.00 Individual $1962.00 Couple $2,655.00 4/16 Individual $990.00 Couple $1,335.00 Individual $990.01 - $1,188.00 Couple $1,335.01 - $1,602.00 Individual $1,188.01 - $1,337.00 Couple $1,602.01 - $1,802.00 Individual $1,980.00 Couple $2,670.00 4/17 Individual $1,005.00 Couple $1,353.00 Individual $1,005.01 ­ $1,206.00 Couple $1,353.01 - $1,624.00 Individual $1,206.01 - $1,357.00 Couple $1,624.01 - $1,827.00 Individual $2,010.00 Couple $2,707.00 4/18 Individual $1,012.00 Couple $1,372.00 Individual $1,012.01 ­ $1,214.00 Couple $1,372.01 - $1,646.00 Individual $1,214.01 - $1,366.00 Couple $1,646.01 - $1,852.00 Individual $2,023.00 Couple $2,743.00 4/19 Individual $1,041.00 Couple $1,409.00 Individual $1, 041.01 ­ $1,249.00 Couple $1, 409.01 - $1,691.00 Individual $1, 249.01 - $1,405.00 Couple $1, 691.01 - $1,902.00 Individual $2,082.00 Couple $2,818.00 4/20 Individual $1,063.00 Couple $1,437.00 Individual $1, 063.01 ­ $1,276.00 Couple $1, 437.01 - $1,724.00 Individual $1, 276.01 - $1,436.00 Couple $1, 724.01 - $1,940.00 Individual $2,127.00 Couple $2,873.00 4/21 Individual $1,074.00 Couple $1,452.00 Individual $1, 074.01 ­ $1,289.00 Couple $1, 452.01 - $1,743.00 Individual $1, 289.01 - $1,450.00 Couple $1, 743.01 - $1,961.00 Individual $2,148.00 Couple $2,904.00 APPENDIX D Division of Welfare and Supportive Services POSSIBLE BENEFITS AVAILABLE TO DWSS CLIENTS Medical Assistance Manual SOCIAL SECURITY-RETIREMENT, SURVIVORS AND 24 Sept MTL 06/24 DISABILITY INSURANCE (RSDI) BENEFITS