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HCA 19-0096 (07/26) SSI/CNIL Standards Program Single Eligible Eligible Couple CNIL Income $994 $1,491 FBR (SSI Standard) $994 $1,491 1/2 FBR $497 N/A Shared Living FBR $663 $994 SSI Resources $2,000 $3,000 Non-Blind Substantial Gainful Activity (SGA) $1,690 $1,690 Blind Substantial Gainful Activity (SGA) $2,830 $2,830 Medicare Standards Program Cost Part A Premium: 40+ work quarters Free Part A Less then 40 but greater then 29 work quarters $311 Less then 30 work quarters $565 Part A Deductible: Inpatient Hospital = $1,736 per benefit period Part A coinsurance for Inpatient hospital $434 per day for 61st - 90th day; $868 per day for over 90 days Part A coinsurance for NF $217 per day for 21st - 100th day Part B Premium $203 Part B Deductible $283 Singles Low Income Subsidy (LIS) Resources $16,590 Couples Low Income Subsidy (LIS) Resources $33,100 Medicare Savings Program (Includes $20 disregard, except in 11+) Alternate financial eligibility standards 4/1/2026 Program Single Person 2-person Household 3-person Household 4-person Household 5-person Household 6-person Household 7-person Household 8-person Household 9-person Household 10-person Household 11-person+ Household QMB Income 110% FPL (S03) $1,483 $2,004 $2,525 $3,045 $3,566 $4,087 $4,607 $5,128 $5,649 $6,169 $521 SLMB Income 120% FPL (S05) $1,616 $2,185 $2,752 $3,320 $3,889 $4,456 $5,024 $5,593 $6,160 $6,728 $569 QI-1 Income 138% FPL (S06) $1,855 $2,510 $3,162 $3,815 $4,469 $5,122 $5,775 $6,429 $7,081 $7,734 $654 QDWI 200% FPL (S04) $2,680 $3,628 $4,574 $5,520 $6,468 $7,414 $8,360 $9,308 $10,254 $11,200 $948