Page 2

SSI/CNIL Standards (1/1/24) Single Eligible Eligible Couple CNIL Income $943 $1,415 FBR (SSI Standard) $943 $1,415 1/2 FBR $472 N/A Shared Living FBR $629 $943 SSI Resources $2,000 $3,000 Medicare Standards 1/1/2024 Part A Premium: 40+ work quarters = Free Part A; <40 but >29 work quarters = $278 <30 work quarters = $505 Part B Premium $174.70 Part A Deductible: Inpatient Hospital = $1,632 per benefit period Part B Deductible $240 Part A coinsurance for Inpatient hospital $408 per day for 61st - 90th day; $816 per day for over 90 days Part A coinsurance for NF $204 per day for 21st - 100th day Substantial Gainful Activity (SGA) 1/1/24 Non-Blind $1,550 Blind $2,590 Low Income Subsidy (LIS) Resources Single $15,510 Couple $30,950 Medicare Savings Program (Includes $20 disregard) Alternate financial eligibility standards 4/1/2023 People in the Household 1 2 3 4 5 6 7 8 9 10 11+ QMB Income 100% FPL (S03) $1,235 $1,663 $2,092 $2,520 $2,948 $3,377 $3,805 $4,233 $4,662 $5,090 $429 SLMB Income 120% FPL (S05) $1,478 $1,992 $2,506 $3,020 $3,534 $4,048 $4,562 $5,076 $5,590 $6,104 $514 QI-1 Income 135% FPL (S06) $1,660 $2,239 $2,817 $3,395 $3,973 $4,552 $5,130 $5,708 6,286 $6,865 $578 QDWI 200% FPL (S04) $2,450 $3,307 $4,163 $5,020 $5,877 $6,733 $7,590 $8,447 $9,303 $10,160 $857 Medically Needy (MN) Standards 1/1/2024 MNIL Standard (1/1/24) $943 $943 $943 $943 $943 $975 $1,125 $1,242 $1,358 $1,483 $1,483 MN Resources $2,000 $3,000 $3,050 $3,100 $3,150 $3,200 $3,250 $3,300 $3,350 $3,400 +50