Page 2

SSI/CNIL Standards (1/1/25) Single Eligible Eligible Couple CNIL Income $967 $1,450 FBR (SSI Standard) $967 $1,450 1/2 FBR $484 N/A Shared Living FBR $645 $943 SSI Resources $2,000 $3,000 Medicare Standards 1/1/2025 Part A Premium: 40+ work quarters = Free Part A; <40 but >29 work quarters = $285 <30 work quarters = $518 Part B Premium $185 Part A Deductible: Inpatient Hospital = $1,676 per benefit period Part B Deductible $257 Part A coinsurance for Inpatient hospital $419 per day for 61st - 90th day; $838 per day for over 90 days Part A coinsurance for NF $209.50 per day for 21st - 100th day Substantial Gainful Activity (SGA) 1/1/25 Non-Blind $1,620 Blind $2,700 Low Income Subsidy (LIS) Resources Single $16,100 Couple $32,130 Medicare Savings Program (Includes $20 disregard) Alternate financial eligibility standards 4/1/2024 People in the Household 1 2 3 4 5 6 7 8 9 10 11+ QMB Income 110% FPL (S03) $1,401 $1,894 $2,387 $2,880 $3,373 $3,866 $4,360 $4,853 $5,346 $5,839 $513 SLMB Income 120% FPL (S05) $1,526 $2,064 $2,602 $3,140 $3,678 $4,216 $4,754 $5,292 $5,830 $6,368 $558 QI-1 Income 138% FPL (S06) $1,752 $2,371 $2,989 $3,608 $4,227 $4,845 $5,464 $6,083 $6,702 $7,320 $639 QDWI 200% FPL (S04) $2,530 $3,427 $4,323 $5,220 $6,117 $7,013 $7,910 $8,807 $9,703 $10,600 $917 Medically Needy (MN) Standards 1/1/2025 MNIL Standard (1/1/24) $967 $967 $967 $967 $967 $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