Full-benefit Medicaid Only

These individuals are entitled to Medicare Part A and/or enrolled in Part B, and qualify for full Medicaid benefits, but not the QMB or SLMB programs. Full benefit Medicaid coverage refers to the package of services, beyond coverage for Medicare premiums and cost-sharing, that certain individuals are entitled to when they qualify under eligibility groups covered under a state’s Medicaid program. Some of these coverage groups are ones states generally must cover (for example, supplemental security income (SSI) recipients) and some are ones states have the option to cover (for example, the “special income level” group for institutionalized individuals, home- and community- based services (HCBS) programs participants, and “medically needy” individuals). Some of the services in the Medicaid benefit package are ones Medicare does not cover, such as certain long-term services and supports (LTSS), behavioral health, transportation, and vision services. Medicaid benefits vary by state. A full-benefit Medicaid beneficiary pays no more than the Medicaid coinsurance (if applicable) for services covered in the state plan (i.e., care that is furnished by a Medicaid provider and that either: (1) Medicaid and Medicare, or (2) Medicaid, but not Medicare, cover). These individuals pay Medicare cost-sharing for Medicare-covered care not included in the state plan unless the state chooses to pay these costs.