Current Federal Poverty Level for Determining Eligibility for Medicare and Medicaid Benefits - 2013

Many federal and state government benefits are tied to the federal poverty level (FPL), or percentages of the FPL. The FPLs, which are also called the federal poverty guidelines, are updated every year.

Following are the FPLs in effect for 2013, split out by family size.

2013 Federal Poverty Level for Continental United States

Following are the most common programs that base eligibility on federal poverty level or a percentage of federal poverty level. Note that, like the SSI program, most of these programs disregard $20 of your monthly income, so the income limit for each program is actually $20 higher than the FPL.

100% FPL

If your income is under 100% of the FPL, your state must pay for Medicare on your behalf, through the Qualifying Medicare Beneficiary (QMB) program. This is a Medicare Savings Program that you may be eligible for if you qualify for Medicare because you are 65 or older or are disabled.

Also, many states use 100% FPL as the income limit for qualifying for Medicaid for adults.

133% FPL

In 2014, 133% FPL will be the income limit that will be used to expand Medicaid to adults in states that opt in to President Obama’s health care reform plan. (Medicaid expansion comes with a new income calculation as well; five percentage points of income will be ignored, so really those under 138% of poverty level may qualify for Medicaid in expansion states.)

Also, in some states, children and pregnant women under 133% FPL qualify for Medicaid, and in other states, parents or even childless adults can qualify for Medicaid with income under this level.

135% FPL

If your income is under 135% FPL, there are other Medicare Savings Programs you can qualify for. One of these programs is the Qualifying Individual (QI) program, which pays your monthly Part B premium. The income limit for another Medicare Savings Program, Specified Low-Income Medicare Beneficiary (SLMB), is 120%, but the program provides the same benefit – payment of the monthly Part B premium.

135% FPL is also the income limit to qualify for Medicare Part D’s Extra Help full subsidy, which pays premiums and deductibles under the Medicare Part D Prescription Drug Plan and provides reduced per prescription copayments.

150% FPL

150% FPL is the limit for Medicare Part D’s Extra Help partial subsidy, which provides reduced premiums and deductibles and reduced per prescription copayments.

150% FPL (for two people) is also the limit used for the “minimum monthly maintenance needs allowance” for individuals whose spouse is in a Medicaid-paid nursing home. This amount, however, is not increased to the 150% of current year's FPL until July 1 of that year.

200% FPL

The income limit for the Qualified Disabled and Working Individuals (QDWI) program is 200% FPL. Individuals who no longer qualify for Medicare because they are working can continue to receive Medicare through this program. Because, like the SSI program, the QDWI program doesn’t count half of the income that you earn from work, you can actually earn quite a bit more than 200% of the FPL.

250% FPL

The income limit for eligibility for out-of-pocket savings for the Silver health care plan that is available through the Health Care Marketplace is 250% FPL. (Coverage starts for these health-care-reform-regulated plans January 1, 2014.)

400% FPL

The income limit for getting a lower cost premium for a health care plan through the Health Care Marketplace is 400% FPL. (Coverage for these health-care-reform-regulated plans starts January 1, 2014.)

2013 Federal Poverty Levels for Hawaii and Alaska

The FPLs for Hawaii and Alaska are higher due to the high cost of living in those states.

Alaska

Hawaii

SSI and Medicaid Long-Term Care Eligibility

Note that SSI, which is based on the federal benefit rate, is no longer tied to the poverty level; instead it receives a cost-of-living adjustment each year. For comparison purposes, the federal benefit rate for SSI is about 75% of FPL.

Many states base income eligibility for a Medicaid-paid nursing home on a multiple of the SSI payment, typically 300%. In 2013, 300% of the SSI limit is $2,130 per month. For more information on eligibility for Medicaid-paid nursing homes, see our section on Medicaid for Nursing Homes.