Many Medicare recipients are astonished to hear they may be responsible for thousands of dollars in additional healthcare expenses yearly. There are premiums, deductibles, copayments, and coinsurance, which vary according to whether you choose traditional Medicare or a Medicare Advantage plan, where you reside, your health, and how much medication you use.
Nonetheless, low- or very-low-income seniors with minimal assets have access to some financial assistance. Depending on your financial circumstances, you may qualify to enroll in Medicare and Medicaid as “dual eligible.” Even if your income is not low enough to qualify you for full Medicaid coverage, you may be qualified for one of the four Medicare Savings Programs that can help you pay for all or a portion of your expensive out-of-pocket Medicare payments. Also, you may enroll in Medicaid and the savings programs anytime, not just during Medicare’s open enrollment period.
The federal government and the states jointly fund Medicaid. While some national eligibility and benefit criteria exist, each state establishes its own Medicaid eligibility rules and determines which optional services it will cover and how much it will pay for Medicare-excluded health care.
Here are the facts you must know regarding dual-eligible programs:
What services may Medicaid cover that Medicare does not?
Medicare Part B premium, which covers doctor visits and other outpatient treatment. In 2023, the monthly premium is $164.90. The Medicare Part B deductible is $226. Medicare Part A (hospital insurance) deductible for hospital stays is $1,600. Both Part A and Part B Medicare have copayments and coinsurance.
Medicare Part D has prescription medication premiums and deductibles. These costs are covered by the Additional Help program, for which Medicaid and Medicare Savings Programs members are automatically eligible.
Long-term nursing home care and community- and home-based services and assistance.
In some states, Medicaid covers things that Medicare does not, such as dental care, transportation to and from medical appointments, eyeglasses, physical therapy, and other services.
Do you qualify for full Medicaid?
The eligibility standards vary by state but states. However, qualifications are based on your yearly income and assets when assessing whether you are qualified for full Medicaid coverage.
You may be eligible if you reside in one of the 41 states (including the District of Columbia) that have expanded Medicaid and if your income does not exceed 138 percent of the federal poverty line (about $18,756 for an individual). Among the states without Medicaid expansion, the income thresholds for eligibility vary widely. The state Medicaid office should be contacted with questions regarding Medicaid eligibility.
If you are enrolled in Medicare, your eligibility for Medicaid may be subject to an asset test. The maximum value of assets you possess and still qualify for Medicaid varies by state. The federal criteria enable you to have $2,000 in assets, but other states have greater requirements or none at all.
The $2,000 asset test does not apply to your primary residence, one vehicle, funeral expenditures, life insurance, or household and personal items. States often examine Medicaid applicants’ assets for five years to ensure that they have not sold or given away assets to qualify.
The asset income restrictions for Medicare Savings Plans were increased and modified annually in January. For 2023, the income restrictions for these programs are $9,900 for a single individual and $15,600 for a married individual living with a spouse and no dependents. As with complete Medicaid, several states have higher resource limits.
According to Casey Schwarz of the Medicare Rights Center, one of the main challenges they have is that individuals feel they are ineligible and do not apply. Individuals should investigate their state’s income and wealth requirements.
If you had Medicaid before turning 65 and enrolling in Medicare, you may no longer be eligible for Medicaid after turning 65 and enrolling in Medicare. Check with your state Medicaid office.
Which four Medicare Savings Programs are available?
QMB (Qualified Medicare Beneficiary) pays for Coinsurance, copays, and deductibles for Medicare Part A and B. As a participant in this program, you are automatically eligible for the Extra Help prescription drug program, which covers your out-of-pocket medication costs.
Medicare Part B premiums are paid by the Specified Low-Income Medicare Beneficiary (SLMB) program. This program does not cover part A premiums and cost-sharing.
The Qualifying Individual (QI) program helps pay only for Part B premiums and no other cost sharing. SLMB and QMB programs are not available to people with high incomes, but the QI program may be able to help. There is limited funding, so these benefits are first come, first served. Individuals who received assistance through this program the previous year are given priority.
QDWI, Qualified Disabled, and Working Individuals cover only Medicare Part A (hospital insurance) premiums. Individuals with disabilities under 65 who are currently working and have lost their premium-free Part A benefit may qualify for this program.
Do most physicians accept Medicaid?
It varies; if you’re applying for Medicaid, you should check with your medical providers to see whether they accept that coverage, particularly for specialist visits.
Does Medicaid have an open enrollment period?
No. You can enroll in Medicaid at any time of the year. However, you must update your enrollment information annually in many states to ensure you still qualify. If you don’t, you risk losing your coverage.”