What seniors qualify for Medicaid?

As we age, worries about funding our medical care and ensuring our golden years are spent fit and healthy come to the fore. Luckily, the Medicaid program offers some solid coverage to eligible seniors to help take this weight off of their shoulders. Learn who qualifies for Medicaid coverage, and the various benefits you will receive.  

Medicaid is run at the state level but with basic minimums guaranteed by the federal government. To qualify for Medicaid, you must have a recognized medical need for the expanded coverage and meet certain income and asset levels that are set at the state level. In some states, especially those with expanded Medicaid programs, those who miss the income limits but have unusually high costs from their medical care may be able to ‘pay down’ into Medicaid coverage throughout the year.

What is Medicaid?

‘Medicaid’ is a catch-all term for various state-federal partnerships to extend medical care for seniors and other eligible people as well as help reduce the burden of medical costs on vulnerable groups with limited income. While there are federally set minimum limits to the care, each state can expand the program as they choose. You will often find Medicaid offered under state-specific names, like ‘Medi-Cal’ and ‘MassHealth’ for California and Massachusetts.

Who qualifies for Medicaid?

To qualify for Medicaid, you must meet your state’s income and asset limits. Some states also run an expanded form of Medicaid, on offer to all people within the income limit. If you are already receiving SSI benefits, you will automatically qualify for Medicaid.

However, you must also have a medical need to be eligible for Medicaid coverage. Typically, this means needing some level of home care services or help with daily activities. The income limit set by the government is 3x SSI benefits. You cannot offload assets to meet the limit, as they will look at your financial movements for the last 5 years when determining your eligibility.

For example, in Florida, your assets must not exceed $5,000 ($6,000 for married couples). This excludes a single vehicle, a home under the limit of $636,000, a burial trust, and basic household possessions (clothing, jewelry, furniture, etc.).

What if I have a too-high income for Medicaid?

In some states, you may be eligible for Medicaid even if you are above the state income limit, provided you meet the ‘resource’, or asset, limit. These states allow you to ‘spend down’ your income to meet the limit. This means you will pay for non-covered medical expenses, Medicaid premiums, and other deductibles until you hit the income limit and qualify.

Instead of being immediately identifiable as needy based on income, this is designed to help those with an unusually high medical cost burden relative to their income. While not all states offer this extension, most states do. If you think you may be in this category, contact your state’s Medicaid Office to know if you qualify for coverage.

What does Medicaid cover?

Each state runs its Medicaid program differently. In general, Medicaid will cover your Medicare Part B premiums, and your share of Medicare costs (coinsurance, co-payments, and deductibles). In some cases, your Medicare Part A coverage (the hospital insurance) will also be covered.

Additionally, Medicaid offers ‘Extra Help’ to make prescription medication more affordable. Medicaid typically offers an expanded medication list and other services, like in-home help, that are not offered under Medicare. It is designed to ‘fill in the gaps’ of other medical coverage you may have. Typical offerings for seniors under the Medicaid program include home nursing, assisted living, adult 'day care', home healthcare, as well as vision, hearing, and dental care.

Is Medicaid free?

Since Medicaid is designed to help low-income families access quality medical care, costs are kept low, and many seniors who qualify for Medicaid will pay minimal costs for the coverage they receive. Generally, the cost does depend on the type of coverage you qualify for and the assistance you need. In most states, there will be no cost at all if you have income under 150% of the federal poverty level. Additionally, your total annual costs cannot exceed 5% of your household income.

How to apply for Medicaid

You will need to apply for Medicaid through your state’s local Medicaid Offices. Typically, applications are processed within 45 days. Medicaid does not transfer between states, and it can be difficult to re-apply in a different state if you move. You can apply for Medicaid at any time of the year since there is no enrollment period as with Medicare.

What is the difference between Medicaid and Medicare?

Medicare is a federally offered ‘health insurance’ for people over 65, younger people with disabilities, and people with End-Stage Renal Disease. As a federal program, the program has strict rules around coverage and costs and will be the same in all states.

Medicaid, on the other hand, is run jointly between federal and state programs. It has a wider pool, as eligibility is based on your income and resources. While the federal government has some overarching rules for the program, each state runs it separately. This means your benefits and even eligibility may vary by state. However, it offers expanded benefits not available under the Medicare program, including home care services. Typically, there’s no cost, but some states may add a small co-pay.

Can I have both Medicare and Medicaid?

You can have both Medicare and Medicaid if you qualify for both programs in your state. This is known as having dual eligibility. Medicare will pay out first, with Medicaid paying the remaining costs and for their expanded services.

Additionally, you can choose to keep standard Medicare or consider Medicare Part C (Medicare Advantage). These programs offer multiple benefits to people with dual eligibility, including Part D (Drug Coverage), and certain special plans, like the Special Needs Plan and the PACE, or Program of All-Inclusive Care for the Elderly, to help you get help and care without the need for a nursing home.