Unitedhealthcare Dual Complete Plans
Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a contract with the State Medicaid Program. Enrollment in the plan depends on the plans contract renewal with Medicare. This plan is available to anyone who has both Medical Assistance from the State and Medicare. This information is not a complete description of benefits. Call TTY 711, or use your preferred relay service for more information. Limitations, co-payments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.
This Plan Is Available In The Following Counties:
Albany,Bronx,Broome,Cayuga,Chautauqua,Chemung,Chenango,Clinton,Columbia,Dutchess,Erie,Essex,Franklin,Fulton,Genesee,Greene,Herkimer,Jefferson,Kings,Lewis,Livingston,Madison,Monroe,Nassau,New York,Niagara,Oneida,Onondaga,Ontario,Orange,Orleans,Oswego,Queens,Rensselaer,Richmond,Rockland,Schenectady,Seneca,St. Lawrence,Suffolk,Tioga,Ulster,Warren,Wayne,Westchester,Wyoming,andYates.
UnitedHealthcare continues to partner with state and local public health departments, following guidance and protocols appropriate to our members that are provided by the U.S. Centers for Disease Control and Prevention , and state and local public health departments that are appropriate for our members. Please review the UnitedHealthcare Coronavirus Information. To learn more, go to CDC.gov.
COVID-19 NY State PPE Fee Guidance
The New York State Department of Financial Services recently issued guidance stating that care providers should not charge members additional fees for items such as personal protective equipment . DFS expects New York care providers to refund any of these charges paid by the member that were more than the members financial responsibility on a claim. If you have questions, you may contact your provider or call the number on the back of your card for assistance with filing a complaint.
We Also Encourage You To Download Our Take On Obtaining Medicaid For Home Care:
Please Note: Information provided herein is for convenience purposes. Nothing on this page or website constitutes legal advice, and we recommend that you verify all information on your own and seek legal counsel where appropriate. Please see full disclaimer at the bottom of this page.
When it comes to Medicaid in NY State, the first thing that one needs to determine is the applicants budgeting category. People in different age groups and circumstances are subject to different eligibility rules, and the services available in each category may also vary. In this section we will be discussing eligibility and services for the aged, blind, and disabled. This category includes people who are 65 and above, certified blind by the Commission for the Blind and Visually Handicapped, and certified disabled by Social Security or NY State . There are three levels of Medicaid for this category:
- Community Medicaid
Get help applying for Medicaid for home care
What is Covered by Community Medicaid?
While Medicaid covers prescription drugs, people with Medicare will not have their prescription drugs paid for by Medicaid directly. Rather, Medicaid will pay Medicare to provide a free Medicare Part D prescription drug plan for these beneficiaries. Click here to learn more about this.
Community Medicaid with Long-Term Care provides everything that Community Medicaid does with the addition of community based long-term care services such as home care, adult day care, and assisted living .
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What Is Medicaid What Does It Pay For
Medicaid was created as a federal health insurance program for people who had little to no income. Today, it’s a joint federal and state program that allows people to receive thousands of dollars worth of healthcare benefits, as long as they can prove financial eligibility.
There are three categories of Medicaid coverage:
- Community services. This covers outpatient doctor’s appointments, dentist appointments, emergency room treatment, prescription medications, and other professional clinical care.
- Home health services. Home care services can pay for in-home nursing care, personal care attendants, visiting physical therapists, and other home health aid services.
- Institutional services. Medicaid can also cover extended stays in medical facilities, such as hospitalization , rehabilitation facilities, and long-term care in a nursing home.
Immediate Need For Personal Care Services / Consumer Directed Personal Assistance Services
If you think you have an immediate need for Personal Care Services or Consumer Directed Personal Assistance Services , such as housekeeping, meal preparation, bathing, or toileting, your eligibility for these services may be processed more quickly if you meet the following conditions:
- You are not receiving needed help from a home care services agency
- You have no adaptive or specialized equipment or supplies in use to meet your needs
- You have no informal caregivers available, able and willing to provide or continue to provide care
- You have no third party insurance or Medicare benefits available to pay for needed help
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How Do I Apply
If you apply at one of our Department of Community and Family Services locations, you will need the following documents:
- If you are a U.S. citizen and provide a valid Social Security Number , a match with the Social Security Administration will verify your SSN, date of birth, and U.S. citizenship. If SSA verifies this information, no further proof is needed. The SSA match cannot verify birth information for a naturalized citizen. You will need to submit proof of naturalization or a U.S. passport.
- Proof of citizenship or immigration status.
- Proof of age , like a birth certificate.
- Four weeks of recent paycheck stubs .
- Proof of all your income including sources like Social Security, Veteranâs Benefits , retirement benefits, Unemployment Insurance Benefits , Child Support payments.
- If you are age 65 or older, or certified blind or disabled, and applying for nursing home care waivered services, or other community based long term care services, you need to provide information of all bank accounts, insurance policies and all other resources.
- Proof of where you live, such as a rent receipt, landlord statement, mortgage statement, current utility bill or envelope from mail you received recently.
- Copy of insurance benefit cards .
- Copy of Medicare Benefit Card .
Note: Medicaid coverage is available, regardless of alien status, if you are pregnant or require treatment for an emergency medical condition and you meet all other Medicaid eligibility requirements.
Are There Any Exceptions To The Look
The 2019 Coronavirus pandemic has had a significant impact on Medicaid eligibility. The COVID Public Health Emergency has been extended several times, most recently in April 2022, prohibiting the government from discontinuing Medicaid or increasing the spend-down until August 1, 2022.
As a result, the 30-month look-back period that disqualifies many applicants from home care or minimum requirements for CDPAP services will not apply until October 1, 2022*. If applicants complete their Medicaid planning and submit their Home Care Medicaid Application before October 1, 2022*, they may not be subject to the standard 30-month look back or penalties for transfers to a Medicaid Asset Protection Trust. For this reason, anyone who needs these services now should speak with our Medicaid planning team as soon as possible.
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New Yorks Requirements For Medicaid Qualification
Eligibility for New York Medicaid is something that is determined by a few different factors that have been developed by the New York state department. The benefits given by Medicaid will aid those who are unable to pay their medical bills, such as those on SSI and others who meet the requirements for eligibility. Before those requirements even come in to play though, you first have to fall into one of the following categories:
- Adults who have an income that does not exceed 138% of the FPL
- Infants and/or women who are pregnant whose income does not exceed 218% of the Federal Poverty Level
To qualify for Medicaid – aside from being in one of the preceding two categories – you need to meet predetermined requirements for eligibility. You have to reach, without exceeding certain income thresholds. Additionally, you have to prove that you are a citizen of the US as well as proving that you are a state resident. You also need to have documentation regarding your living situation and your marriage license if you are married, along with your SSN .
Are You Already Getting Insurance Through Your Employer
If you have health insurance coverage through your employer, you should keep that insurance and reach out to HRA. Medicaid may cover the cost of the premium for that insurance coverage.
The MBI-WPD program does not offer family coverage. Single people and married couples are both covered under this program if both individuals are working and have a disability. Spouses without a disability and children may be covered through other programs such as Medicaid through New York State of Health or Child Health Plus.
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Appealing A Denial Of Medicaid
Tip: Save the envelope as well as the letter. You may need it to prove when you received the letter.
Who Is Eligible For Medicaid In New York
Adults in New York with incomes up to 138% of poverty level are now eligible for Medicaid. Pregnant women and children under the age of one are eligible with an income of up to 218% of poverty level . And starting in March 2023, Medicaid for the mother continues for 12 months postpartum, instead of ending after two months. This is due to legislation that the state enacted in 2022 to take advantage of an American Rescue Plan provision that provides five years of funding for extended postpartum Medicaid coverage .
Children from age one to eighteen are eligible for Medicaid with a household income up to 149% of poverty, but the state also has separate CHIP coverage available for children with household incomes up to 400% of poverty level the highest threshold in the country.
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No Existing Medicaid Coverage
If you dont already have Medicaid coverage, and you meet the above conditions, you may ask to have your Medicaid application processed more quickly by sending in a completed Access New York Health Insurance Application and the Access New York Supplement. If needed, you will also need to provide a physicians order for services and a signed Attestation of Immediate Need
.
Applying For Medicaid In New York State
This article is not intended to provide you with legal advice. Should you seek legal advice, please consult an attorney. KTS would gladly recommend an attorney should you need one. Its important to have an attorney take appropriate actions on your behalf and to avoid issues that may be discussed in this article.
Applying for Medicaid in New York State? New York State Medicaid is a program available to eligible, low-income New York State residents who require additional help paying for their medical expenses. This joint state and federal government program provides health care insurance to people with limited income and assets.
New York Medicaid is available to all New York State residents who are legal citizens, and who meet certain eligibility requirements. Medicaid is the most widely used medical assistance program in the United States. Coverage will only be granted to people in qualifying situations.
Although Medicaid is a federal program with guidelines that all states must follow, each state is able to set its own eligibility for Medicaid requirements, rules, and regulations. This article outlines the specific guidelines for New York State residents, the eligibility requirements, and how to apply for Medicaid. It also lists the robust benefits that approved Medicaid applicants will be able to use.
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How To Apply If In Ny City:
If you are in New York City, you can easily obtain applications from Human Resources Administration. You can also request information and applications on phone by calling at 718 557 1399.
NOTE: If you need any further assistance, you can call helpline at 693-6765.
Other requirements for applying
In order to apply for Medicaid, you will need to provide
- Proof of citizenship
- If someone above 65 years of age, disabled or blind lives with you, you will need to provide proof of your income and resources
- Proof of your residence
- If you have any other insurance, you’ll be required to provide its proof and information about it
Medicaid Benefits
Medicaid provides a comprehensive coverage for various health services including
- Inpatient and outpatient services
- Home health care through approved agencies
- Access to smoking cessation agents
- Lab facilities and access to tests
- Eye, dental and mental health services
- Prescription drugs, medical supplies, and necessary medical equipment
- Transportation services
Medicare Savings Program Eligibility Requirement Changes
Healthfirst Medicare Advantage Members may be able to save money thanks to new expanded eligibility requirements for the Medicare Savings Program. With a new, increased income limits, you may now qualify for extra assistance through the Medicare Savings Program and/or Medicaid. We can help you apply to make sure you get all the savings youre entitled to.
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Are Medicaid And Medicare The Same Thing
No. Medicaid is a needs-based program primarily used to pay for long-term care, whether in a nursing home or through New Yorks Home and Community-Based Services program.
Medicare is a government-sponsored healthcare insurance program that covers adults over 65 and people with severe disabilities. While it covers regular doctors visits, emergency treatment, and prescriptions, it wont provide enough to cover the full costs of long-term nursing care.
Medicaid Dental Coverage Ny
NYS Medicaid covers all essential dental services. Essential means that only medically necessary procedures will be covered, such as extractions to prevent disease. Kids can receive a bit more dental care thanks to the EPSDT program. That includes regular oral exams as well as preventative, restorative, and emergency dental care. Kids can also get emergency orthodontic care. Implants, bridgework, dentures, and cosmetic work are NOT included.
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What Is The Look Back Period
New York has a 60-month “look back” period for Medicaid applicants seeking nursing home care. Officials will review the applicant’s financial transactions for 60 months before the application date, checking whether any assets were sold or given away for less than fair market value.
The “look back” was created to discourage applicants from simply giving their possessions and cash to friends and family to qualify for Medicaid. If any transfers violate the fair market value rule, the applicant will endure a penalty period of Medicaid ineligibility.
Learn About Requirements For Medicaid In New York
To learn how to qualify for Medicaid in New York, applicants need to understand the eligibility requirements set by state and federal guidelines. Obtaining Medicaid benefits eligibility means that applicants have met essential qualifications, such as income level and medical expenses. Unlike Medicare, Medicaid focuses more on income levels instead of age. The program uses federal, state and local funding to provide health insurance to families struggling with purchasing care. The process to qualify for Medicaid involves understanding Medicaid eligibility requirements and knowing what information potential beneficiaries need to provide officials. Once an applicant knows and gathers the necessary details, the process to get benefits starts with an application form. Get answers to the question What are the income requirements for Medicaid in NY? and others by reading the information below.
Who qualifies for Medicaid in New York?
What are the requirements for Medicaid in New York?
To meet qualifications for Medicaid in New York, some applicants will need to demonstrate that their household income falls below a certain percentage of the federal poverty level . However, these specific income levels will depend on the particular Medicaid program for which the applicant qualifies. To learn more about income requirements for Medicaid, .
What are the Medicaid application guidelines in New York?
What are common Medicaid disqualifications in New York?
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Eligibility Criteria For Ny Medicaids Long Term Care Programs
To be eligible for NY Medicaid, a person has to meet certain financial requirements and functional requirements. The financial requirements vary by the applicants marital status, if their spouse is also applying for Medicaid and what program they are applying for Nursing Home Medicaid, Home and Community Based Service Waivers or Disabled, Aged 65+ or Blind / Regular Medicaid.
NY Medicaid Nursing Home Medicaid Eligibility Criteria
For married applicants with both spouses applying, the 2022 asset limit for Nursing Home Medicaid through NY Medicaid is $24,600 combined between the two applicants/spouses and the income limit is $1,367 / month combined. For a married applicant with just one spouse applying, the 2022 asset limit is $16,800 for the applicant spouse and $137,400 for the non-applicant spouse, and the income limit is $934 / month for the applicant. The income of the non-applicant spouse is not counted. However, if the income of the non-applicant spouse is greater than $3,435 / month, NY Medicaid will request that 25% of the amount over $3,435 / month be given to the state to help cover the care costs of the applicant spouse. If the non-applicant spouse does not want to do this, they can institute spousal refusal.
NY Medicaid Home and Community Based Services Waivers Eligibility Criteria
NY Medicaid Disabled, Aged 65+ or Blind Medicaid Eligibility Criteria
