Can My Wife Get Medicaid

Medicare If You’re Married

You and your spouse’s Medicare coverage might not start at the same time. Medicare is an individual plan . However, you may be eligible for Medicare based on your spouses work history — even if you are not eligible on your own. You and your spouse’s Medicare coverage might not start at the same time. Since you each must enroll in Medicare separately, one of you may be able to sign up before the other one, depending on your age.

Your premiums may change because of your total income. There are no family plans or special rates for couples in Medicare. You will each pay the same premium amount that individuals pay. Here’s what to know about costs:

Can I Keep My Own Income

While some of the Medicaid applicants income may go to the nursing home, the community spouses income is usually not counted in determining a spouses Medicaid eligibility. However, if a community spouse earns a significant amount, they may be required to contribute to the costs of a spouses care.

A persons income must be below a certain threshold in order to qualify for benefits, so many applicants have to spend down their excess earnings before Medicaid will cover their nursing home costs. Some of this excess income may be transferred to the community spouse if they need additional financial support.

Both state and federal laws set limits on the amount of a spouses income that a community spouse may keep, called the Minimum Monthly Maintenance Needs Allowance . The federal minimum is currently $2,115 while the maximum is $3,259.50, but the exact dollar amount changes each year. In New York, up to $3,216 in monthly income is exempt from calculations when determining whether the applicant spouse is eligible for Medicaid.

Effect Of Marital Status On Treatment Of Income And Resources

The previous section illustrates how marital status determines whether a person receives benefits under the individual or couple rate. Marital status also affects how income and resources are counted in determining a person’s SSI eligibility and monthly benefit amount. For eligible couples, some rules for excluding income and resources treat the couple as a unit. Therefore, if two eligible persons married or represented themselves as husband and wife, they would lose the benefit of two separate exclusions. For couples with one member ineligible, the rules require that the income and resources of the ineligible spouse be considered in determining the other spouse’s eligibility for and monthly amount of SSI benefits. If an eligible individual lives with another person and they are not married or are not representing themselves as husband or wife, the eligible individual’s SSI benefit is determined without considering the income from the other person.

The following analysis reviews the rules for several exclusions and the rules for considering the income from an ineligible spouse. The analysis points out how the rules differ in their treatment of married couples or persons representing themselves as two single persons living in the same household. Although the benefit rate options discussed above are mutually exclusive alternatives, the exclusion and deeming options presented below could be implemented in combination with one another and with one of the benefit rate options.

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Treatment Of Married Couples In The Ssi Program

SSA booklet on Supplemental Security Income

The Supplemental Security Income program serves as an income source of last resort for elderly or disabled individuals. SSI eligibility is restricted to people with limited income and resources, and recipients’ countable income reduces their benefit amount. In establishing eligibility and the benefit amount, SSI also considers the financial resources of certain people associated with the recipient, such as spouses of SSI recipients. Marital status, therefore, can be an important factor in determining eligibility and in calculating the amount of the benefit.Benefits for a married couple, both of whom receive SSI and have no other income, amount to 25 percent less than the total they would receive if they were living together but not as husband and wife. This analysis identifies how marital status affects benefit rates and the counting of income and resources in determining eligibility. The comparisons made between married couples and two adults living together suggest that the rules provide a financial advantage for a man and a woman who live together but are not married. The paper also presents options for making the program more neutral toward marital status.

This paper was prepared by Richard Balkus and Susan Wilschke, Office of Policy, Office of Disability and Income Assistance Policy. Questions about the analysis should be directed to them at 202-358-6012.

If Your Spouse And You Both Need Medicaid Coverage For Home Care This Strategy Can Get It For You And Still Protect Your Income And Assets

Many people incorrectly believe that they cannot achieve Medicaid eligibility because of Medicaids five-year look back. In New York, there is no look back for Community Medicaid, which includes home care and assisted living. Unfortunately, even without the look back, meeting Medicaid qualifications for combined home care is not easy. There are stringent Medicaid requirements you must comply with in order to achieve Medicaid eligibility. Without proper planning, youll have to pay the cost of your own care, until virtually all your cash and other assets are depleted.

If that sounds like your situation, theres a better way. Its possible to get Medicaid coverage of home care for both of you simultaneously, and to protect your money, income and assets. Heres a detailed explanation of how it can be accomplished with an Elder Law attorneys help.

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Making Sense Of Medicaid Income Limits

A long-term care Medicaid beneficiary is expected to pay all their income to the nursing home since Medicaid foots the bill for their room, board, utilities and care. Aside from personal items, such as clothing, snacks, toiletries and other incidentals, everything is covered. So, there is no need for them to retain this income. Medicaid nursing home residents are allowed to keep a small personal needs allowance of at least $30 per month for these incidental purchases, but the exact amount varies by state.

Unlike assets, each spouses income is considered separately based on who the payments are addressed to/intended for. Therefore, a community spouses income, no matter how large, does not have any bearing on whether their spouse qualifies for long-term care Medicaid. This aspect sounds refreshingly straightforward, but the rules can still be complex in certain situations.

Is It Cheaper To Get Health Insurance As A Married Couple

In some cases, it could be cheaper to get health insurance as a married couple. There are plenty of options for affordable health insurance for married couples, but the cost of specific health insurance plans can vary depending on the type of plan you choose. That is why you always need to take a look at the details of health insurance plans before you decide to sign up for one, particularly if you are looking for a health insurance plan for you and your spouse.

There are some situations where you might need to pay a spouse surcharge, and there are other situations where employers may not subsidize your spouse as much as they subsidize the employee.

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Incarceration Institutionalization And Medicaid

If you are incarcerated, Medicaid doesnt pay for medical care. However, you can apply for Medicaid while in jail or prison so you can receive benefits more quickly upon release. Some states do allow incarcerated individuals to stay on Medicaid, even though they do not receive benefits while in jail or prison.

Those institutionalized in non-prison or jail settings are usually able to keep Medicaid coverage, as long as the facility meets state and federal certification standards.

Three Keys To Preserving Your Income And Assets

Step 1: If you own a house, condominium or co-operative apartment, it should be transferred into a special protective trust . Under federal law, this protects your home from being subject to a Medicaid lien. Otherwise, when your home is no longer your primary residence, Medicaid may recover the cost it has incurred from the equity in the home. The trust protects the home against claims from Medicaid or from other future creditors.

Since the cost of home care for two people can range up to $10,000 or $15,000 a month, you can see how quickly the equity in your home will be depleted, if you dont protect it. That means you wont be able to preserve the equity for your own future needs, or leave it to your children or heirs. Yet with this strategy, you will.

Step 2: Transfer your money, investments, and other assets to the same protective trust, or to your children or other relatives or friends. Once in their hands, they can use these assets to pay for goods and services for you. Transfers of your money or other assets will not incur any Medicaid penalty when you are applying for home care benefits. Also, these transfers will not be subject to tax.

You can learn more about the asset protection strategies used in the event that either or both of you need nursing facility care by clicking on these links:

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Medicaid Eligibility Income Chart By State Updated Jul 2022

The table below shows Medicaids monthly income limits by state for seniors. Income is not the only eligibility factor for Medicaid long term care there is also an asset limit and level of care requirements. Additionally, there are state-specific details. Click on the state name below to see that states complete Medicaid eligibility criteria.

The maximum income limits change dependent on the marital status of the applicant, whether a spouse is also applying for Medicaid, and the type of Medicaid for which they are applying. Nursing home Medicaid may have a different income limit than home and community based Medicaid services, and both of those may differ from the Aged, Blind and Disabled income limits.

Exceeding the income limits does not mean an individual cannot qualify for Medicaid. Most states have multiple pathways to Medicaid eligibility, such as a medically needy pathway. Furthermore, many states allow the use of Miller Trusts or Qualified Income Trusts to help person who cannot afford their care costs to become Medicaid eligible. There are also Medicaid planning professionals that employ other complicated techniques to help persons become eligible. Finally, candidates can take advantage of spousal protection laws that allow income to be allocated to a non-applicant spouse.

Will Medicaid Pay For Primary Insurance Copays

Most Medicaid recipients in Arizona dont owe a monthly premium for the services. Instead, youll only need to make payments while receiving care.

If youre 19 or older, you might have to make small copayments for Medicaid-covered services. You wont have to cover copayments, however, if youre 18 or younger, pregnant, in hospice care, or exempt under certain other conditions.

Arizona Medicaids copayments will be much more affordable than copayments from private insurance companies. Keep in mind that if your primary insurance provider charges a copay to receive services, Medicaid may not cover that. You will need to contact your Medicaid service provider to find out.

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Can I Stay On My Parents Insurance After Marriage

If you have been covered under your parents health insurance plan, you might want to keep that coverage after you are married. Under federal law, young adults may keep their coverage under their parents plan until they turn 26 years old. This is the case even if you get married before the age of 26. There is also no restriction stating you must continue to live with your parents to keep that coverage.

What Income Is Protected

Spouses of long-term care patients receiving Medicaid are allowed to keep all of their own income, and they may be able to keep some of their spouse’s income if they need the financial support. The amount of money that a spouse may keep and that is exempt from the Medicaid eligibility calculation is called the “minimum monthly maintenance needs allowance” . The MMMNA varies from state to state, but the federal government sets a minimum and a maximum periodically that is tied to poverty guidelines. The minimum amount that a state must allow a community spouse to keep is $2,115.00, and the maximum is $3,259.50 . For example, California, Texas, and New York use a monthly figure of $3,216. That amount of income is disregarded by the state Medicaid agency in evaluating whether the “needy” spouse is financially eligible for Medicaid.

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Most Medicaid Enrollees Get Care Through Private Managed Care Plans

Over two-thirds of Medicaid beneficiaries are enrolled in private managed care plans that contract with states to provide comprehensive services, and others receive their care in the fee-for-service system . Managed care plans are responsible for ensuring access to Medicaid services through their networks of providers and are at financial risk for their costs. In the past, states limited managed care to children and families, but they are increasingly expanding managed care to individuals with complex needs. Close to half the states now cover long-term services and supports through risk-based managed care arrangements. Most states are engaged in a variety of delivery system and payment reforms to control costs and improve quality including implementation of patient-centered medical homes, better integration of physical and behavioral health care, and development of value-based purchasing approaches that tie Medicaid provider payments to health outcomes and other performance metrics. Community health centers are a key source of primary care, and safety-net hospitals, including public hospitals and academic medical centers, provide a lot of emergency and inpatient hospital care for Medicaid enrollees.

Figure 6: Over two-thirds of all Medicaid beneficiaries receive their care in comprehensive risk-based MCOs.

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Will I Have To Give Up Shared Assets

Under federal Medicaid laws, a community spouse is allowed to keep a certain portion of the couple’s marital assets or resources. The amount of resources that the community spouse may keep changes from state to state and is adjusted for inflation every few years. In 2021, the federal maximum CSRA is $130,380, while the federal minimum is $26,076.

In New York, the spouse entering long-term care may currently keep assets up to $15,900 in their own name. As of 2021, the community spouse may have up to half of the couple’s total combined assets up to $130,380, or $74,820 . This includes resources in the community spouse’s name only, resources in the Medicaid spouses name that exceed $15,900, and any of the couples joint resources.

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Can I Buy A Policy On The Marketplace If My Spouse Has Access To An Employer

You are not obligated to buy family health insurance from your spouses employer. In some cases, a family health insurance plan can be more expensive than a similar plan chosen through a private, state, or federal marketplace.

Keep in mind that if you have access to a family health insurance policy through your spouses work and choose instead to purchase through an exchange, there can be some unexpected costs. For example, you may not be eligible for Obamacare subsidies if you or your spouse have access to an employer-sponsored health insurance plan, but opt to buy your own plan off an exchange. When assessing relative costs between the family health insurance and individual marketplace plans, be sure to account for subsidies that you are no longer allowed.

What Can Be Done To Protect My Assets

You cannot simply give your assets away to qualify a spouse for Medicaid. This can put you in violation of Medicaids 5-year Look Back Period and result in a period of Medicaid ineligibility. However, there are ways for you to protect your assets. You can put money into non-exempt assets, such as paying for home modifications / renovations, vehicle modifications, or purchasing an irrevocable funeral trust. You can also pay off debt, such as your mortgage loan or credit cards. In addition, you could purchase an annuity. This takes countable assets and transforms them into non-countable income. Some of these approaches are straightforward and others are complicated. It is best to consult with a Medicaid eligibility expert before taking any action to ensure you are not in violation of Medicaids complicated rules.

Eldercare Financial Assistance Locator

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Spending Down To Qualify

If youre single and applying for Medicaid services, you cant have over $2,000 worth of countable assets . Its also against the rules to give away your resources in order to qualify for benefits within five years of applying for Medicaid.

ALTCS and other benefit programs may deny applicants who have too much value in assets. Spending down is one strategy you can use to qualify financially for Medicaid benefits in Arizona. To spend down means to reduce these assets and reapply later.

If you decide to try this strategy, its ideal to work with an attorney to ensure you do it in the best possible way.

Income Limits For The Nursing Home Spouse

When only one spouse is applying for Medicaid long-term care, the applicant must meet an income limit to qualify. The Medicaid income limit in 2022 is $2,523 per month. Certain states use this number as a hard limit for applicants, while other states allow applicants with high health care costs to spend down excess income on their own care.

The rules for the nursing home spouses income are as follows if their community spouse receives $2,177.50 or more of their own income each month in 2022. This threshold is called the minimum monthly maintenance needs allowance and will be discussed in further detail below.

How Medicaid Treats Income in Income Cap States

While the financial requirements in income cap states may seem black and white, there are ways that applicants with excess income can achieve Medicaid eligibility. Certain trusts, such as Miller trusts, can be used as part of a Medicaid planning strategy to qualify for long-term care coverage.

Read:How to Set Up a Miller Trust for Medicaid Eligibility

How Medicaid Treats Income in Medically Needy States

In medically needy states, an applicant can spend down to a different limit which may be called the medically needy income limit or maintenance needs allowance . These limits vary by state and depending on whether the applicant is living in a nursing home or in the community.

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