How Mepd Services Are Provided
If you’re an adult with a disability and qualify for MEPD, these services are typically provided by STAR+PLUS. You will choose a STAR+PLUS health plan from the ones available in your service area.
If you have a child with a disability who qualifies for MEPD, these services are typically provided by STAR Kids. You will choose a STAR Kids health plan from the ones available in your service area.
You might also be enrolled into traditional Medicaid. Traditional Medicaid just means the state pays your doctors, nurses and other caregivers directly.
Moving From Expanded Medicaid To Medicare Advantage
Depending on your circumstances, you might choose to enroll in a Medicare Advantage plan that provides prescription, dental, and vision coverage and caps enrollees annual out-of-pocket costs for Parts A and B, which traditional Medicare does not do. Many of these plans are available with no additional premiums, which means youd pay just the $148.50/month for your Part B coverage .
And some Medicare Advantage plans even have a give back benefit that pays some of that Part B premium for you.
Medicare Can Pull You Out Of The Coverage Gap
Although the transition from expanded Medicaid to Medicare can be financially challenging, eligibility for Medicare will likely come as a welcome relief if youve been in the coverage gap in one of the 11 states that have refused to expand Medicaid.
Being in the coverage gap means you have an income below the federal poverty level. Once you transition to Medicare so as long as your assets dont disqualify you youll be eligible for the most robust MSP, which covers Original Medicares premiums, deductibles, and coinsurance.
Even if your assets do make you ineligible for an MSP, you could still enroll in Original Medicare or a zero-premium Medicare Advantage plan and pay just $148.50/month in premiums .
And although its not an ideal solution, you do have the option to reject Part B and just enroll in Part A, which is premium-free as long as you or your spouse have worked at least 10 years in the U.S. and paid Medicare taxes.
Although the asset tests in most states might still put an MSP or full Medicaid coverage out of reach once you transition to Medicare, the option to have health coverage for under $160/month is far better than the alternatives that exist for most people under age 65 in the coverage gap.
In most states, unsubsidized premiums for ACA-compliant coverage are three times a high for a 64-year-old versus a 21-year-old, and people in the coverage gap are not eligible for any financial assistance with their coverage.
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How Much Assets Can You Have On Medicare
You may have up to $2,000 in assets as an individual or $3,000 in assets as a couple. As of July 1, 2022 the asset limit for some Medi-Cal programs will go up to $130,000 for an individual and $195,000 for a couple. These programs include all the ones listed below except Supplemental Security Income .
Who Among The Four Eligibility Groups Would Benefit From Our Instruction To Apply For Ssi
Anyone who is 65 or older or have a disability with income below $750. There could even be some in the special long-term care income limit program who have income less than $750 and never applied for SSI, or have resources over the SSI limit. Medicaid also has provisions for spousal impoverishment considerations.
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Can One Have Dual Eligibility For Both Medicare And Medicaid
Yes, Medicare and Medicaid are not mutually exclusive programs. Persons who are eligible for both are referred to as having Dual Eligibility, Dual Eligibles, or often simply Duals. Medicare is the first payer of covered benefits, while Medicaid is the secondary payer.
Typically, Medicaid will pay for Medicare premiums and co-payments for dual eligibles. In fact, many states have special programs intended to make it easier for seniors to manage their dual eligibility status, as it can be confusing to know where to turn for what services. This is generally in the form of managed care.
There are also programs called Medicare Saving Programs for low-income seniors that dont quite qualify for Medicaid.
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
Who Will Supplemental Security Income Help
Currently, the only recipients in the Special Income Level group whose eligibility is not impacted are those receiving Supplemental Security Income . Non-SSI recipients would fall into the Special Income Level group even if the income is less than $750 and could be impacted by the budget cuts. Waiver recipients will lose waiver benefits unless they are eligible and receive SSI.
We recommend you apply for SSI if you have not already done so in order to protect your current Medicaid eligibility. It can sometimes take around six months for an SSI eligibility determination to be made by the federal government.
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What Are The Differences Between Medicare And Medicaid
Medicare is a federal health insurance program open to Americans age 65 and older and those under the age of 65 with specific disabilities. Medicaid, a combined state and federal program, is a state-specific health insurance program for low-income individuals with limited financial means, regardless of their age.
Medicare, generally speaking, offers the same benefits to all eligible participants. However, coverage is divided into Medicare Part A, Part B, and Part D. Medicare Part A is for hospice care, skilled nursing facility care, and in-patient hospital care. Medicare Part B is for out-patient care, durable medical equipment, and home health care. Part D is for prescription coverage. Not all persons will elect to have coverage in all three areas.
In addition, some persons choose to get their Medicare benefits via Medicare Advantage plans, also called Medicare Part C. These plans are available via private insurance companies and include the same benefits as Medicare Part A and Part B, as well as some additional ones, such as dental, vision, and hearing. Many Medicare Advantage plans also include Medicare Part D.
Medicaid is more comprehensive in its coverage, but the benefits are specific to the age group. Children have different eligibility requirements and receive different benefits from low-income adults and from elderly or disabled persons.
Helpful Resources
I Have Ssdi Does That Qualify Me What Is The Difference Between Ssi And Ssdi
Social Security Disability Income is not the same as Supplemental Security Income . SSDI is based on an individuals earnings record. Whereas, Supplemental Security Income serves the needy and eligibility is based on having limited income and resources. It is possible for an individual to qualify for both SSDI and SSI benefits but you must apply for SSI with the Social Security Administration to retain Medicaid eligibility if there are budget cuts to these programs. Having SSDI will not maintain your eligibility.
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If Your Income Is Low And Your State Hasnt Expanded Medicaid
If your state hasnt expanded Medicaid, your income is below the federal poverty level, and you don’t qualify for Medicaid under your state’s current rules, you wont qualify for either health insurance savings program: Medicaid coverage or savings on a private health plan bought through the Marketplace.
- Find out why
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- When the health care law was passed, it required states to provide Medicaid coverage for all adults 18 to 65 with incomes up to 133% of the federal poverty level, regardless of their age, family status, or health.
- The law also provides premium tax credits for people with incomes between 100% and 400% of the federal poverty level to buy private insurance plans in the Health Insurance Marketplace®.
- The U.S. Supreme Court later ruled that the Medicaid expansion is voluntary with states. As a result, some states havent expanded their Medicaid programs.
- Adults in those states with incomes below 100% of the federal poverty level, and who dont qualify for Medicaid based on disability, age, or other factors, fall into a gap.
- Their incomes are too high to qualify for Medicaid in their states.
- Their incomes are below the range the law set for savings on a Marketplace insurance plan.
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States are continuing to make coverage decisions. They could expand Medicaid in the future.
Person Who Is Aged Blind And/or Disabled
Apply if you are aged , blind, or disabled and have limited income and resources. Apply if you are terminally ill and want to get hospice services. Apply if you are aged, blind, or disabled live in a nursing home and have limited income and resources. Apply if you are aged, blind, or disabled and need nursing home care, but can stay at home with special community care services. Apply if you are eligible for Medicare and have limited income and resources.
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How Does Medicaid And Chip Work For Pregnant Women
Medicaid provides health coverage to low-income pregnant women during pregnancy and up to two months after the birth of the baby. CHIP Perinatal provides similar coverage for women who cant get Medicaid and dont have health insurance.
When do you no longer qualify for Medicaid after giving birth?
If found eligible during your pregnancy, youll be covered for 60 days after you give birth. After 60 days, you may no longer qualify. Your state Medicaid or CHIP agency will notify you if your coverage is ending. You can enroll in a Marketplace plan during this time to avoid a break in coverage.
What are the income limits for Medicaid for pregnant women?
The income limits for pregnancy-related Medicaid vary, but states cannot drop eligibility for this coverage below a legal floor that ranges from an income of 133% to 185% of FPL , depending on the state. States are permitted to set a higher income cutoff. Childrens Health Insurance Program
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What Medicaid Covers For Medicare Enrollees
Medicare has four basic forms of coverage:
- Part A: Pays for hospitalization costs
- Part B: Pays for physician services, lab and x-ray services, durable medical equipment, and outpatient and other services
- Part C: Medicare Advantage Plan offered by private companies approved by Medicare
- Part D: Assists with the cost of prescription drugs
Medicare enrollees who have limited income and resources may get help paying for their premiums and out-of-pocket medical expenses from Medicaid . Medicaid also covers additional services beyond those provided under Medicare, including nursing facility care beyond the 100-day limit or skilled nursing facility care that Medicare covers, prescription drugs, eyeglasses, and hearing aids. Services covered by both programs are first paid by Medicare with Medicaid filling in the difference up to the state’s payment limit.
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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.
| Medicaid Eligibility Income Chart Updated July 2022 |
| State |
How Are My Health Care Costs Reimbursed If I Have Medicare And Medicaid
When dual eligible beneficiaries have healthcare expenses, Medicare pays first and Medicaid pays last. But this is not the case for things Medicare doesnt cover, like long-term care. If Medicaid is covering a beneficiarys long-term care, Medicare will still be the primary payer for any Medicare-covered services like skilled nursing care or physical therapy.
Although it is less common, if a dual eligible individual has additional coverage then Medicare pays first, Medigap will pay second, and Medicaid is the last payer for their claims .
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Medicaid Adults 65 And Older & People With Disabilities
The Medicaid program provides comprehensive medical coverage to seniors and people with permanent disabilities. People receiving SSI benefits automatically receive Medicaid. Seniors and people with disabilities who are receiving Social Security Retirement or Disability benefits and have income/resources that exceed the SSI limits may be eligible for Medicaid under the rules described in this section.
Note: People with disabilities who are waiting for a decision on eligibility for SSI or Social Security Disability Insurance benefits may be eligible for Medicaid under the MAGI category.
Who Qualifies?
- People who have a severe physical and/or mental disability that has lasted or will last longer than one year or will result in death and prevents any substantial gainful employment.
- Must be a citizen or eligible immigrant. Eligible immigrants include refugees or persons granted asylum. Lawful Permanent Residents who entered the U.S. on/after 8/22/96 must be in status for at least 5 years. In addition, immigrants who were in lawful status in the U.S. before 8/22/96 and lived in RI at some time before 7/1/97 may be eligible for coverage.
Income and Resource Limits
How to Apply
You can apply on-line at healthyrhode.ri.gov. You can also request a paper application from a DHS office by calling: 1-855-697-4347 or by downloading the form from the EOHHS website at:
For more information on Medical Assistance see the EOHHS website.
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What Is The Medicaid Program
Good health is important to everyone. If you can’t afford to pay for medical care right now, Medicaid can make it possible for you to get the care that you need so that you can get healthy and stay healthy.
Medicaid is available only to certain low-income individuals and families who fit into an eligibility group that is recognized by federal and state law. Medicaid does not pay money to you instead, it sends payments directly to your health care providers. Depending on your state’s rules, you may also be asked to pay a small part of the cost for some medical services. In general, you should apply for Medicaid if you have limited income and resources. You must match one of the descriptions below:
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What Are Medicaid Requirements
Medicaid beneficiaries generally must be residents of the state in which they are receiving Medicaid. They must be either citizens of the United States or certain qualified non-citizens, such as lawful permanent residents. In addition, some eligibility groups are limited by age, or by pregnancy or parenting status.
Transitioning From Expanded Medicaid To Medigap
The more expensive way to cover the gaps in traditional Medicare is to buy a Medigap policy, which generally costs anywhere from a minimum of $25/month to more than $200/month to cover out-of-pocket costs for Parts A and B. Thats on top of premiums for Medicare Parts B and D .
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Why Are Letters Going Out Now
Two reasons. First, we want to give everyone impacted by this cut as much notice as possible in order to make plans for such a change and begin the process of seeing if individuals may be eligible for other services. We know from speaking with some individuals and their families already that explaining these complex reductions can take time.
Second, because of federally required timelines and approval processes, we must start the public notice step of rulemaking, CMS notification and their approval process. This could be lengthy. We believe it to be responsible to explain to enrollees what that public notice means, provide advice on applying for other available programs, and how to contact us if they have questions.
Who Qualifies For Medicaid
Medicaid qualification is different in every state. You must be a resident of the state in which you are applying for benefits and must be a U.S. citizen or otherwise qualified non-citizen such as a lawful permanent resident.
Federal law requires every state to provide Medicaid to the following mandatory eligibility groups that meet certain income and asset requirements:
As you can see from the federal guidelines, the only reference to age is in regards to children. Each state governs its own Medicare program in adherence to federal regulations. Some states may have an age requirement in order to qualify for its Medicaid program while other states may not.
You can find your states Medicaid eligibility requirements to learn more.
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How Does Medicare Part D Coverage Work With Medicaid
If you have Medicaid and then become eligible for Medicare, youll have to find new prescription coverage through Medicares Part D drug program. Then youll automatically qualify for the federal Extra Help program, which enables you to receive Part D drug coverage without paying premiums or deductibles. Youll also have low copays for your drugs.
But to get this coverage, you need to enroll in a Part D drug plan. If you dont do this yourself, the Centers for Medicare & Medicaid Services will select one for you.
Part D costs, coverage and preferred pharmacies vary by plan, so its a good idea to shop around and choose a plan that works best for you and your circumstances. You can compare coverage for your medications and pharmacies under the plans in your area with the Medicare Plan Finder or you can work with your SHIP to get help choosing the best Part D plan for your needs.
Keep in mind
You may no longer qualify. If you had Medicaid coverage before you turned 65, you may no longer be eligible after you turn 65. Some Medicaid programs dont continue coverage past 65, but the rules vary a lot by program and state. Find out about the requirements from your state Medicaid office.
And possibly extra help. You may also qualify for help with Part D premiums and copayments from the Extra Help program, which has higher income limits than Medicaid and is expanding to even higher income levels in 2024.
