What Costs Should You Expect If Youre Moving From Expanded Medicaid To Medicare
If youve been enrolled in expanded Medicaid, its likely that you havent had to pay any monthly premiums. But that may change when you turn 65.
For most people, Medicare Part A is premium-free, but Medicare Part B costs $148.50/month in 2021, and is projected to be $158.50/month in 2022. This is true even for many of the people who qualified for premium-free expanded Medicaid prior to age 65.
However, full Medicaid coverage is available to people age 65+ who have very limited income and assets. And there are Medicare Savings Programs that will cover the cost of the Part B premiums , for people who are eligible. Depending on the MSP, the income limits can be quite a bit higher than the income limit for expanded Medicaid eligibility.
But the catch is the asset limits. There are several states that dont use asset limits for their MSPs. In most states, however, to be eligible for MSP assistance, your assets cant exceed $7,970 if youre single, or $11,960 if youre a couple. There are some assets that arent taken into consideration, including your primary residence, one car, household belongings, and a burial plot, along with up to $1,500 in burial expenses.
If Youre Eligible For Both Medicaid And Private Insurance
There are a few upsides to being eligible for both Medicaid and private insurance. For services covered by both programs, private insurance will pay first, then Medicaid picks up the difference between your providers allowable charge and private insurance payment, up to your states Medicaid payment limit.
Private health insurance policies usually have copay and deductible requirements. If you qualify for both Medicaid and private insurance, Medicaid may cover these out-of-pocket expenses for you.
Besides collaborating with other payers on a third-party basis, Medicaid may also arrange for private insurance plans and other entities to pay health care providers for services covered by Medicaid. Most Medicaid beneficiaries receive some services through managed care plans that contract with states directly.
When enrolled in Medicare , generally, you wont get coverage through the health insurance marketplace. However, if you already have a marketplace plan but are not enrolled in Medicare, you can retain the marketplace plan even after your Medicare coverage kicks in. However, you can expect to lose the premium tax credits or savings youve been receiving on your marketplace plan.
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Who Can Get Medicaid
- No matter your state, you may qualify for Medicaid based on your income, household size, disability, family status, and other factors. But if your state has expanded Medicaid coverage, you can qualify based on your income alone.
- Enter your household size and state. We’ll tell you who is eligible for Medicaid, if your state expanded and if you qualify for Medicaid based only on your income.
- If you think you have Medicaid eligibility, you can create an account and fill out a Marketplace application. If it looks like anyone in your household qualifies for Medicaid or CHIP, we’ll send your information to your state agency. They’ll contact you about enrollment. You can apply any time of year.
- If you don’t qualify for Medicaid, we’ll tell you if you qualify for financial help to buy a Marketplace health plan instead.
Medicaid Is Jointly Financed By States And The Federal Government
Medicaid is financed jointly by the federal government and states. The federal government matches state Medicaid spending. The federal match rate varies by state based on a federal formula and ranges from a minimum of 50% to nearly 75% in the poorest state. Under the ACA, the federal match rate for adults newly eligible was 100% for 2014-2016, phasing down gradually to 90% in 2020 and thereafter . The federal matching structure provides states with resources for coverage of their low-income residents and also permits state Medicaid programs to respond to demographic and economic shifts, changing coverage needs, technological innovations, public health emergencies such as the opioid addiction crisis, and disasters and other events beyond states control. The guaranteed availability of federal Medicaid matching funds eases budgetary pressures on states during recessionary periods when enrollment rises. Federal matching rates do not automatically adjust to economic shifts but Congress has twice raised them temporarily during downturns to strengthen support for states.
Total federal and state Medicaid spending was $577 billion in FY 2017. Medicaid is the third-largest domestic program in the federal budget, after Social Security and Medicare, accounting for 9.5% of federal spending in FY 2017. In 2017, Medicaid was the second-largest item in state budgets, after elementary and secondary education .
Figure 8: Medicaid is a budget item and a revenue item in state budgets.
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What Is The Income Range For Beneficiaries Who Are Dual Eligibles
Generally, beneficiaries earning less than 135 percent of the federal poverty level are eligible for the MSP if they also have limited savings . This equates to $17,226 annually for single beneficiaries and $23,274 for married couples. Beneficiaries qualify for full Medicaid benefits if their incomes and assets are even lower .
Many seniors who live in nursing homes are dual eligible: they qualify for Medicare based on their age, and Medicaid because of their financial circumstances. It is also common for Medicare beneficiaries who are under 65 and live on Social Security Disability Insurance to receive Medicaid benefits.
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Qualifying Medicaid Beneficiary Only
This is for people who are not eligible to receive full Medicaid benefits. Medicaid will pay the recipients Medicare Part A premiums . It will also pay their Medicare Part B premium for them. Besides, there may be extra help with Medicare insurance deductibles and copayments.
If youre a QMB recipient, you chose the Medicare insurance that you like. Then, Medicaid helps with your deductibles and copayments.
You will want to have good Medicare insurance, like a Medicare Advantage plan, in place if you receive Medicaid benefits. Remember, QMB is a dual-eligible program, not a Medicaid-only program.
Maximum monthly income for those aged 65 and over to qualify for QMB in 2021 is $1,094 for an individual and $1,472 for a couple. For 2021, the maximum asset level is $7,970 for an individual and $11,960 for a couple.
In certain situations like nursing home benefits, people with greater assets may be asked to spend down their assets first before Medicaid kicks in with help.
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How To Know If Youre Dual Eligible
Eligibility requirements vary from state to state, but typically take into consideration your income and financial assets. You can contact your Medicaid office to learn if youre dual eligible for both Medicare and Medicaid.
Typically, beneficiaries earning less than 138% of the federal poverty level are eligible for Medicare and Medicaid. In most cases you also have to meet a limited savings requirement. Additionally, seniors living in a nursing home are typically dual eligible due to their age and financial circumstances.
Close To Dual Eligibility Check With Your States Medicaid Office
As part of the Affordable Care Act, each state was allowed to broaden its Medicaid assistance levels. Some states agreed to expand coverage but others did not. So dont automatically rule yourself out discuss your circumstances with your local social services provider.
The Medicare-Medicaid Coordination Office: Medicaid can be quite confusing. Complexity keeps some people from even applying for Medicaid, even though the application process is quite simple.
To help solve that problem, the federal government runs a Medicare-Medicaid Coordination Office. The office streamlines the experience of getting healthcare to those who need it. They work to develop insurance policies designed to work especially with dual-eligible citizens.
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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.
Costs Of Custodial Care
Unfortunately, Original Medicare usually doesnt cover copayments, coinsurances, and deductibles for custodial care, but Medicaid can.
Institutional Medicaid typically works with a small asset limit of $2,000 and provides a personal care allowance of about $50 a month.In conclusion, Medicare will not cover the costs of custodial care. Thats where institutional Medicaid can help.
Medicaid is a program that helps those with limited income and resources pay for medical costs. It serves as a supplement to Medicare to cover costs that Medicare may not typically cover, like nursing homes.
Over time, Institutional Medicaid has become the primary payer for this kind of long-term care. It can cover general nursing home expenses like room and board, personal care, and therapy.
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What Is Custodial Care
Custodial Care is additional care beyond medical and hospital services that takes place in a skilled nursing facility , assisted living facility , or in your home.
Custodial care includes bathing, feeding, dressing, personal hygiene, or meal preparation. Medicare does not cover 24-hour care, meal delivery, homemaker services, and skilled nursing care if your needs are only custodial care.
Is Medicare Or Medicaid Primary
If you have both Medicare and Medicaid, Medicare is the primary insurer and will pay first. Medicaid will then pay second. Medicaid never pays first for services covered by Medicare. It will only pay after Medicare, employer group health plans, and/or Medicare Supplement insurance has paid.
However, there are some services Medicaid covers and Medicare does not, such as nursing home care. In this case, Medicaid would pay for the service and Medicare would only be primary payer for any Medicare-covered services received.
Medicaid will also help pay for other out-of-pocket expenses such as Medicare premiums, deductibles and copays.
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What Are Dual Special Needs Plans
Dual health plans are also known as dual special needs plans. Theyre offered by private insurance companies, so you can find a dual health plan that best meets your health insurance needs. Being on a dual health plan does not change your Medicaid eligibility or benefits.
See UnitedHealthcare plans in your area.
Dual-eligible or Medicaid plan benefits can change depending on where you live. Search using your ZIP code to find the best plan to meet your health care needs.
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Looking for the federal governments Medicaid website? Look here at Medicaid.gov.
Who Qualifies For Medicare Vs Medicaid
Nearly every American will one day qualify for Medicare, but Medicaid is only for those with a low income. Beneficiaries can enroll in Medicaid through the state program office. If you think you are eligible for Medicaid benefits, contact your state health department to apply. To qualify for Medicaid, your income will need to be below a predetermined amount set by your state government.
If your income is above this amount, but you struggle with high medical costs, you may want to check if a Medicaid spend-down program is available in your state. Medicaid spend-down programs allow beneficiaries who exceed the income requirement to deduct their medical costs from their income to meet the state-appointed income requirement.
To qualify for Medicare, you must meet the below requirements:
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Be a U.S. Citizen or documented resident for at least five years AND one of the following:
- Age 65 or above
- Amyotrophic lateral sclerosis diagnosis
- Receiving SSDI benefits for at least 24 months
As you can see, eligibility requirements for the two health insurance programs differ. However, some people fit into the cross-section of qualifications. If you qualify for both, the two health programs work together.
If You Qualify For Both Medicare And Medicaid You’re What’s Known As Dual Eligible
Medicare provides medical coverage and benefits to people age 65 or older, or who have a qualifying disability. Medicaid is a federal and state program that helps with medical costs for some people with limited income and resources, and also offers benefits not normally covered by Medicare.
In most cases, even if you have Medicaid, you must enroll in Medicare when youre eligible. This is because Medicare is the primary insurance and will provide benefits and coverage for health care services you need. If you do not enroll when youre eligible, you may face a late enrollment penalty.
That said, you are able to be enrolled in both Medicare and Medicaid at the same time, and just because you become eligible for Medicare does not mean youll lose Medicaid. This is called dual eligibility, and more than 12 million people are dual eligible each year.
Understanding when youre eligible, how to be eligible, and how Medicare and Medicaid work together can help bring clarity to your health care coverage needs.
Medicaid And Medicare Can You Get Both
If you qualify for both Medicare and Medicaid, thatâs called being dual eligible. So besides your Medicare Part A and Part B coverage, Medicaid may also cover additional services. Specific benefits can vary by state, but may include medical transportation, vision, chiropractic and dental care, and nursing facility care beyond the 100-day limit that Medicare covers.
There are four Medicare Savings Programs available, with each providing a different level of financial assistance:
- The Qualified Medicare Beneficiary Program helps pay Medicare Part A and part B premiums, deductibles, copayments, and coinsurance.
- The Specified Low-Income Medicare Beneficiary Program helps pay Medicare Part B premiums.
- The Qualifying Individual Program helps pay Medicare Part B premiums.
- The Qualifying Disabled and Working Individuals Programpays Medicare Part A premiums for certain people who have disabilities but are still working.
Dual-eligible beneficiaries who are eligible for the Qualifying Individual, Specified Low-Income Medicare Beneficiary, or Qualifying Medicare Beneficiary Programs will automatically be eligible to get Extra Help , which helps with Medicare prescription drug costs.
Each Medicare Savings Program has different eligibility requirements, which may change from year to year. Check with your stateâs Medicaid program to see if you qualify.
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Medicaid Prescription Drug Costs
Technically, prescription drug coverage is an optional federal Medicaid benefit. Since Medicaid is a state-based program, all states determine their own prescription drug coverage. Currently, all U.S. states provide outpatient prescription drug coverage to eligible Medicaid beneficiaries. Depending on your state, you will receive either free or heavily discounted prescription drugs when receiving Medicaid benefits.