Your Medicaid Questions Answered
If you are curious about health insurance and thinking about signing up for Medicaid, you might have some questions about how it all works. Here we will discuss some common questions and connect you to information to help you learn more!
What does health insurance do?
Health insurance helps people pay for medical care like doctor visits, medicine, and medical treatments. People who earn over a certain amount of money pay for their health insurance by paying a monthly bill to a private insurance plan, and in return, the health insurance company shares some of the cost.
What is Medicaid?
Not everyone has enough money to cover their medical bills. Many people have medical problems or family situations that make paying for medical costs difficult or too expensive. To provide Americans with the health care we all deserve, the United States has the Medicaid program, which provides free or low-cost health coverage to millions of Americans, including some low-income people, families and children, pregnant women, the elderly, and people with disabilities.
Who can participate in Medicaid?
All over the United States, Medicaid is available to people who are over 65 years old, are blind, disabled, or pregnant, and to low-income adults. The exact income limits to define what low-income adults can use Medicaid vary from state to state.
To learn more about the requirements to qualify for Medicaid in Illinois visit HealthCare.gov.
What medical services can I get through Medicaid?
What Qualifies You For Medicaid In Illinois
Adults with income under 133% of the federal poverty level are eligible for Medicaid. Children and pregnant women have higher income limits. Women who have given birth with incomes up to 208% of the federal poverty level are eligible for Medicaid coverage. This coverage can last up to 12 months after giving birth.
Medicaid Penalties In Illinois
Because of Medicaids asset and income limits, some seniors attempt to find loopholes in the requirements by transferring their assets without compensation to their friends or family. If they dont receive anything in return for transferring their assets, they will not have any additional income or resources to submit to Medicaid, and in theory they may improve their eligibility to receive benefits.
However, Medicaid is not unaware to these tactics, and the program may assign penalties to anyone who transfers their resources in such a way. Medicaid evaluates the value of each gift an applicant gives during their look-back period and uses the total to determine how long they will delay a persons benefits before the penalty ends.
In Illinois, the individual value of each gift is irrelevant. If a person has issued multiple improper transfers, Medicaid will total their value and treat them as a singular transaction. Once Medicaid totals a persons gifts, they will divide the result by the average daily rate of nursing homes in the state to create their penalty period.
In Illinois, a person may reduce or eliminate their penalty period by reversing their improper transfers. For example, if an applicant gave their car to their son without compensation, Medicaid may eliminate the penalty associated with transferring the car if the son agrees to return ownership to the applicant. A person may eliminate their penalty entirely if they reverse each of their improper transfers.
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What Is The Monthly Income To Qualify For Medi
Medi-Cal does have the option of reviewing an applicants income on an annual basis if they qualify for the program. The monthly Medi-Cal income for a single adult was $1,482 per month. After inflation, the monthly income will grow to $1,564. In other words, an adult can earn up to $1,564 per month and still be eligible for Medi-Cal benefits at no cost to them.
Can I Have Both Illinois Medicaid And Medicare
The following people are eligible to sign up for the Medicare-Medicaid Alignment Initiative:
- Obtaining complete Medicaid and Medicare coverage ,
- Age 21 and older,
- Enrolled in the Medicaid category of aid for the elderly, blind, and disabled , and
- A resident of a county covered by the Medicare-Medicaid Alignment Initiative. Go here to find out if your county has a Medicare-Medicaid Alignment Initiative health plan.
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How Much Is The Federal Poverty Level
The federal poverty level in 2021 is equal to an income of $12,880 per year for an individual adult, plus $4,540 for each additional household member. Alaska and Hawaii have different benchmarks because of their differing costs of living.2021 Federal Poverty Level by State
Number of people in home
48 states and Washington D.C.
Illinois Chip Fact Sheet
For more than two decades, the Childrens Health Insurance Program has provided health coverage to children in families with low to moderate incomes. Each state has the option to cover its CHIP population within its Medicaid program, design and structure a separate CHIP program, or establish a combination program using both options.
CHIP is currently funded through federal fiscal year 2027 by the HEALTHY KIDS and ACCESS Acts. The Acts also extended the maintenance of effort provision, which requires states to maintain eligibility standards that were in place in 2010 through FFY 2027. However, beginning in FFY 2020 MOE only applies to children in families with incomes at or below 300 percent of the federal poverty level .
Modified adjusted gross income eligibility levels for CHIP/Title XXI in Illinois
|143 313% FPL||143 313% FPL|
Income Eligibility Levels as a Percentage of the Federal Poverty Level for Children and Pregnant Women by State, April 2018. Note: Eligibility levels do not include the mandatory 5% income disregard.
Coverage for Pregnant Women
Using CHIP funding, states can opt to provide coverage for pregnant women and/or services through the unborn child coverage option. Illinois provides coverage up to 208% FPL through the CHIP unborn child option.
The provider network in All Kids is the same as Medicaid. Most children are required to enroll in either primary care case management or managed care.
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Cost And Coverage Of Medicaid In Illinois
The point of Medicaid is for low-income individuals and families to receive access to health care they otherwise would not be able to obtain. Many people do not pay anything towards their coverage, and instead, receive their services for free. The state takes on the expenses. Those that do have to pay often only spend a cash amount of $3.90 per visit for emergency rooms, clinics, and even prescriptions.
What Is Medicare Savings Program
Many Medicare beneficiaries who struggle to afford the cost of Medicare coverage are eligible for help through a Medicare Savings Program . In Washington, D.C., this program pays for Medicare Part B premiums, Medicare Part A and B cost-sharing, and in some cases Part A premiums. Qualified Medicare Beneficiary : The income limit is …
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Asset Requirements & Limits
When Medicaid evaluates a persons finances to determine their eligibility, they divide their resources into two main categories: assets, and income. Assets include stocks, bonds, checking and savings accounts, annuities, homes, and vehicles. Income includes wages, SSI, child support, and alimony. Typically, Medicaid considers assets jointly for married applicants, and income independently. Some assets and income are exempt from Medicaids consideration, and others will count toward a persons eligibility.
Residents of Illinois must retain fewer than $2,000 worth of countable assets to qualify for AABD Medical. Married applicants or those with dependents may retain up to $3,000 worth of countable assets, and spouses who are not applying for benefits may retain some assets free from Medicaids consideration.
If one spouse applies for benefits and the other does not, the applicant is known as the institutionalized spouse, and the non-applicant as the community spouse. To protect community spouses, Medicaid allows them to retain up to $109,560 worth of assets without impacting their partners financial eligibility to receive benefits. This serves as the Community Spouse Resource Allowance , and it allows community spouses to financially support themselves while the institutionalized spouse uses their resources to pay for care.
Illinoiss Requirements For Medicaid Qualification
The state of Illinois sets particular requirements for enrollees to qualify for the Medicaid program. First, certain income standards must get met if residents in the area hope to qualify. What was once given to children and pregnant women is now available for women and men as well, as long as they meet the criteria. Those who fall far above the poverty level cannot receive this state insurance. If you would like to find out if you should apply, use the Check If I Should Apply button on the Application for Benefits Eligibility website. It asks questions regarding your family size, age, gender, taxes, health coverage through work, medical needs, and more.
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Medicaid Eligibility By State
Each state in the US has different eligibility requirements. Senior Planning offers an interactive map showing Eligibility for Medicaid long-term care. Just pick the state you want to see the requirements for.
Medicaid is available for low-income people and families. For people who dont qualify for Medicaid, open enrollment starts in November 2022. Visit Get Covered Illinois to learn more about healthcare coverage options. If you have not registered yet, you may qualify for Marketplace through the Special Enrollment Period. You have 60 days after a qualifying event to enroll.
What Is The Lowest Income To Qualify For Medicaid
There are 13 states that do not grant Medicaid access to individuals based on income alone.
Of those that do, only Wisconsin uses a limit lower than 138%. An individual in Wisconsin can make no more than the federal poverty level in order to qualify for Medicaid.
Texas has the lowest income limit to qualify on a family basis, at 17% of the FPL. A two-parent household with one child in Texas can make no more than $37,332 and qualify for Medicaid.
How To Apply To Medicaid In Illinois
An Illinois resident may apply to Medicaid using one of three methods. They may apply:
- Online, using the Illinois website or by using the Healthcare.gov application portal.
- In-person, at their local Department of Human Services office.
- Through the mail, by requesting an application online, as a fax, or over the phone by calling 1-800-843-6154. Once they receive their blank application in the mail, they should fill it out and send it to their local Family Community Resource Center.
Illinois Medicaid Expansion Update
The state of Illinois expanded Medicaid in 2014, and more than 600,000 people have gained coverage as a result.
As a result, the states uninsured rate has dropped from 12.7 percent in 2013 to 6.8 percent in 2017.
Additionally, the state has been approved for a waiver that allows Illinois to pilot new mental health and substance abuse treatment approaches.
Furthermore, Illinois Medicaid has expanded coverage for Hepatitis C medication.
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Medicaid For Illinoisans In Nursing Homes
In Illinois, people who are sixty-five or older, disabled, or blind, can qualify for Medical Assistance through the Aid to the Aged, Blind and Disabled program, if they also meet income and asset limits. Medical Assistance and the AABD program, administered through the Illinois Department of Healthcare and Family Services , also provides cash benefits.
If you already receive Medical Assistance in Illinois, then your Medicaid coverage includes nursing home care if you need it. Nursing homes are residential facilities that offer around-the-clock skilled nursing care in addition to other supportive services. You can find a list of licensed nursing homes in Illinois here.
Can You Be Denied Medicare
In all but four states, insurance companies can deny private Medigap insurance policies to seniors after their initial enrollment in Medicare because of a pre-existing medical condition, such as diabetes or heart disease, except under limited, qualifying circumstances, a Kaiser Family Foundation analysis finds.
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Medicaid And Medicare Dual Eligibility
If you qualify for both Medicare and Medicaid, you are considered dual eligible. In this case, you may qualify for a certain type of Medicare Advantage plan called a Dual Eligible Special Needs Plan . D-SNPs are designed to meet the specific needs of people who have Medicaid and Medicare.
You can compare plans online to find out if D-SNPs are available where you live, or you can call to speak with a licensed insurance agent for information about eligibility and enrollment.
Who Qualifies For Medicaid
In all but 13 states, adults who make below a certain income may qualify for Medicaid. In all states, Medicaid is available to people who make a low income and also meet other criteria such as being at least 65 years old, disabled, pregnant or other qualifications.
Each state runs its own Medicaid programs with its own set of qualifying criteria.
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Income Requirements For Illinois Medicaid
Income requirements vary depending on household size and outgoing bills. Larger families have a lower threshold to meet than single-family households. An individual can make up to 183 percent of the poverty level, equating to a monthly income total of $1,366. A couple can make $1,845 combined for both to qualify.
What Are The Medicaid Plans In Illinois
Illinois has contracts with a variety of health plans overall.
VMC is provided by Family Health Network, Harmony Health Plan, a local for-profit plan, and Harmony Health Plan, a nationwide for-profit plan . ICP is offered through several health plans servicing various counties throughout the state.
Cook County IlliniCare Health Plan, Blue Cross Blue Shield of Illinois, Cigna HealthSpring of Illinois, Community Care Alliance of Illinois , Humana Health Plan, Meridian, and Aetna Better Health are some of the regional, for-profit affiliates of Centene Corporation .
Aetna Better Health and IlliniCare are available in DuPage, Kane, Kankakee, Lake, and Will Counties. Aetna, Community Care Alliance of Illinois , Knox, Peoria, Stark, and Tazewell Counties:
My Health Care Coordination , Meridian, and Molina. Boone, McHenry, and Winnebago Counties: Aetna.
Rock Island and Mercer Counties: IlliniCare and Precedence. Madison, Clinton and St. Clair Counties: Meridian and Molina.
- Voluntary Managed Care program covers primary, acute, and specialty care, and behavioral health services on a voluntary basis to low-income children and families, pregnant women, and American Indians who live in certain counties.
- A medical home will coordinate acute, primary, and specialty care under Illinois Health Connect .
- In some counties in the state, older persons and adults with disabilities who are qualified for Medicaid but not Medicare are required to participate in the Integrated Care Program .
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What Is The Highest Income To Qualify For Medicaid 2022
Medicaid eligibility is based on meeting certain federal poverty levels. For the lower 48 states and the District of Columbia, the Federal Poverty Level is established by the number of people in a given family. It will cost $13,590 for a single adult person in 2022, $27,750 for a family of four, and $46,630 for a family of eight in 2022, according to the Bureau of Labor Statistics.
District Of Columbia Medicaid
Eligibility overview: Washington, D.C., has one of the most generous Medicaid programs in the U.S., covering adults with household incomes up to 215% of the FPL as part of its expansion program. It also has programs for pregnant, parent/caretaker, elderly, disabled and child residents.
Income requirements: The expansion covers adults without dependents who make up to $2,082 a month when applying on their own. Elderly, blind or disabled D.C. residents are eligible if they make up to 100% of the FPL, or $1,073.33 per month for one individual, and have resources below $4,000 for one person. D.C. also covers pregnant women with incomes up to 319% of the FPL, or $4,703.40 monthly for a two-person household, and parents/caretakers with incomes up to 216% of the FPL.
How to apply for Washington, D.C. Medicaid: You can apply online at DC Health Link or by visiting your closest Income Maintenance Administration Service Center.
Other notable programs: Long-term care and nursing home care services Spend Down, a Medicaid program for people who exceed income limits, but have high medical bills Emergency Medicaid for people who cant qualify for standard Medicaid due to citizenship/immigration status.
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How To Apply / Learn More
Additional information about the Medicare-Medicaid Alignment Initiative can be found on the Illinois Department of Healthcare and Family Services website. One can also call the Illinois Department on Aging at 800-252-8966 for more information. Or, to enroll, one can call the Medicare-Medicaid Alignment Initiative at 877-912-8880. To see which managed care organizations serve the area in which you live, . .
Please note, while some counties have mandatory enrollment, individuals can still opt-out of the program and receive Medicaid and Medicare benefits separately. That said, participants must enroll in a HealthChoice Illinois plan, such as the Medicaid Managed Long Term Services and Supports Program.
Whats The Income Level Requirement To Qualify For Medicaid
The income level to be eligible for Medicaid will be determined by two factors. First, the state you live in. While the federal Medicaid program sets minimum standards, each state has the authority to increase the income eligibility level in order to provide coverage for more people.
Income eligibility for federal Medicaid standards is based on the Federal Poverty Level or a percentage of the FPL. The table below shows income levels based on FPL and family size.
So, for example, if your state sets eligibility at 200% of the FPL, you just look at 200% and find your family size to see what your maximum income can be for eligibility. In order to determine the income eligibility levels for your state, you can visit your states Medicaid website. You can also contact the Medicaid office within your county. When you apply for Medicaid, you apply through the county office.
The second factor taken into consideration is the size of your household. The more people there are in your household the higher your income can be. For Medicaid, a household is determined by those that are claimed as dependents when filing your taxes. It includes you, your spouse, and any dependents, which may include children, elderly parents, or other elderly or disabled relatives.
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