Where Can Medicare Beneficiaries Get Help In Texas
Texas Health Information, Counseling and Advocacy Program
Free volunteer Medicare counseling is available by contacting the Texas Health Information, Counseling and Advocacy Program at 800-252-9240.
The SHIP can help beneficiaries enroll in Medicare, compare and change Medicare Advantage and Part D plans, and answer questions about state Medigap protections. Counselors may also be able to provide referrals for home care agencies or long-term care services. Individuals can enter their zip code on this website to find a local office that offers Medicare counseling.
Elder law attorneys
Elder law attorneys can help individuals plan for Medicaid long-term care benefits. Visit the National Academy of Elder Law Attorneys website to find an elder attorney locally.
Income Cap States Vs Medically Needy States
Some states have a cap on the amount of monthly income a Medicaid applicant can receive and still qualify for coverage of long-term care costs.
This situation is sometimes referred to as income-cap states or income test states.
The cap can vary, but the maximum income limit for 2021 is $2,382 .
In states with the income cap, when an applicant receives income that exceeds the monthly amount allowed by Medicaid, the applicant can become eligible by redirecting some or all of that income to an income trust.
Redirecting income simply means having a source of income directly deposited into a checking account titled in the name of the trust.
Any income coming into the income trust is not counted when determining income eligibility for Medicaid.
Because these trusts reduce the amount of income received directly by the applicant to an amount less than the income cap, they help the applicant qualify for benefits.
However, not all states allow for income trusts.
The states that do not allow for income trusts are called medically needy or Medicaid spend down states.
In these states, if an applicant for has income above the state limit, the applicants income must be spent down on medical costs.
Income trusts are not used in these states because applicants qualify for benefits when their health care expenses reduce their income below the states medically needy income standard.
Effective Date Of Coverage
Once an individual is determined eligible for Medicaid, coverage is effective either on the date of application or the first day of the month of application. Benefits also may be covered retroactively for up to three months prior to the month of application, if the individual would have been eligible during that period had he or she applied. Coverage generally stops at the end of the month in which a person no longer meets the requirements for eligibility.
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How Much Does It Cost
Children’s Medicaid is free.
If we find your child can get Children’s Medicaid, there is no cost to receive services.
CHIP fees vary based on your income.
If we find your child can get CHIP, your enrollment fee and co-pays will be based on your family’s income. Enrollment fees are $50 or less per family, per year.
Co-pays for doctor visits and medicine range from $3 to $5 for lower-income families and $20 to $35 for higher-income families.
Texas Medicaid Application And Qualifications
It is easy to confuse Medicaid with Medicare. The two programs are not without their similarities. One key difference is that Medicare is a federal program, whereas Medicaid is a state program with rules that vary depending on where you are. The other major difference is that Medicare is based largely on age and disability, while Medicaid is based largely on income.
Depending on your circumstances, you can be on both at the same time. Circumstances is the key word. Medicare tends to be long-term, if not permanent. Medicaid is often a shorter-term solution. There are other programs that are generally associated with Medicaid such as financial and grocery assistance. It is possible that if you have qualified for these other forms of assistance, Medicaid will be included.
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What Are My Next Steps
If you would like to apply or reapply for Medicaid, your next step is to get a QIT.
Medicaid may cover past medical expenses, schedule a consultation to see if you can have those expenses reimbursed. If you have all the documentation, we can prepare your application in a matter of days.
If you need Medicaid for long-term care and dont want to be denied, Holman Law provides expert advice on Qualified Income Trusts and long-term care planning. Schedule a free consultation today.
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Whats The Difference Between Medicaid And Medicare
On the other hand, Medicare is managed by the federal government and is mainly based on age.
However, there are special circumstances, like certain disabilities, that may allow younger people to get Medicare.
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Is My Child With Disability Eligible To Apply For Chip
Is my child with disability eligible to apply for Chip?
If your child has a disability, you may be able to apply for long-term support and service through CHIP. These include the following:*Apply to have someone help you take care of the child and take them to the medical appointments. *Personal and home care such as helping monitor your childs health and assist them in performing daily activities. *Nursing home care*Hospital services for your childs mental illness*A place that provides care for children with intellectual disabilities.
Is there an Income Criteria to Qualify for CHIP?
Yes, there is an income limit for the parents of kids with disabilities to qualify for Texas Medicaid for children. Medicaid Eligibility in Texas is easy to figure out. The chart below gives you an overview of the maximum household income limit to help determine your eligibility. For any additional person, add $504 to the last figure, and that will be your maximum income limit per month. There is an enrollment fee that may cost you up to a maximum of $50. If you are a low-income family, your co-pay for each doctors visit and medication is around $3 to $5. This cost increases and costs between $20 and $35 for high-income families.
The Income Eligibility Threshold For Medicaid Which Strives To Help Low
Many Americans still lack healthcare insurance despite the Medicaid expansion under the Affordable Care Act which increased the income thresholds to qualify for Medicaid. In 2020, US Census Bureau data showed that 28 million people, or around 8.6 percent of the US population, did not have health insurance at any point during that year.
There are 12 holdout states that still havent expanded Medicaid leaving over 2 million people in the “coverage gap”. This is a situation where they earn too little to qualify for subsidized health plans on the Affordable Care Act insurance exchanges, but dont meet their states income requirements for Medicaid.
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Who Can Get Medicaid In Texas
You should apply for Medicaid if your income is low and you match one of the descriptions below:
- You think you are pregnant
- The parent or caretaker of a child and/or teenager under the age of 19.
- You are a child or teenager age 18 or under.
- An adult age 65 or older.
- You are legally blind.
- Living with a disability or disabled.
- You are in need of nursing home care.
How To Qualify For Medicaid
Almost every state has multiple Medicaid programs. But, as a good rule of thumb, if you make less than 100% to 200% of the federal poverty level and are pregnant, elderly, disabled, a parent/caretaker or a child, theres likely a program for you. And if you make less than 133% of the FPL**, theres possibly a program for you, depending on whether your state expanded Medicaid under Obamacare. In 2021, the federal poverty levels range from $12,880 to $44,660 .
In 2021, the federal poverty level in Alaska ranges from $ $16,090 to $55,850 . The federal poverty level in Hawaii ranges from $14,820 to $51,360 .
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Texas Medicaid Enrollment Numbers
Despite the fact that the state opted against using federal funds to expand Texas Medicaid , the state still enrolled 141,494 people in Medicaid and CHIP through Healthcare.gov from October 2013 through April 2014. These people were eligible under the states existing guidelines, but hadnt enrolled prior to October 2013.
From late 2013 to October 2018, total Medicaid/CHIP enrollment in Texas grew by only 4%, adding a net 182,451 people to the program . Texas has nearly 4.4 million people enrolled in Medicaid/CHIP second only to California and New York, where 11.7 million and 6.1 million people are enrolled, respectively .
If Texas were to expand Medicaid, its estimated that 1.7 million currently uninsured people would be newly eligible for coverage. Of those people, 771,000 are currently in the coverage gap and have no realistic access to health insurance at all. They dont qualify for Medicaid, but their incomes are under the poverty level which means they are not eligible for subsidies in the exchange.
Prior to 2014, Texas had the highest uninsured rate in the country, and that is still the case. According to U.S. Census data, 22.1% of Texas residents were uninsured in 2013. It stood at 18.4% in 2019, which was still the nations highest uninsured rate.
Why Buy A Texas Medicare Advantage Plan
Nearly 1.7 million Texans enrolled in Medicare Advantage, which is an alternative way to get Medicare Part A and Part B benefits.19 Here are some highlights of Medicare Advantage plans:
- Offers Extra Benefits: Medicare Advantage plans offer extra benefits Original Medicare doesnt cover. Many plans include prescription drug coverage and other benefits, such as dental, vision, and hearing care.
- Expanded Benefits Starting in 2020: In 2020, Texas Medicare Advantage plans can offer even more benefits, including adult daycare, in-home caregiver support, and access to safety devices.
- Affordable: You can find many Medicare Advantage Prescription Drug Plans in the $20 monthly range for coverage effective 2020.5 There are also plans available for as low as $0 per month.*
- Many Chances to Enroll or Change Plans: You can enroll during your Initial Enrollment Period, which lasts a full seven monthsfrom three months before the month you turn 65, through your birthday month, and then three months after your birthday month. You get an opportunity each year to switch your Medicare coverage during the annual Open Enrollment Period from October 15 to December 7. You can also switch to a different Medicare Advantage plan or leave your plan and return to Original Medicare during the Medicare Advantage Open Enrollment Period from January 1 to March 31.
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How Much Does Texas Health Insurance Cost
The average monthly premium for Obamacare Texas health insurance costs $436 in 2021.1 How much you pay for coverage will vary based on factors such as where you live, the plan type you choose, and the insurance company offering the plan. For 2020, a 21 year old in Dallas, TX earning $35,000 could get an Obamacare silver plan for $351 before subsidies and $145 after.2
Texas Catastrophic Health Insurance If You Experiencing Financial Hardship
Catastrophic coverage usually requires you to be younger than 30. But if youre over 30 and experience hardship, such as eviction, high-medical debt, or bankruptcy, you can qualify for a hardship exemption to buy a catastrophic health plan.
Although these plans arent as comprehensive as standard Obamacare plans, they include all the ACA essential health benefits. Catastrophic plans are sold on Healthcare.govs individual Marketplace, so Texas open enrollment dates apply.
Missing Out On Billions In Federal Funding
By refusing Medicaid expansion under the ACA, Texas has already missed out on billions in federal funding that would otherwise have flowed to the state to provide medical care for their low-income residents. And in addition, the states emergency rooms are providing $5.5 billion in uncompensated care each year, treating patients who dont have health insurance. If Medicaid eligibility had been expanded, uncompensated care would have dropped considerably, so hospitals and business groups across the state have been pressuring lawmakers to relent on their opposition to Medicaid expansion.
Because Texas has refused to expand Medicaid, the federal government has warned the state that continued access to federal funding to help cover uncompensated care is in jeopardy . But Governor Greg Abbott has continued to reject Medicaid expansion, and described the federal governments tactics as coercive .
Since residents in states not expanding Medicaid still have to pay federal taxes, there has been a significant outflow from Texas residents to fund Medicaid expansion in other states. Over a decade , Texas residents will pay $36.2 billion in federal taxes that will be used to pay for Medicaid expansion in other states.
This is by far the highest of any state the next highest is Florida, where residents will pay just over $20 billion to pay for other states Medicaid expansion by 2022 .
How Medicaid Works
Medicaid was created in 1965 to cover health care for Americans unable to work. The program is voluntary. States don’t have to participate, though they all do. Participating states must meet parameters set by the Center for Medicare and Medicaid Services to get federal funding, but they also have a lot of control over eligibility and covered health care services.
President Barack Obamas health care law moved to standardize Medicaid requirements, specifically so any American making up to 133% of the poverty line could qualify. But that provision was challenged and overturned by the Supreme Court. States could expand Medicaid, but they no longer had to. Thirty-five states did 15 didnt. And eligibility across states varies since the Trump administration announced it would allow states to impose work requirements for low-income and needy Americans receiving Medicaid.
In other words, figuring out whether you qualify for Medicaid is even more challenging than before. Enter our state-by-state guide to Medicaid, which well update as changes go into effect.
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What You Can Keep
Texas is one of the unlucky 13 states with a Medicaid eligibility income cap with no allowance for medical expenses. In 2019 it is $2,313/month. The average Texas nursing home cost greatly exceeds this. For almost everyone in between $2,313 and the cost of nursing home care, even selling every last thing does not help for long.
And those with an income of $2,314/month will never meet the eligibility cap. They may qualify medically. They may need Medicaid for nursing home or home health care. But they will not qualify for it financially.
Since income is defined more broadly than for federal income tax purposes, many people who think they qualify based on income may not. The rules can be complicated.
Fortunately, in 1993 the federal Omnibus Budget and Reconciliation Act allowed people to transfer part or all of their income to a Qualified Income Trust.
A Qualified Income Trust pays a personal needs allowance for someone receiving Medicaid benefits . It pays for unreimbursed medical expenses such as dentistry and health insurance premiums. It pays up to $3,160.50 per month to maintain the spouse who remains in the community, and then pays a co-pay to the nursing home. There is rarely enough to pay the nursing home in full. Medicaid, funded by taxes collected by Texas and the federal government, pays the rest.
Buying Health Insurance In Texas
There are two paths to health insurance for Texans: private and government-funded. Deciding which works best for you depends on factors, such as your age, income, health condition, or whether or not you own a business.
- Private Health Insurance Plans: These include comprehensive health insurance plans regulated by the Affordable Care Act , short-term health plans, Medicare Advantage plans, and Medicare Supplement plans.
- Government-funded Health Insurance: This includes Original Medicare, Medicaid, CHIP coverage, TRICARE military insurance, and VA Health Insurance.
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Texas Medicaid Income Limit
The Texas Medicaid Income Limit is calculated as a percentage of the Federal Poverty Line.
To qualify, you must meet the Texas Medicaid Income limits listed below.
Here is the Federal Poverty Level for 2021.
|2021 Federal Poverty Levels for the 48 Contiguous States & D.C.
Additionally, to be eligible for Medicaid, you cannot make more than the income guidelines outlined below:
- Children up to age 1 with family income up to 198 percent of FPL
- Any child age 1-5 with a family income up to 144 percent of FPL
- Children ages 6- 18 with family income up to 133 percent of FPL
- CHIP for children with family income up to 201 percent of FPL
- Pregnant women with family income up to 198 percent of FPL
- Parents of minor children with family income up to 14 percent of FPL
- Individuals who are elderly, blind, and disabled with family income up to 74% of the FPL